Liz Ashall-Payne looks ahead to the end of the decade and predicts to what extent health apps will be part of the healthcare system and part of our daily lives
Six years ago, when ORCHA (the Organisation for the Review of Care and Health Apps) was early in its development, my ambition was simply to give people access to top quality digital solutions, which would encourage self-management of health.
This was based on my career as an NHS Clinician and system leader, where waiting lists were lengthening yet as a clinician I was only able to see six people a day. Changing the system became an obsession.
As the pace of change has quickened – and Covid-19 has fast-forwarded digital adoption by five years in about 18 months - it has become entirely possible to envisage a new generation of health service, with digital at its very core.
This tsunami of acceptance of – and enthusiasm for – digital, will carry us into the future and a health service which could look quite different.
By 2030 every digital health solution will be quality assured
Quality and trust are key issues, but we will solve this. Of the multiple thousands of apps available on app stores, around 80 per cent would currently fail standards and regulations assessed and processed by us at ORCHA. At ORCHA we measure compliance of health apps against 350 standards, including elements of the NICE framework and the government’s new Digital Technology Assessment Criteria (DTAC).
As the market matures, and healthcare professionals and patients become more used to digital support as part of care pathways, there will be a levelling out. The good tech will win. The poor-quality apps will be side-lined. Remember how Facebook overtook MySpace.
Digital health will be prescribed, just like medicines
This is an idea whose time has come. Research by Mount Sinai hospital found that 92 per cent of patients who are prescribed an app will use that app. In contrast, around £300 million is wasted every year in the NHS on unused or partially used medicine (NHS Confederation, 2018).
And in a OnePoll survey for ORCHA, nearly half the respondents thought healthcare staff should be able to prescribe high quality health apps, even where there is an in-app cost.
Germany is already there. Its Digital Care Act (2020) led the way in Europe, allowing doctors to prescribe digital health apps in the same way they prescribe traditional medicines or talking therapies.
Policy makers can really enable this, especially with the recently introduced DTAC enabling high standards. However, this is just the beginning with the next step being to facilitate a way to find and share those solutions that meet these compliance standards. Crucially, a way to reimburse and pay for high quality digital health apps needs to be at the forefront of any digital transformation, at a local, regional and national level.
Patients will use apps at home, to support healthcare staff
This is happening already but as healthcare staff become more familiar with digital tech and its possibilities, apps will be further embedded into care pathways. One excellent example is Intellin, which helps people manage their diabetes. It allows users to track many variables including blood sugars, blood pressure, insulin levels, weight and height. It flags high risk areas for particular patients – problems with feet or eyes, for example, and offers tailored advice. The app offers a clinician’s dashboard, so a doctor can check remotely, and at a level far more advanced than any other system currently available, how a person manages their diabetes outside the consultation room.
Apps can be used in so many different ways: to track and monitor symptoms, as demonstrated above, to help with lifestyle changes, to alert citizens to potential conditions, such as skin cancer, to educate, to help recovery from surgery and to support mental health, to name a few.
Citizens will have health vaults
We already have our own bank vaults online. Online accounts enable us to hold a wealth of financial information securely and then choose who we connect with, to pay bills or purchase from retailers.
Imagine every citizen having a health vault containing exercise regimes, dietary information, heart rate, steps taken, sleep patterns and menstrual cycles plus information on mental well-being and long-term conditions. This data, wholly owned and managed by each individual rather than by a government-led health service, would be instantly accessible. We are moving towards this already, with systems like Fitbit and services like Patients Know Best.
The opportunity is massive, as this data would be far richer than any records held by a health service and provide a far more comprehensive picture of a person’s overall health. This data could conceivably be used to create risk profiles of people’s health, predicting the likelihood of stroke or heart attack, for instance.
Healthcare will be truly global
Armed with our own health vaults, which come with us wherever we go, we’ll be able to provide information to doctors abroad. ORCHA is already part of a project led by Nordic Innovation where the five Nordic states are working together to share health data. The objectives are to give citizens in the region access to high quality health apps through channels they can trust and to make digital solutions for both treatment and preventative health widely available.
This partnership is being watched globally as it is a global challenge because people don’t stay static any more – we are constantly on the move. The vision is for both clinical data on a patient’s condition and general health data gathered their use of apps to be co-ordinated so it is readily available whichever country they happen to be in.
Doctors will be able to work from home
GP surgeries will re-open their doors to the public, of course, and patients must have access to this service, but there will always be a place for remote consultation. In some cases, it will work better than face-to-face visits.
An 80-year-old patient living in the heart of Cumbria without access to a car would benefit from video consultations. Disabled GPs, or those with long-term conditions, would be able to carry on working, if based from home. And why shouldn’t a patient have access, for example, to a world-leading specialist consultant via link?
The ideas I’ve discussed here are based on a growing body of evidence. Individual apps are reporting fantastic outcomes in terms of patient quality of life and even showing how they can reduce A&E admissions. The global pandemic has shown how useful digital can be when we embrace it. European countries are forging ahead with bold plans and showing us how its done.
However we get there, I believe that by 2030 digital will be entirely integrated into our health systems and we’ll look back and wonder why it all took so long.
Liz Ashall-Payne is founding CEO of ORCHA, the Organisation for the Review of Care and Health Apps.
