Accelerated Access Review – my blog

As a member of the Stakeholder Reference Group of the Accelerated Access Review, this editor was recently invited to write a blog to encourage contributions to the review, the purpose of which is to identify actions necessary to accelerate the uptake of innovation into the NHS. It seemed a shame for the blog also not to be shared with TelecareAware readers, so here it is:

The Digital Health & Care Alliance (DHACA), of which I am Managing Director, has a strong interest in the success of the Accelerated Access Review, both because the majority of our 550-odd members work in SMEs whose very existence depends on the responsiveness of the health & care organisations in the UK, and because all of our members have a strong interest in improving patient outcomes & treatment efficiency.

One thing I’m going to be very interested in seeing emerge from the Review is the consensus on how innovators gather and use evidence to develop their product to meet the demands of the NHS and needs of patients. In DHACA we think we have a fairly clear idea about how our members go about this, however we can only claim to represent the digital health stream in the Review, and then only for small organisations. Allied to this is the much tougher question for many, particularly our smaller and more innovative members, of how to sell to the NHS.

A factor that has been of such concern to our members that we established a Special Interest Group (SIG) to focus on it is regulation; as a result DHACA has drafted a process paper describing the details of the  regulation of digital health medical devices that is currently out for review by members. One finding of our work is that whilst innovators mainly are aware of medical device legislation, there is less understanding that, irrespective of whether something is a medical device, there are still serious regulatory issues to address concerning data protection and the advertising of benefits. I wonder how others see this.

One of the issues that currently distinguish digital health from pharma, and perhaps even medical technologies, is the rapid rate of development. This is incompatible with the format of the traditional method of testing medical innovations – the randomised controlled trial – which typically takes far too long to complete.  DHACA has therefore been lobbying NICE (in particular) for agreement to a far faster method of benefit assessment, perhaps relying on the A/B testing technique used by online retailers. For digital health this is really key as at present one of the reasons professionals give for not recommending apps to patients is that they have no evidence of their efficacy, and need to feel that an organisation like NICE has checked this out.

A related issue is finding appropriate clinical testing grounds for trials. In digital health, I know from personal experience that it can be a major challenge as it (to an extent understandably) goes against the innate conservatism of many in the medical profession to experiment with relatively untried interventions. The question “where has it been successfully deployed before?” makes first-time deployment a serious obstacle to overcome, particularly for SMEs looking for a foothold in the NHS or local government.

In turn related to this is the question of how should digital innovations be measured for effectiveness/safety, both to reassure clinicians and patients. Thankfully in digital health, there are some very effective safeguards for identifying and minimising clinical risk (which are also incorporated into DHACA’s draft regulation process document mentioned earlier). Not everyone knows about them though.

Which brings me to the key question that, as a member of the Accelerated Access Review Stakeholder Reference Group, we are most interested in readers’ views on: what single action could government realistically take to accelerate digital health innovation in the UK health and care services? Not an easy question to answer, as there are so many contenders, some of which I’ve hinted at above.

One thing is certain though and that is that the health & care services in the UK cannot for ever increasingly slow the speed of adoption of digital technology.  History shows that when a trade or an industry turns its back on innovation, in the short term people suffer. However in the longer term, innovation just goes round the obstacle and leaves it isolated. Perhaps the online services from the likes of Dr Now, Babylon or Dr Morton’s offer an alternative future that health & care organisations need to be concerned about?

The Review welcomes your comments, before 11th September.

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