Comment / Taking the lead in digital health technologies

A growing number of NHS patients are enjoying the benefits of digital health technologies (DHTs). These are tools that use digitised data to empower patients to manage their own conditions and to access support from peers or clinicians as and when they need it.

Examples from the huge range of DHTs available include apps to help patients manage their mental health and wearable devices that help patients with diabetes to maintain blood glucose levels. DHTs can also improve care by giving frontline staff more timely patient information, so they can make better use of their time. 

However, despite DHTs’ great potential for improving health and health care services, their uptake is not uniform across the NHS. One reason is that UK policies shaping their development and adoption aren’t doing all they could to support the speedy spread of well-evidenced DHTs. 

If the UK can fix these policies, NHS patients will benefit from a faster-flowing stream of well-evidenced DHTs. The UK could also take a leading role in shaping the global regulation of these emerging technologies.

We are working closely with NHS England and NHS Improvement, the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (Nice), in collaboration with clinicians, patients and industry, to create a better DHT policy framework. Our guiding principle is to value DHTs according to their proven safety and effectiveness for patients. So our priorities are to:

• define what constitutes safe and effective DHTs and use this definition to set clear standards for DHT developers who make their products available to the NHS;
• make clear how safe and effective DHTs will be paid for by the NHS, making sure the NHS is getting fair value;
• help clinicians and patients to adopt safe and effective DHTs rather than expecting them to adopt these new products without support; and
• improve the quality and usability of data generated by DHTs, so that insights drawn from the data they generate can be used to improve care along the entirety of patient pathways.

There are four key priorities if we want to maximise the benefits for digital health technologies.

Improving regulation and setting standards for access

Regulators are making a raft of improvements to clarify rules governing DHTs and how they are made available to the NHS, and to make sure these are proportionate and appropriate to the technologies. The MHRA is reforming medical device regulation for software and artificial intelligence (AI), while NICE is upgrading its evidence standards for DHTs, so they cover all relevant digital and data driven technologies.

We have introduced the digital technology assessment criteria for health and social care (DTAC). This set of criteria helps NHS organisations thinking of using a new DHT to make sure it meets expected standards of clinical safety, data protection, security, interoperability, accessibility and usability. Widely adopted by NHS organisations, the DTAC is already driving an increase in NHS use of DHTs that comply with clinical safety legislation.

Making clear what the NHS will pay for, and how

To be funded by the NHS, DHTs should be backed by sound evidence showing they are safe and effective for patients and represent a good use of NHS resources. We are detailing these standards and also the process for determining which DHTs should be NHS-funded, with clear roles for appraisal by MHRA (where appropriate), DTAC and Nice. Technologies for which the evidence is not yet complete may be eligible for contingent funding if they look cost-effective given the current evidence and could make a big difference for patients.

We think maximum prices for DHTs should be agreed nationally to allow the NHS to benefit from its scale as a purchaser. This would also give product vendors a level of certainty and relieve them of having to negotiate prices with numerous local commissioners, though local commissioners will still be free to negotiate a lower than national price where they can.

Supporting adoption within the NHS

One barrier to rapid adoption of approved DHTs has been uncertainty about who in the NHS should pay for them. We think they should be paid for from the same budgets as their substitutes and complements, rather than a separate ring-fenced budget. This would allow clinicians to integrate DHTs smoothly into wider treatment pathways and standard clinical practice. The payers could be local or national commissioners depending on the product.

Even with a well-designed regulatory and funding process, adoption of DHTs may remain sluggish. To counter this risk, we are doing more research on adoption barriers and facilitators and will draw the findings into a set of recommendations. Some of these could be ‘nudges’ that are cheap and simple to apply at scale, for instance, minor adaptations to existing or planned communications, governance or training.

Setting clear standards on data

Data and data flows generated by DHTs have the potential to produce insights that can be used to improve care along the entirety of the patient pathway. But they need to be handled in ways that meet defined standards, while maximising their usability. These standards must protect patient privacy and data security, manage the impact on clinician liability and workload, and integrate into existing systems. Some of these requirements will be addressed through DTAC, and some through our work on interoperability. 

We will be working on these four priorities over the coming months.

For more information or if you have any comments, contact [email protected].

The HFMA, supported by Health Education England, is delivering a 12-month programme of work to increase awareness amongst NHS finance staff about digital healthcare technologies, and enable finance to take an active role in supporting the use of digital technology to transform services and drive value and efficiency.