12 Nov 2021

Mind the gap: Digital health without infrastructure isn't working

Guest blog: Dr Lloyd Humphreys, Managing Director at ORCHA, discusses the importance of building trust in digital health.

The importance of healthcare professionals in the uptake of digital health is borne out in the data. Sixty-five per cent of healthcare professionals believe health apps will encourage patients to take more responsibility for their health (Research Now).

Patients trust professionals and their digital choices, as they do for other forms of care. Yet, healthcare professionals are not recommending products at the levels and volumes needed to effect real change in the system.  Why not? It boils down to one word - trust.

Can we expect healthcare professionals to trust products that they may not have used, were never trained in delivering and have little support for from their organisations? Most professionals come to new technology from their organisation in the following way: “We’ve just commissioned this app, please go and give it to your patients.” We’re expecting blind trust in new technology within a healthcare system increasingly defined by mistrust, medical negligence, liability and patients challenging every decision. Is it any wonder professionals are not recommending products?

In order to avoid the potential backlash against digital health technologies post-pandemic and capitalise on the gains made, we need to instil trust in the system by enabling infrastructure.

What do we mean by 'infrastructure? Let’s put this in context.  For prescription medications there are approximately 20,000 licenced products and they have – in the UK – the MHRA to approve and licence products, NICE to evaluate the effectiveness and impact, the BNF to collate these products along with indications and contra-indications, and we now have electronic prescribing. We even have systems to recommend switching from branded drugs to generics, where available. Even for over-the-counter medications there are robust processes to deliver trust and safety. All of this sits on top of training in which products to prescribe in which circumstances and this is all embedded as core principles in foundational courses. 

Yet none of this infrastructure exists for 365,000 digital health technologies, with 250 new products coming on to the market on a daily basis and only 20% reaching quality thresholds (based on ORCHA thresholds).

One could argue that medication and other approaches carry greater risk of adverse events and need these robust procedures, but is this true when we think about apps that address suicide, addictions, eating disorders, self-monitoring of long-term conditions or advice for treatment? We simply do not know the level of risk or adverse events following the use of digital solutions, precisely because of the lack of processes and technology to enable its measurement.

In some countries we see parts of this critical infrastructure for digital health emerging, but only bits. We can see regulation without the scale and pace to create critical mass; there are assessment systems in place without the means to distribute approved digital technologies; there are digital formularies without the robust assessments in place, but there is, to the best of my knowledge, still no mandatory training taking place in any country across the world.

So, we are expecting digital health to flourish and complement, enhance or even replace traditional care without any of this enabling infrastructure layer? That’s a BIG ask and a naive one.

To build trust in digital health and super-charge its use, we must empower our healthcare workers, through training, with the ability to trust and recommend digital health products. We must mirror how we handle medicines and provide the assurance and systems to be able to recommend (‘prescribe’) solutions, not just a single app but a formulary of vetted technologies that can meet the individual needs of patients plus the health and care system.

We need the infrastructure in place, through standards and frameworks, which defines the threshold for quality and impact.  We need the ability to assess at pace and the scale to build a critical mass of products, a formulary that clinicians can prescribe from and a system to track the delivery, with safety recall in place and adverse event reporting. ORCHA has been championing all this for over 6 years and continues to do so.

We need to walk the well-trodden path of other forms of intervention and healthcare administration and stop thinking ‘if we build it, they will come.’ Let’s empower the health and care system, not one product at a time, but with the right foundations.

This article was originally authored by Dr Lloyd Humphreys, Managing Director at ORCHA (the Organisation for the Review of Care and Health Apps) and an NHS Innovation Accelerator alumnus.