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The Pros and Cons of Digital Apps in the Complex NHS Landscape

The Pros and Cons of Digital Apps in the Complex NHS Landscape

Across the industry and patient groups, there is a growing push towards adopting and gaining insights from digital solutions and applications. But deploying apps in the NHS is not that straightforward, since any system, solution or product is likely to need to go through approval processes to ensure it is authenticated and can overcome governance issues. Questions persist around how data is gathered from patients, how it is fed back to the NHS and how the healthcare system can effectively use the data gathered.

These questions and issues are compounded by financial pressure on the NHS and by cynicism about the pharmaceutical industry and its objectives. Payers want to know that the industry is being completely transparent.

That is not to say there is no appetite for digital solutions. The Welsh NHS system is openly trying to engage with digital developers to make sure that anything developed fits in with Welsh IT structure and can be used by the local health system. In England, there is an NHS apps library indicating those digital apps reviewed and endorsed (though not necessarily paid for) by the NHS. The process of reviewing these is set to shift to a newer NHS body with responsibility over digital transformation in the NHS (NHSX). NICE also has an assessment framework for digital technologies.

These national processes have their place, especially if the app requires integration into the NHS standard computer and data systems. However, adoption of digital apps continues to be local and disparate, with pilots run in one or two healthcare institutions where there is clinical buy-in to the concept. The disparate take-up is both a positive and a negative. It contributes to a growing number of overlapping apps and multiple interfaces for healthcare professionals to engage with. However, it is essential to get clinician input and buy-in for any app to be taken up, because clinicians are at the frontline and therefore understand best what the patient need is. It is also best to generate a “pull” from within the system, rather than just a push from outside it. In addition, in the current climate, some apps can be prescribed by a local clinician under a social prescribing budget.

If a company is seeking to bring an app to the market to support patients and clinicians using its product, it needs to adopt a careful, well-considered and well-researched approach.

Our team of experts at Gatehouse ICS has the contacts, experience and market understanding to help determine the value of a solution before any potential launch. We would start by testing the appetite for a digital solution before development. We would reach out to the wide network of clinicians to find out if there is a gap, what that gap is and how it might be addressed.

Next, if it is an app that needs to be integrated, we would carry out the necessary research to determine whether and how it would feed into clinicians’ notes and records, so we would look to interview IT specialists involved at a local level to assess the technical possibilities and barriers.

We would also look to get feedback from patient organisations, since they represent the widest viewpoint. We would ask questions such as, “Is the app appropriate for the patient group in question?”, “Does it present challenges for certain populations?”, “Are patients likely to use it?” If the condition largely affects an older patient population, it may well be that an app will have limited value.

Know your market

In addition to interviews, our team carries out desk-based research to determine current trends, needs, and opinions to help shape the interview process.

Often the biggest challenge is that while the digital solution or offering around a product might seem to the pharmaceutical company to be a great addition, there is a wider context within the healthcare system in terms of implementing such schemes. That is because these offers can mean massive amounts of paperwork for the different Clinical Commission Groups (CCGs) that manage the services for local hospital and community services. It’s important, therefore, that the pharmaceutical industry understand the time and resource constraints facing the NHS, and that’s typically not possible without garnering good internal insights.

While there is some caution over digital solutions, all payers want to move to an outcomes-based way of working and they want to be able to manage patient populations more effectively. If an app helps them do that, and if their budget and internal capabilities allow them to make the necessary adjustments to manage the implementation of that app, there is likely to be greater appetite for such a solution.

The emphasis, though, is on whether that app helps or hinders. Years ago when I started out in the industry, one of the payers I was working with said to me, “Don’t come to me with a problem, come with a solution.” Pharmaceutical companies are good at developing solutions, but when working with the NHS to bring new digital capabilities to healthcare, they must make sure those solutions are detailed, well-considered and that their approach is completely transparent.