75% of UK patients go online for health information – How should healthcare respond to this digital demand?
Written by: Sophie Walker
Over the past decade, many industries have been shaped and sharpened by technological advances and growing consumer expectations. As the public becomes increasingly tech-literate many businesses, products and services are slowly being streamlined and moved online or onto mobile digital products. Tasks that used to be time consuming and required a customer’s physical presence to complete – such as grocery shopping, booking a holiday, or filing a tax return – can now be done from the comfort of one’s own home with a few clicks.
One industry in the UK that has not moved as swiftly as others through the digitisation revolution and would particularly benefit from it is the healthcare industry; and in particular the public sector. However with increasing public demand, pressure from governments and a growing community of startups and companies providing a rich digital marketplace, this is set to change.
In the UK, 75% of people go online for health information . Today’s patients are much more open to seeking health advice online and 50% of us use the technology to self-diagnose. However contrary to popular belief, it isn’t primarily younger generations that are doing this. In a 2014 survey into Healthcare’s Digital Future, McKinsey found that more than 70% of patients aged over 50 want to use digital healthcare services . The key difference between these two age groups is the types of digital channels that they are comfortable using when it comes to healthcare. Older patients generally prefer website and email – though with the growing use of smartphone and tablets with the over 50’s this could soon change – and younger generations are more open to newer channels such as social media.
Digital health can be segmented in a number of ways but roughly the four key areas are: Telehealthcare, which includes telecare and telehealth and focuses on telecommunication technologies to deliver health services or information; mHealth, also known as mobile health, which encompasses the growing market of health apps and wearable devices; health analytics and finally digitised health systems . Of these groups the two rising stars are mHealth and digital health systems. In 2013 mHealth global revenues were valued at £1.6 billion and predicted to reach £14.8 billion by 2018, while out of the four areas, digital health systems represent 66% of digital health sales, making them the largest market globally and in the UK . Within public health, NHS Digital Technology is looking to apply some of these technologies and systems. They see them as playing a significant role in the sustainability and transformation of services. Whether this is in delivering primary care at scale or supporting new care models, they are creating Sustainability and Transformation Plans (STPs) to ensure the plans harness every digital technology opportunity.
As the public becomes increasingly used to everyday services seamlessly flowing from the analog to the digital, they will come to expect more from health services. And with 75% of patients expecting to use digital services in the future, health services have a lot of catching up to do. However patients won’t be satisfied with a poorly cobbled together app or sparsely designed platform. As with the digital products and services produced by other sectors they want carefully designed, user centred work that fits with their specific healthcare needs. In a 2015 report, Deloitte found that one of the three most important factors in getting people to use health apps was ease of use, simplicity and design. Other important factors were unsurprisingly, trustworthiness, accurate data and a guarantee of data security.
One of the many issues that are holding back the digitisation of public health services is the need for security, both from the public and for the data itself. Because of the sensitive nature of many health related issues, all products that the NHS use internally or are recommended to patients must have been created using and continue to follow the type of rigor and security guidelines that you might find in the Fintech industry.
Unfortunately unlike other industries where developers can create nimble, high level products and service hacks that evolve with user demands giving minimal thought to data security, the security problem has the ability to make or break innovation in the healthcare industry. Such was the case with the NHS Health Apps Library. After its creation in 2013 the website, which offered public certified ‘clinically safe and trustworthy’ patient focused health apps, found itself closed after just two years amid concerns about the security of recommended apps. Of the 79 approved apps, 89% were found to be transmitting information to online services and none of them encrypted user’s personal data when it was stored locally.
While data security of products created externally is something the NHS might only be able to exert minimal control over, preparing for the current and the rapidly growing threat of cyber attacks is something they can control. In February 2016 the Hollywood Presbyterian Medical Centre in Los Angeles found their computers were held hostage using a piece of ransomware. The malware locks computers and prevents users from accessing data until they pay an agreed ransom amount – often in the untraceable cryptocurrency Bitcoin. In this case, computers were offline for over a week before hospital officials paid the demanded Bitcoin sum of roughly £11,700 . Similar attacks happened a month later at the Methodist Hospital in Henderson, Kentucky and to MedStar Health, which operates 10 hospitals and 250+ outpatient clinics. Malware and other hacks can enter a system via any internet connection – even medical machines. As hospitals rely on having up-to-date information for individual patients, delays can be life threatening, putting providers under huge pressure to pay the ransom demand. While this problem is currently primarily within the United States, it will only grow as more health services become digitised.
With the NHS trying to cut back and save at every corner, going digital is an incredibly attractive idea. However building the infrastructure is lengthy, costly and fraught with issues. Especially while dealing with the legacy of current NHS systems – many of which do not talk to each other. These challenges can often leave staff within the NHS feeling ill-equipped to spearhead the change. Planning, building and commissioning of digital services for many is a new, unknown and quite daunting territory. With the Health Secretary Jeremy Hunt’s promise to make the NHS paperless by 2020, health services have been presented with a monumental challenge, however there are some CCG’s and private companies that have taken on the challenge of tackling this issue.
There are many exciting projects in the UK looking to tackle the healthcare digitisation challenge and in London, there is a definite air of positivity when it comes to this issue. In digital mental health, Uscreates has been working with Tower Hamlets CCG on the Digitial Mental Wellbeing project. Based on the ‘Recommendation 28′ in the London Health Commission report, Better Health for London, the project is creating a London-wide digital service that will help thousands of working-age Londoners affected by common problems such as low mood, stress, anxiety, sleep difficulties, unhappiness or loneliness. It is a world first service and aims to put London at the centre of the global revolution in digital health.
In the wider UK companies like Inhealthcare are creating products and services with the aim of digitising other areas of the NHS. Their focus is “connecting patients to care teams securely, simply and cost effectively, enabling them to be cared for at a convenient place and time.”
A good example of this is their work with County Durham and Darlington NHS Foundation Trust (CDDFT). The Trust provides anti-coagulation support for over 2,600 patients on warfarin, and approached Inhealthcare to look for new ways to deliver quality care whilst improving their efficiency and capacity. Working with patients, the Trust had found that the clinic-based approach was restrictive to patients. Therefore they wanted to create a digital health option; in particular a telehealth concept, which Inhealthcare specalise in. Working with patients, clinicians and pharmacists, the team created a self-management telehealth solution.
The new digitally enabled international normalised ratio (INR) service lets patients self-monitor using a basic handheld meter and automated telephone calls. The call time and date are pre-scheduled, and each call collects information on patient INR readings and general health. While Inhealthcare do offer online, SMS and mobile app communication options, the demographic of patients on Warfarin pathways in Darlington combined with the poor internet signal in the area meant that telephone calls were deemed more appropriate for the target audience. With these calls, patients no longer need to come into clinics for a physical update. Their information is sent straight to the warfarin clinic where staff can determine their next dosage. The service works around the issue of the NHS multi-systems, as data can flow straight into EMIS WEB and SystmOne allowing practitioners to access the data in real-time.
For health professionals this service showed a 20% improvement in patient’s’ time for those in therapeutic range (TTR) and a 70% improvement for those in the pathfinder. 100% of patients said they would recommend the service to others because of the flexibility and freedom it gave them to test their blood where and when they wanted .
Oliver Lees from Inhealthcare believes this is just the start; “Health and social care is changing within the NHS. They are slowly realising the possibilities and the importance of digitalisation. There are now jobs such as NHS England’s Director of Digital Technology, and the Health and Social Care Information Centre (HSCIC) is changing its name to NHS Digital. While this doesn’t seem like much now, changes like these will start trickling downwards until hopefully we will begin to see jobs such as ‘Digital Lead’ embedded within teams”.
Last December, as a positive step to help with the growing issues of digitalisation, the Digital Marketplace opened their doors to allow suppliers to apply to sell their services through the Digital Outcome and Specialist framework. The Digital Marketplace is used by government departments and other public sector organisations to help find and compare suppliers who can help deliver their services to provide first class outcomes.
Uscreates are official suppliers on this framework and offer four services:
- Digital Specialist- Able to provide a specialist to work on a service for a project that can provide timely deliverables and a defined scope. This includes a project manager, designer, communications specialist, user researcher etc.
- Digital Outcomes – Helping to build and support digital services for public sector and government organisations by using user experience and design, service delivery and service development.
- User Research Studios – Able to provide a comfortable, private and safe environment for participants, researchers and observers to work in via the Uscreates Lab.
- User Research Participants – Able to recruit users research participants from a wide variety of background, skills and experience.
We look forward to working with organisations through this framework to demonstrate the value our design thinking approach brings to digital.
If you would like to learn more on digitising healthcare services for your organisation please email email@example.com
Uscreates is an award-winning, 10-year-strong strategic design consultancy working to improve health, care and wellbeing through embedding a design approach across organisations. We design communications, services, systems, processes and strategies for a range of public, private and third sector clients including private hospitals and clinics, NHS England, the Department of Health, CCGs, Nesta, the Health Foundation, World Bank and PwC.
Sophie Walker is a Service and Communications Designer specialising in creating innovative and engaging ways to improve user services and experiences. She has a background in Trend Forecasting and uses this experience to create long lasting, sustainable services. She has worked on projects for Uscreates tackling troubled families, smoking and pregnancy, early years’ health and wellbeing, unemployment and improvement of mental health services and support . Many of these projects required her to use ethnographic skills with users to gain a full understanding of how services could be improved by communicating the findings in simple, often visual way.
 ‘The UK: your partner for digital health’, Department of Health and UKTI, 2015 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/402227/Healthcare_UK_Digital_Health_Jan_2015.pdf)
 ‘Healthcare’s digital future’, McKinsey, July 2014 (http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/healthcares-digital-future)
 Segmentation taken form ‘Digital Health in the UK’, Deloitte, Sept 2015 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/461479/BIS-15-544-digital-health-in-the-uk-an-industry-study-for-the-Office-of-Life-Sciences.pdf)
 ‘Connected health: How digital technology is transforming health and social care’, Deloitte 2015
 ‘Why Hospitals Are the Perfect Targets for Ransomware’, Wired March 2016 (https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/)
 ‘Case study: Durham and Darlington Foundation Trust’, Inhealthcare
 Interview with Oliver Lees from Inhealthcare by author