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Nuffield Trust shows caution on digital health tools



New study by the research charity indicates that so far the evidence does not always support the hype around the use of new technologies in healthcare

New digital tools for healthcare have received mixed reviews in a new report from the Nuffield Trust.

The healthcare analysis charity has come up with a few positive judgements and acknowledges the potential of a collection of technologies in its The digital patient: transforming primary care? review.

But it also points to shortcomings and makes the point that in most cases there has been limited take-up.

It gives some credence to the popular case that digital tools could transform the experience of care and help people self-manage medical conditions, and that in turn this could reduce demand on stretched health services.

But it says that in most cases there is not enough evidence to prove the impact, and finds emerging problems in the use of some tools.

Risk averse

Online triage, for example, can reduce the strain on GP surgeries and hospitals. But the symptom checkers used for self-assessment are often risk averse and may actually send users to a doctor when it is not necessary.

Alternatively, the tools fall short of the full clinical assessment that is often needed. This prompts the trust to say there is a need for more research on how patients use the tools alongside rigorous testing of the technology itself.

Similarly, there is evidence that some patient apps are helping patients eat better, take more exercise and stick to their medication. But many are inaccurate and the efficacy of most is unknown.

Varying notes of caution are sounded for each of the other groups of tools:

  • Monitoring and wearable technology can encourage patients to look after themselves better, but some studies suggest they do not always carry on using them.
  • Online appointment booking and prescription ordering can help patients, but take-up has been relatively low and there is little evidence they have provided administrative efficiencies.
  • Remote consultations, by email and video, can save time and have been well received by some patients – but these have largely been people who struggle to make face-to-face contact with doctors. There is mixed evidence on how they affect demand for services.
  • Online access to medical records can do well in engaging patients, but it can actually increase the number of visits to GPs and A&E, and there are governance concerns around access to the data.

The one area for which the report is broadly positive is on the use of online sources of health information, which it says are helping patients manage their conditions. This is often even better when they are members of a patient network, and when web based interventions take place.

The report follows with a handful of recommendations, including that healthcare professionals provide guidance on the use of specific apps, and that they show patients how to use their online records in supporting self-care.

It will also require funding and support at all levels of the system, at least in the short term.

Exclusion issue

The report also raises questions about how the use of the tools relates to digital exclusion. In a blogpost on the Nuffield Trust’s website, Adam Micklethwaite, director of business and innovation at digital inclusion charity the Tinder Foundation, points out that many people will find it difficult to use the tools.

He points to a previous initiative run by the foundation to connect GPs with community based digital inclusion services, saying it helped more than 250,000 patients to use relevant tools. An evaluation showed that for every £1 invested it would save the NHS £6.40.

“The potential of digital to transform health care is enormous,” Micklethwaite says. “But we need to find ways to address digital exclusion at scale, and we need to do it alongside the continuing transformation of the NHS.”

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