The Secretary of Health for the UK, Jeremy Hunt recently said “…while mobile broadband technology is revolutionising most walks of life, there is a problem once people encounter the relatively antiquated systems of the NHS.” The UK has developed an initiative called Digital First. As described, “Digital first…is a Department of Health initiative which aims to reduce unnecessary face-to-face contact between patients and healthcare professionals by incorporating technology into these interactions. By ‘unnecessary’ we mean, for example, attending a hospital or GP appointment to receive a test result that says everything is OK; or a visit to an outpatient clinic or GP surgery for something that could be discussed on the phone or via email or SKYPE. Digital first is not about replacing doctors or nurses with technology. Patients will still be able to get an appointment with a doctor or a healthcare professional if they choose to. Instead, it is about using technology in healthcare where it can deliver the same high standards in a way that is more flexible and convenient for patients, and at a lower cost.”
In the USA as well, healthcare lags considerably behind other sectors (retail and finance) in the adoption of digital technology into its quotidian workflow. Technologies adopted are not done so in a universal manner as in the UK. Telehealth has been adopted in over 40 states, but not necessarily uniformly within a given state. Barriers include cross-state professional licensing and reimbursement issues. Healthcare resource utilization varies widely among healthcare provider systems, commercial and public payers, and geographic areas in the US (with resultant variable costs). The national Digital First type of program is not something we can expect here. Statewide Medicaid programs, vertical healthcare organizations, large self-insured commercial enterprises and a few progressive academic institutions are the closest the US comes to sizeable uniform implementation of such programs and they should be applauded for their investments in these technologies.
Digital First and the above-mentioned US-based organizational mHealth initiatives which will hopefully be tied to robust outcomes data, and will allow us to observe this real-time type of experimental comparison of adoption modes between them and the ‘usual care’ group. This type of data is lacking and I look forward to seeing it. Not only will outcomes data be important, but also data about the process itself. Frequency and reasons for utilization, demographics, temporal relationship to last visit and effect on visit frequency are all areas of interest.
Opponents to the Digital First initiative argue that older patients prefer face to face visits. In addition, Katherine Murphy, chief executive of the Patients Association, said “The telehealth agenda must be driven by a desire to improve clinical outcomes and patient care, not the Government’s plans to save £20billion.” However, there are many years of cost-saving and patient care data supporting telemedicine’s use. In addition, over a decade of experience (personal and population) of remote monitoring of implantable cardiac rhythm devices has demonstrated increased cost and provider efficiency, patient preference and adherence, and improved outcomes in both countries. Another type of technology which is less controversial because it does not profess to decrease office visits (though it might very well accomplish this) is demonstrated by Scotland’s NHS website nhs24.com where one can use their easy to navigate self-help guide.
Health and medical apps are appearing on the traditional healthcare scene in both countries. The UK is encouraging the prescribing of smartphone apps to patients. The US is first becoming aware of the concept of prescribing medical and health apps. Both eagerly await the FDA Guidance document on mobile medical apps.
The adoption and success of mHealth need not emanate purely from the public or private sector. There are exemplary public-private partnerships in mHealth which are will definitely make an impact on healthcare. Paths to the adoption of mHealth technologies are different between the UK and the US. It will be interesting to observe and compare how political, regulatory and systematic differences impact this foray into a ‘brave new world.’
