Comment Blog 4 June, 2018

Healthcare transformation by design

As the NHS approaches its 70th birthday, the Prime Minister is expected to announce a multi-year funding settlement. If invested in services strategically, this funding could transform the traditional model of care. Technology is one such area that can enable this transformation. Given Jeremy Hunt’s comment last week on the NHS “leading a technological revolution”,technology appears to be high on the Government’s agenda for additional funding.

This was a topic explored at the Reform annual health conference. The panel of experts explained how technology can be at the heart of transformation. Websites like NHS Choices and the growing list of trusted ‘NHS Apps’ offer a more personalised experience to patients, whilst digitising administrative tasks are quick wins for making processes more efficient. The panel emphasised growing public expectation of NHS services. This stems both from the user experience of digitised, customer-focused organisations like Uber or Spotify, and from the increasing number “connected” people in the UK; adult smartphone usage is at 85 per cent and rising.

The panel highlighted, however, that technological change in the NHS has been slow and there are several barriers in the way to widespread adoption. Some of these are “well-rehearsed”, such as data quality issues. Others are less well-known but of equal importance, for example “user-centred design”. This is crucial to successful adoption. A lack of user-centred design has resulted in a number of technological interventions in the NHS failing because they have “simply created additional workload for professionals”.

Well-designed technology is based on empathy. In other words, putting yourself in someone else’s shoes to be able to solve their problems. Successful technological projects in the NHS have supported this, demonstrating the need to engage with users (clinicians or patients) when designing tech. Taking decision support systems as an example, this results in straightforward interfaces which provide clinicians with the advice they need, at the right time, rather than clunky systems, with numerous alerts, which end up being ignored. Indeed, poorly-designed technology can lead to disengagement and even resentment from users, as was found to be the case by the Wachter Review’s assessment of the failed National Programme for Information Technology.

Given the current pressures on the NHS, it is even more important that additional funding goes towards effective technology. This means investing based on evidence, not merely because of hype. Wearable and apps, for example, have exploded onto the health scene, but it is yet unclear the impact many of these have on people’s health. Indeed, one research project on weight-loss wearables found that although the wearable produced a lot of data, it was not successful in changing behaviour. Those using the technology actually reported a lower than average weight loss compared to the control group. Examples like this are a reminder that technology should not be implemented for technology sake but should be introduced when it can improve outcomes.

There are a growing number of well-designed technologies leading to improved outcomes, which government and industry can learn from. For example, one digital sleep improvement programme in a trial with NICE, moved 68 per cent of anxiety and depression patients to recovery, versus a national average across IAPT interventions of 45 per cent. Importantly, this programme has been developed in collaboration with NHS partners. This app is now becoming the first NHS rollout of direct-access digital medicine.

The Helix Centre is a further example of collaboration between the NHS and industry to develop technology that “addresses real healthcare problems”. One Helix Centre creation, Hark, a smartphone platform to help clinicians better manage their workload at night, was developed through tech designers shadowing junior doctors on their night shift. Methods for understanding challenges faced by users first-hand, like shadowing or patient-focused groups, is something that should become widespread practice when designing health tech.

If a long-term funding settlement for the NHS is to be used “not just to sustain the system, but to transform it”, then some of it should rightly go towards technology. However, the Government must be cautious and choose well-designed, effective technology to invest in. Funding poorly-designed technology will do little to support the NHS in its efforts to move towards a transformed, sustainable model of care.