ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
An apps library for a digital NHS
Rachel Murphy, digital delivery director of NHS.uk, writes exclusively for Health Business magazine on ambitious NHS plans to harness the power of digital healthcare apps
There has never been a better opportunity for people to take control of their own health and well-being through the use of digital technology. Consumer behaviour has changed more in the last decade than in the previous 50 years and our means of looking after our own health is an intrinsic part of that revolution.
The health and well-being apps market is among the fastest growing of any sector. There are already around 250,000 apps that cater for health and well-being and use of them in the UK is skyrocketing.
That is why NHS Digital, working with NHS England, is in the process of developing a digital tools library. In this fast changing and vast marketplace of apps and digital services, it is important that patients are able to find tools that have genuine potential value to them. The benefits are obvious, both in terms of the opportunities technology can offer to patients for self-care and prevention and in taking pressure off NHS frontline services.
If you have NHS approved apps that are evidenced to work, that will inevitably reduce physical visits to primary care. While some tools will replace the need to visit a doctor in person, other apps and wearables which will enhance contact time for patients with clinicians. The increased capability to accurately monitor and measure symptoms will save valuable time, allowing clinicians to focus more on treatment.
We hope in time that doctors will be able to prescribe our digital services, of which the tools library will form a part. Indeed, prescribing use of apps or wearables is already happening to a degree, for instance in assisting people quit smoking.
With so many apps available already, and the sector growing so quickly, our job is not to fill a gap in the market, but to provide patients with an informed way of choosing which products are proven to be effective and safe. The NHS is a trusted brand – people believe in it, so if a patient is looking for an app to monitor a health condition or an element of their lifestyle, seeing ‘NHS approved’ will carry weight. The onus is therefore clearly on us to deliver on that public trust with rigorous assessments.
How we go about selecting apps to include
Alongside the tools library we have created a mobile health space for app developers on developer.nhs.uk. This is the means by which developers apply to have their apps accredited by the NHS and included in our library. It is necessarily a rigorous process, with the need to protect the rights and safety of patients paramount. Lots of research is being done to make sure we are prioritising apps that people need and want to use.
Developer.nhs.uk is an enablement platform, giving developers the tools and information they need to deliver high quality products and allowing us to filter the thousands of apps on offer to pick out the best of the best. It involves a lengthy and extremely detailed assessment to measure the clinical benefits and safety, and technical security, of products or concepts.
Clinically, what are the benefits to the user of the app? Is it safe? Is it effective? Is there evidence that it works. Clinicians are playing an integral role in this process.
And technically, is the app as watertight as it can be from viruses, malware and other malicious software or potential cyber attacks? Will its use and storing of data be secure, safe and legal?
This process will eventually be automated to allow us to increase volume of apps entering our library.
There is no doubt that digitising healthcare means more patient data being gathered and that has its own implications for privacy and security. But there is an opportunity here for patients to become gatekeepers for their own data in a way they have not been able to before. No one is going to make using these apps compulsory, of course.
Indicators clearly show, perhaps unsurprisingly, that there is a large cultural shift with younger generations. A study by the SAS Future Foundation in September 2016, entitled Analytics for the Future: The New ‘Data Generation’, showed that 67 per cent of millennial internet users in the UK are comfortable sharing personal data with healthcare sector, compared with 32 per cent for retailers and 28 per cent with social media companies.
There will be reservations, and more so among older generations, but the same was said a decade ago of internet banking, which is now commonplace.
Some of the apps already in the NHS Library
The NHS Apps Library is currently in development stage, with a Beta site now live following a soft launch in April, before moving to the next phase this autumn when several demonstrator apps will become available.
One app already granted ‘NHS Approved’ status is myCOPD. This helps people with the lung condition COPD to better manage their illness, perfect their inhaler technique, learn to improve breathing, track medication and more.
Babylon uses the latest AI technology to assess symptoms and then arranges video or phone consultations with real doctors within minutes. It provides speedy access to online healthcare from anywhere in the world, allowing users to check any symptom, chat with real doctors (recordings of which are made so the patient can recall important treatment advice) and can send prescriptions to your door.
Some apps focus on mental health or well-being, such as Chill Panda which measures your heart rate and suggests tasks to suit your state of mind, such as breathing techniques to ease worries.
HealthUnlocked links up people with similar health conditions. It has over 700 online communities on topics ranging from cancer and thyroid disease to running and weight loss, as well as four million monthly users.
Using data intelligently
The potential to allow patients to radically increase their ability to monitor and improve their healthcare and well-being goes without saying. But, like other technological advances, by ensuring it is a joined up system – not just a stand-alone library of tools in isolation – there is huge potential to use the data that these apps and services will gather.
At the front end, apps will allow patients to take greater control of their own healthcare. But at the back end, the datasets that can be obtained will be hugely valuable. Patients using apps will essentially become ‘data donors’ to the NHS. We can use that data to inform what we do, identify areas of greatest need and for clinicians to research patterns and prevalence of conditions and symptoms on a scale not previously possible.
This already happens in all sorts of sectors. For example, a sat-nav app’s primary purpose is to help its users get from A to B. But by collecting users’ data it can then show traffic jams – helpful for users collectively and valuable for traffic management agencies working to eradicate bottlenecks.
The same applies within healthcare. By responsibly harvesting the data that digital apps and services create, we can see which are most popular, where there is most demand and need, which apps are effective (for example, which means of asking someone to use technology to monitor their alcohol intake works best). And that’s without mentioning the world of opportunities for clinicians to study data from large groups of patients.
Technology is developing quickly, and in the near future the use of artificial intelligence, wearables and embeddable devices interacting with apps could provide countless solutions and advances in self-care and prevention.
By the NHS playing a leading role in assessing, vetting and accrediting apps – and potentially playing a role in incentivising start-ups to deliver their app ideas – we can help ensure as much as possible that patients utilise only the safest and most effective products. This requires our apps library to become part of a properly integrated digital NHS, with the NHS.uk digital platform (the successor to NHS Choices) its patient-facing hub. We intend that patients will be able to create an account with NHS.uk so we will be able to serve them with the personalised content and facilities that most benefit them.
No one tool is going to solve all our challenges. But by enabling innovation, and giving patients the digital toolkit they need, we can bring about significantly better healthcare to our public.