Digital Health Needs You! Five Ways the NHS Can Help Digital Health Innovators

By Ben Heubl and Nick Saalfeld

London has just hosted the 4th annual Health 2.0 Europe conference, highlighting the latest innovations in digital and data-driven health. European entrepreneurs and innovators in health tech are particularly fond of the NHS: it offers an opportunity to reach statistically significant numbers of patients and care providers under a single banner.

Recent announcements such as the controversial but potentially revolutionary Care.Data programme suggest that the feeling is mutual. Tim Kelsey, NHS National Director for Patients and Information says, “Care.Data is about liberating the clinical data assets of the NHS to deliver a number of key benefits: outcome improvements for patients, but also the development of digital services; tools to help patients and professionals take more control of individual health and care.”

That, at least, is the theory. Says Kelsey, “I reflect often on the online banking example where it took twelve years to get from no users at all, to half the adult population doing all their banking online. If it takes that long [to maximise the value from online service delivery], I honestly think we’ll be at risk of the NHS becoming increasingly unsustainable.”

However, healthtech’s innovators are united in needing assistance and even recognition from the NHS – rank and file as much as top level management– if their many new services are to become sustainable and profitable. Pascal Lardier, International director of digital health promotion organisation, Health 2.0, says, “It’s tough trying to do business with the NHS- a change of culture is needed from the decisionmakers.” Here are five ways you can assist.

1) Evangelise for digital health records. Nobody would deny that the narrative of EHRs has been horrific. An inflammatory media which loves stories about data loss, the scrapping of ID cards, the collapse of the National Program for IT, and the fact that nobody joined the NHS to become an IT expert are all grist to a negative storyline. It’s not been a good start.

Richard Smith, ex-editor of the BMJ and professor at Imperial College (amongst many other hats) is also Chair of Patients Know Best, the UK’s most integrated personal health record. He believes that EHRs are an essential tool for managing modern health challenges. “We now live in a world where people don’t have one problem, they have multiple problems, and that yields exponential complexity. Patients are seeing many people in their care pathways. Furthermore, much of the evidence base for treatments may be based only on one problem, so patients need greater dialogue with their care team to get the best result”.

That demands a new rationale with patients. Smith says: “It’s obvious to me that it has to be the way to go that the patient has the record. Instead of talking about ‘sharing the clinical record with the patient’, we need to start talking about ‘the patient sharing their record with their care team’.

2) Answer the phone. Tim Williams is an ex-doctor and CEO of MyClinicalOutcomes (MCO), just one of the smart new data-oriented businesses which promises both simplicity and better outcomes in clinical episodes; indeed it has been built from the ground up with the NHS in mind. Yet Williams says: “We’ve struggled in the NHS, because we’ll find a keen clinician in a keen department, but it then takes six meetings to then meet managers, the information governance guys and then the Chief Executive. We were spending more on train fares than they were ever going to pay us. So, for us, the story of the NHS is one of getting ourselves up and running in a few key sites, to ensure that what we’re doing is fit for purpose and is meeting a need in the NHS; but as a startup we’ve had to focus on the private sector to prove the commerciality of the NHS.” MCO is gaining most traction in the private and third sectors.

Williams is not alone. In a recent survey by Health 2.0, three quarters of health tech entrepreneurs would rate their experience of working with the NHS as difficult or very difficult.  85% of UK entrepreneurs identified long decision-making times and finding the appropriate person in an organization to speak to as barriers to working with the NHS. And nearly 60 per cent of respondents said there was a resistance to working with private sector companies.

3) Procure wisely and locally. Following on from the above, of course, the reconfiguration of NHS services has yet to bed down, and many CCGs are learning about procurement on the job. In the same survey, over 80% thought that procurement processes were too complicated. Matthew Holt, Co-Chair of Health 2.0 says “Much of the success of digital health businesses depends on the biggest acquirer in Europe, which is the NHS. The NHS needs to prime the pump with support for small companies. It must help CCGs to become intelligent and informed buyers. And this should include assistance for deploying and using these tools in clinical contexts at local and regional levels.”

4) Contribute your knowledge. The NHS is Europe’s largest single repository of clinical expertise, and it is sorely needed by these new digital health businesses. Unfortunately, they need clinical input now, while they are small companies, rather than later on when they hope to have become household names.

Vishal Gulati, a Partner at investors Radiant Capital, and Chairman of the Digital Health Forum, offers this example: “I meet a lot of entrepreneurs who are building an app with relatively limited resources”, he says. “They have not dealt with the regulatory system, and some of them have not much respect for the regulatory system. That worries me. Because if you’re going to build an app which is going to tell you what dose of insulin to give to your mother, I hope it is regulated. It’s a dangerous product if it’s not. It’s a necessary element of this sector.”

Gulati’s point is that he and his colleagues will not invest in any business without the clinical, regulatory, pharmaceutical or NHS strategic knowledge to get their good ideas to market.

5) Embed digital health tools in care pathways. Finally, adopting digital tools is a form of behavioral change in itself. And, as we all know, behavioral change is hard. Tim Williams of MyClinicalOutcomes says that when digital techniques are embedded as a natural part of care pathways, all of take-up, adherence and long-term outcomes are improved. Put simply, if clinicians and administrators don’t buy in, neither will the patient.

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