Encouraging Uptake of Health Apps Across the NHS

Eleanor Smith MP chaired a parliamentary roundtable discussion on Tuesday 16 October 2018, supported by Roche Diabetes Care, to discuss and determine how the use of health apps can be encouraged across the NHS for the benefit of patients.

Experts were brought together to discuss:

• The potential benefits of health apps to patients and the NHS

• The key challenges and barriers to utilising health apps in the NHS

• What advice and support should be provided to those wanting to develop or adopt a health app

• The role the life sciences industry should play in the health app NHS landscape

This note provides an overview of the key themes from the discussion, which was held under the Chatham House Rule.

Background 

Through proactive leadership from NHS England and NHS Digital, health apps are being increasingly utilised
at national and local levels across the NHS. This welcome leadership and ‘open-door policy’ is most evident in the
creation of the NHS Apps Library and the development of the NHS App. Attendees commended this proactive approach, noting that it is viewed as a global exemplar.

Alongside an update on both initiatives, attendees highlighted various health apps that have been developed by the NHS and by the digital industry, to meet specific healthcare challenges or requirements. These apps can provide different types of digital support, including:

Empowering patients and carers to self-manage and to improve health outcomes

• Improving patient care from prevention to management
• Complementing existing care delivery
• Addressing health inequalities
• Acting as portals to other digital services
• Supporting administrative tasks
• Relieving pressure on the current NHS workforce

It was agreed that, despite the success to date, more can be done to fully realise the potential of apps.

Key themes from the discussion

There was consensus among attendees on the potential of health apps to support improvements in service delivery and patient
care. The group identified four interconnected themes and made a number of recommendations to improve uptake of health
apps. These themes and recommendations are as follows:

1/ Facilitating greater data sharing

For the full potential of health apps to be realised within the NHS it is vital that there is effective data flow and
interoperability between apps and traditional services, for example by linking data from apps with an individual’s patient
record. Interoperability through suitable platforms and engagement criteria should be incorporated within plans for joinedup
national electronic patient records. Attendees referenced the ‘Blue Button’ concept – developed by the US Government
to signify that a site has functionality to download health records – as a potential opportunity for learning for the NHS.
Recommendation A system of efficient and effective data sharing needs to be established for appropriate health apps
to be compatible for integration within electronic patient records.

Whilst debate continues around the ‘ownership’ of patient data, the importance of ‘intellectual property’ that is produced
by health apps should not be undermined. Attendees discussed the need to develop a centralised model of patient consent
to ensure effective data flow and interoperability. Before such a model could be introduced, attendees recommended that
an extensive public engagement campaign be undertaken around the benefits of data sharing to the individual and wider
health system.

Recommendation

A consultation should be launched by NHS England on establishing a centralised model of patient consent, alongside a public engagement programme on the benefits of data sharing for individuals and the wider NHS.

2/ Expanding public engagement and education on the use of technology

The public should be made aware of the ‘trusted’ health apps that have been accredited by the NHS through sufficient
evidence submissions and how they could use these to achieve their health goals. The group suggested that public
engagement and education should utilise the most effective methods, both digital and traditional, for spreading messages
amongst all parts of the population to promote these evidence-based options over less regulated solutions. Attendees were
conscious of health inequalities and highlighted that any solutions and/or engagement should be focused on reducing
these inequalities across the country.

Recommendation

An extensive public engagement and education programme should be undertaken, using digital platforms where appropriate, to showcase effective / evidence-based health apps and encourage
wider usage.

3/ Incorporating health apps into relevant clinical pathways

To encourage the uptake of accredited health apps, the group suggested an aim of including them in relevant clinical
pathways where appropriate as complementary or alternative options to traditional care. For this to happen, attendees noted
the importance of healthcare professionals understanding and trusting the various levels of evidence required for apps to be
accredited. Attendees commended the work of NHS England and NHS Digital to categorise the associated evidence required
for the app to be assessed. Healthcare professional ‘buy-in’ to health apps and new digital solutions was recognised as a key
component for successful uptake, alongside tailoring to a specific region or condition as needed.

Recommendation

Health apps should be incorporated into relevant clinical pathways, with engagement to secure
‘buy-in’ from healthcare professionals.

It was noted that the current system primarily supports and rewards the initial innovators of apps, and not those adapting
or adopting health apps to meet local patient need. To encourage and spread best practice, the group recommended
improving signposting to examples, as well as increased support both for the initial innovators and for future
adaptors/adopters.

Recommendation

Support needs to be from conception to roll-out for innovators developing health apps, as well as to those looking to adopt or adapt existing apps for local or regional contexts.

The group discussed the approach to appraisal of health apps and the value of establishing reimbursement pathways at a
national and local level to provide structure to support uptake and foster further innovation. The potential success of
personal budgets was raised by attendees. It was suggested that a similar scheme could be rolled-out for the use of health
apps, by allocating additional budgets for people with long-term conditions to choose and purchase their own health apps.

Recommendation

Reimbursement pathways, with clear evidence benchmarks, should be created at both local
and national levels to encourage the continued uptake of, and innovation in, health apps.

4/ Utilising health apps to support the NHS workforce

Health apps have the potential to reduce pressures on the NHS workforce, through providing time-saving efficiencies in
the delivery of care. In order for this to be exploited, healthcare professionals need to be sign-posted to approved and relevant
health apps for their specialism and trained on their use. As the NHS looks to the future, the potential of health apps should
be viewed as a key opportunity for improving the delivery of care and reducing pressures on the stretched NHS workforce,
with health apps being either prescribed or accessible ‘off the shelf ’ solutions that individuals can download themselves.

Recommendation

Sign-posting to newly approved health apps and training on their use should be included within
programmes for newly qualified and established HCPs.

Attendees with experience in developing health apps highlighted the importance of sustainability through ensuring the
products and solutions are regularly updated through partnerships with end-users to get their feedback. As part of the
NHS Apps Library it will be important that mechanisms are established that enable both developers and users of apps
to share feedback and best practice.

Recommendation

Health app developers and end-users should be supported to share feedback and best practice
on the practical development and evolution of health apps.