In healthcare we are constantly striving to scale and roll out solutions so everyone everywhere can have equal access to high quality care which incorporates the newest approaches and research findings. However in reality we struggle to make scale happen. We don’t ask if scale and spread are possible, why they are needed and do we lose anything through scale and spread. This is the first part in a series of posts exploring scale and spread of healthcare solutions.
Tech companies are targeting healthcare and wellbeing as the next market where technology could significantly change the status quo. Often these companies are venture capital (VC) backed which means investors are typically supporting companies that will demonstrate significant growth in users and revenue - a current mark of success is achieving status as a “Unicorn” or a privately held company valued at 1 Billion USD or more. To reach this ambition companies need to scale and spread.
In theory there are advantages to scale for the supplier, system and patients and carers. For solution suppliers benefits include reducing costs by sharing costs amongst more users, captured audience and market share, regular revenue, data to improve solutions, and a stable business which can be further developed. For users with scale comes a consistent experience (however you choose to use the solution), potentially competitively priced products, quality assured products, reputation reassurance of a large provider, large and stable organisation able to provide support giving reassurance that the organisation and solution will continue to exist and can be depended upon. These translate into dependable quality assured solutions improving the system. So why is scale and spread so challenging?
Healthcare is wide and diverse encompassing patients, carers, clinicians, GP practices, hospitals, pharmacists, physiotherapists, IAPT and more. This means there’s not a single way but multiple ways of delivering a solution to support a persons health and wellbeing. We can classify the different parts of the system that a solution can target broadly speaking as
1) Solutions created specifically for patient and/or carer use (e.g. private direct to consumer mindfulness apps),
2) Solutions developed for place based care for use by clinicians or healthcare professionals (e.g. online consultation, decision support tools, messaging systems etc), and
3) Solutions for place based care developed for use by the patient and/or carer (e.g. prescription apps, flash glucose monitors, smart inhalers).
Direct to consumer solutions
These solutions utilise consumer facing technologies which are typically cutting edge, utilise familiar design and user interfaces to make modern solutions that are easy to use. Such solutions sit on well established smartphone or computer platforms which have mature marketplaces and established interoperability. The marketplace mechanisms enable the user to be the purchaser vastly simplifying the process compared to within a healthcare system. In combination, these mean direct to consumer solutions have the highest potential to scale.
These type of solutions currently are best placed to support self care and so typically help people who already have a good awareness of their health and wellbeing. They rely on the individual being able to afford the solution and have the right technology to be able to access the solution. This means some people will be excluded from accessing these solutions.
Direct to consumer means we can develop a group of users who can benefit from a solution irrespective of geographical location as long as they have access to certain enabling technologies such as internet and computer/tablet/smartphone. Solutions aiming to scale can be generic platforms (e.g. running motivation apps) or specific solutions for a specific group. In the later case the solutions are optimised for a group of users - people that self identify in a specific way (e.g. ethnicity) and have a certain health condition or collection of conditions. This could mean developing a solution that specifically supports Indians with type 2 diabetes or Eastern Europeans with liver failure. Such an approach enables tailored solutions incorporating details on culture and language that can be essential for success. Digital in this instance enables solutions to overcome isolated small communities in specific geographies to be able to scale to support a larger number of people bringing with it the advantages of a large numbers of users. The solution provider also establishes a direct relationship with the user which allows for insight and trust into the solution. The benefit of this is that each and every user is a potential advocate for the solution and a member of their community that can communicate the positives of the solution to their specific community.
Sustainable solutions
Solution providers can face challenges in developing a trusted monetisable product. For example, digital solutions are often packaged as Apps which are seen as being low cost products typically costing under £1. The challenge is in overcoming this mindset to establish a higher perceived value, the alternative is exploring other business models such as advertising (which can be intrusive) or using gathered data (which can infringe on user privacy). There are products that rely on a combination of an app and physical counter part such as home based urine testing where testing is facilitated by software guidance through the camera. By having a physical addition to the solution it adds complications in addition to the above challenges faced by digital only tools. For example there are manufacturing and transportation costs associated with physical products. However they are also potentially better placed to establish a higher perceived value through a physical counterpart to a digital tool.
The Clinical Gap
Clinicians are a key part of supporting a persons health but current direct to patient solutions struggle to effectively engage with clinicians. Furthermore the clinical infrastructure to facilitate easy engagement is not established. Many of these types of solutions attempt to interface with clinical teams and the healthcare system through two mechanisms.
Firstly pushing information into healthcare IT systems making information available for all who have access to the healthcare record. Unfortunately members of the clinical team are not always aware that this information is available, it’s not always in a format that’s easily understandable or actionable. Limited consultation time means clinicians typically don’t have the time to go through this information to prepare for a consultation. Additionally there are increasing number of digital tools and clinicians can’t know about them all or whether to trust them which can stop any utilisation of information provided. The NHS apps library could support this to change by providing a trusted source of apps but these are not yet available direct to consumer.
A second approach to engaging clinicians is through a dedicated web platform for clinicians to log into which in addition to the above challenges have additional barriers. For example presenting the healthcare team with yet another logon portal, clinicians often have multiple systems to log in to and navigate. Care provider organisations often suffer from poor connectivity and old systems which can severely impact the time it takes to log in to a portal and load up the information.
The GP IT Futures programme has interoperability as one of its key aims. If successful this will mean GP systems will be capable of smoothly interfacing with other tools and systems. But providing the information is just the first step, it needs to be in a clear and intuitive format that is actionable. As more solutions want to provide information into the healthcare system (e.g. apps, wearables, smartwatches, fall monitors etc) there’s potential for it to turn into a dumping ground for data. Instead we need purpose made tools to enable interpretation of information in an intuitive way to provide actionable insight that supports the individual. This will mean spending the time to co-develop definitions and standards as could need changes in clinician training.
Direct to consumer tools are the best positioned solutions to scale. However the way they interface with healthcare providers needs to be vastly improved to enable better impact on improving health to more individuals beyond those that are already actively aware of their health.
Next week we’ll look at place based care solutions.