Established to evaluate Digital Health products and services, the Digital Assessment Questionnaire (DAQ) has evolved over time, first setting standards too low, then too high. But after years of development and significant NHS investment, the DAQ became a global digital exemplar – one of the world’s most rigorous digital health assessment models, yet capable of processing an evaluation within a matter of days. A standard that adapted requirements and thresholds based on need in its broad-based sector.

Any standard intended to replace the DAQ must offer a leap in benefits to the NHS, patients and developers. As such, the initiative by NHSX to design a new standard offers a huge opportunity. After working with national bodies worldwide, helping to develop the NICE standards, and recently, as an approved assessor, applying the DAQ for the past 18 months, we are excited by what can be achieved.

As the consultation on the new NHS Digital Health Technology Standard closes, our call to NHSX will be to ensure that the new standard:

1. Uses lessons learned: In the development of the DAQ, there were many approaches tested and removed because they were unsuccessful. A close understanding of lessons will ensure that time and resources are not wasted. For example, it is tempting to think that the tougher the standard, the more protection it offers. But set the standard too high and no solutions designed to help patients can make it to the market. Regulation needs to measure the right things and set the bar at an appropriate level, giving consideration to the risks that it is designed to mitigate.
2. Does not collate but adapts: Simply collating all appropriate standards into a single assessment process does not work. For example, the Open Web Application Security Project (OWASP) security standard is required in the proposed new NHS Technology Standard, yet the ability to demonstrate compliance with its principles is a hugely complex task, which has, to date, proved impossible. We would encourage the approach taken by the DAQ for the DCB0129 Clinical Risk Management information standard. Here, the assessment process was refined to accommodate the standard’s requirements. This involved developing a granular interpretation of which solutions the standard was or was not applicable to, as well as a refined and more detailed breakdown to evaluate compliance. This step should also seek to remove duplication in checks made by standards.
3. Leverages international programmes: If the new NHS Technology Standard is to utilise international best practice, a good starting point would be the EU sponsored project team behind the crafting of a CEN/ISO Technical Standard for Digital Health and Wellbeing solutions. ORCHA has been supporting this work and can recommend this initiative. The CEN/ISO standard is a significant programme that consolidates an array of the most applicable standards in the Digital Health space into one overarching model. This is a great starting point for any national standard and represents a solid foundation for assessment. The new NHS standard does reference the new CEN/ISO Draft Technical Standard, but with a view to adding it to a list of requirements, rather than using it as an opportunity to consolidate the list of standards required for developers and the process to follow.
4. Is designed with process in mind: The creation of a standard is just the starting point. A process is needed to implement the standard, which can take between 9 to 12 months to develop.  Considering how a standard will be applied throughout development will ease this development stage. Development with process in mind may also help the programme to consider a closed-loop system. For instance, ORCHA works with national bodies across EMEA, providing a review process, national app library and local app libraries which correspond to the national platform. This means the whole process and offer is connected, ensuring a 360° view and management. For example, every time an app is updated in an app store, our system triggers a re-review and the app libraries notify users that the review does not include the latest update.
5. Incorporates AI and other emerging technologies:It will be important for any future standard to build suitable assessment elements around technologies such as AI. With experts in the field, ORCHA has already developed an assessment module for AI and would be happy to support the NHS team in this area. The issue of data interoperability is another essential consideration in terms of future technologies.

We call for these areas to be considered, but most importantly, we ask for clarity around the goal for the programme. There are some fantastic principles and concepts in the draft standard, but it would be good to understand the specific step change in outcomes wanted. Only once we know what the problem and target is, will ORCHA and the digital health ecosystem be able to help the NHS to shape the future of Digital Assessment and the New NHS Technology Standard.

Health apps have grown enormously in popularity, even more so during the COVID-19 Pandemic. As recently reported (1), since early March, more than 500 health apps contain coronavirus-related keywords in their description.

People are taking advice from these apps, often using them to share sensitive information. Yet, in a time of fake reviews, scams and personal data breaches, not all health apps can be trusted.

The Organisation for the Review of Care and Health Apps (ORCHA) today launches a health app formulary to help healthcare professionals and consumers know which health apps they can trust.

As a free to use resource, the site includes reviews of health apps across a range of health conditions relevant to the COVID-19 pandemic, including reviews of COVID-19 apps launched to date.

ORCHA is also offering free professional accounts to all NHS staff for the next three months. The ORCHA Pro Account lets healthcare professionals find and recommend health apps to patients via text or email. This avoids any errors in remembering or downloading the wrong app, and gives the professional a record of who has been recommended an app.

ORCHA measures the health of health apps. It verifies the accuracy, security, and risks associated with their use.  Any app offering special pricing or approaches at this time, if it is particularly useful in supporting the COVID-19 response, or if there are any implementation approaches to support the COVID-19 challenge, is given a specific ‘COVID-19’ label in the formulary.

The COVID-19 Health App Formulary can be found at: https://covid19.orcha.co.uk/

Health Professionals can sign up to their free ORCHA Pro Account here, too.

Commenting on the move, Brian Donnelly, Chief Executive, CECOPS CIC said: “In the current COVID-19 crisis, finding the most effective health apps that meet trusted standards is so important. People need assurance when selecting apps. CECOPS fully supports the timely initiative by ORCHA to deliver a site where technologies that uphold standards can be found. This is a tremendous piece of work, well done!”

Andy Bleaden, Director Ecosystems and Membership ECHAlliance, adds: “We are really delighted to see the launch of his site is a vital source where the digital health community can find trusted information on health apps. ECHAlliance regard this as an excellent hub for health and social care professionals.”

Big Health co-founder and Professor of Sleep Medicine at the University of Oxford, Professor Colin Espie, added: “In these difficult times, digital therapeutics can help to alleviate the overburdened NHS system, and importantly they can do so with immediate effect and at huge scale. This is because therapies such as Sleepio are fully-automated and highly engaging, and deliver cognitive behavioural therapy (CBT) to anyone who needs it – today. Importantly, Sleepio is what we call ‘evidence-based’. This means that it has been the subject of an extensive clinical trials programme. In fact, 12 Randomised Controlled trials (RCTs) have shown that Sleepio reduces symptoms of poor sleep by up to 76 percent. We are proud to be included in the curated health apps within the ORCHA COVID-19 App Library. This is a wonderful initiative, and we look forward to helping users easily access safe, assured solutions that actually work and make a difference in their lives.”

Alyson Scurfield, Chief Executive, TSA (TEC Services Association), also commented: “Technology can transform the lives of vulnerable people during the COVID-19 pandemic. In these unprecedented times there has never been a more important moment for us, as professionals and the public, to engage with digital solutions, to keep us all safe and well and achieve our health and wellbeing outcomes.”

1. https://www.computerweekly.com/news/252480599/Coronavirus-Be-alert-to-rogue-mobile-apps-exploiting-outbreak

To minimise risks of exposing patients to COVID-19, around 70,000 physiotherapists in the UK alone¹ are being asked to adopt remote consultations. Already growing in popularity, physiotherapy apps are now a vital tool for physiotherapists to improve patient outcomes.

Apps can be used effectively to help in assessment, treatment compliance, monitoring of symptoms, or self-management of conditions, improving a patient’s physical and mental health.

On behalf of NHS organisations, ORCHA assesses more apps than anyone else, looking at clinical assurance, safety, data privacy and user experience. Below are two top scoring apps that are designed to help with remote physiotherapy.

Click below to watch our videos about each app:

GPEP Physiotherapy Exercises has been designed with the help of NHS GPs and physiotherapists with the aim of bringing users access to self-help advice from professionals, enabling users with back, muscle and joint conditions to start their recovery early.

The Chartered Society of Physiotherapy (CSP) has recently launched an App Library to enable its 59,000 members to take a leadership role in incorporating digital technology in their practice.

In our latest video, hear Karen Middleton, Chief Executive Offier, CSP, and Euan McComiskie, UK Health Informatics Lead and Professional Advisor for Northern Ireland at CSP, discuss how apps can help as part of assessment, treatment compliance, monitoring symptoms, and allowing people to self-manage.

“We’re working with ORCHA to try and enable our physios to be able to confidently recommend worthwhile apps to their service users, and for our members to use for their own benefit.” – Euan McComiskie

The CSP’s Physiotherapy App Library can be found at csp.org.uk/applibrary