Unleashing the potential of digital health isn’t simply a tech challenge
From biosensors and biometrics to wearables and widgets, the age of digital health is well and truly upon us.
But beyond the headlines of record-breaking digital health funding, a big question remains as to how the tremendous potential of digital technologies can be translated into real-world value in the healthcare sector.
Let’s not forget that in healthcare, ‘value’ centres on one simple thing: health. Either a healthier end user or a healthier, more economical healthcare system.
So what can we do to more consistently – and measurably – help to improve health with digital technologies?
Here’s my 5-part manifesto:
You’ve heard the narrative: that those whippersnappers born with a smartphone strapped to their palm and busily Instagramming smashed-avocado-on-rye are bestowed with early-embedded digital skills beyond those of their tech-idiot parents.
It makes sense. But guess what? Digital natives don’t really exist. Certainly not in a way that meaningfully impacts how we design digital health services.
Recent research punctures the myth of the multi-tasking digital native. It shows that the younger generation uses technology in the same ways as older people, and is no better at multitasking.
Of course people born in the past couple of decades have had the opportunity to use more digital technologies. But such use doesn’t automatically equate to true expertise or ability to access and understand digital health information. No matter your age, the mental effort – or ‘cognitive cost’ – of using badly designed digital tools can come at the expense of meaningful learning and engagement.
So don’t fall into the trap of presuming younger generations are innately predisposed to ‘get’ digital. Instead, think in terms of minimising cognitive cost and creating as undemanding an interface as possible, for everyone. And don’t presume digital is beyond the capabilities of older generations simply because they’ve been around the sun a few more times.
So how do you minimise cognitive cost? Through thoughtful, evidence-backed design. Research is plentiful on how to simplify language, design and interfaces. From straightforward things like font size and contrast ratios to information architecture, this sort of stuff isn’t about the latest design fad, but what the evidence says works when it comes to engaging patients in health information.
And evidence is plentiful. Understanding that lots of people have low health literacy – and learning about ways to address that – is helpful. But also look out for things like the NHS Information Standard and industry guidelines from the likes of the Government Digital Services to get started. Then delve into the copious research that deals with accessible design in health.
Together these standards and research-backed principles point to a bigger concept we should be striving for in health: digital inclusiveness.
Thought experiment: if only the healthiest people were offered a hospital bed, leaving the least healthy stranded, what would you think?
Because with digital we’re in danger of forsaking those in most need, leaving them without a digital bed to lie in. The seeming ubiquity of digital masks the fact that many of the most vulnerable and least healthy are those who are also digitally isolated. Some stats:
This digital divide must be addressed, otherwise we’re in danger of cementing inequalities through digital health rather than shrinking them. True inclusiveness goes beyond simply building usable digital ‘things’ – it’s just as much about work to widen digital participation.
See what the NHS Widening Digital Participation team are doing for a blueprint for creating an inclusive digital society.
But if you’re in the thing-building business, remember that the most beautiful and usable digital health intervention is only really as good as the outcome it provides. So if a new digital tool is to be taken seriously, then it needs to be held to higher standards than the Candy Crush’s of the world.
While it may not always be appropriate in digital, the holy grail in medicine is the randomised controlled trial (RCT). And there are already examples of digital health interventions that have passed muster in RCTs. For example, an ‘ePRO’ tool was recently shown to improve survival in lung cancer independent of treatment.
Equally important to such clinical outcomes data, the development of industry regulations and standards is going to be crucial to the success of digital health. In the UK, things like the beta NHS Apps Library and MHRA guidelines on medical device health apps are key.
Across the pond, it will be interesting to see where the FDA’s new ‘digital health software pre-certification pilot program’ leads, which is assessing the processes and capabilities of the pilot software companies themselves, rather than simply the software they build.
This fast-developing regulatory environment is a sign of a maturing marketplace. And that’s of course a great thing. The more established digital becomes as a regulated and measurably effective tool for health, the more likely we can help people be healthier.
So to finish, I’d say now is a good time to pause and think about whether the moniker ‘digital health’ is really fit for purpose anymore to capture the myriad of ways people are using tech in the health sector.
How about instead we talk of supporting health in the digital age?
That feels more aligned to what we’re ultimately meant to be doing with digital technologies in health, doesn’t it?
August 2017
January 2017