The UK dallas initiative – reporting on lessons learned from a national digital health deployment Professor Frances S Mair Head of General Practice & Primary Care Institute of Health & Wellbeing
Acknowledgements • Our Funder: Innovate UK • Co-Investigators: Dr Marilyn McGee-Lennon, Dr Matt- Mouley Bouamrane, Dr Alison Devlin, Prof Catherine O’Donnell, Siobhan O’Connor, Ruth Agbakoba, Eleanor Grieve, Dr Sarah Barry, Prof Emma Macintosh, Camilla Baba, Annemieke Bikker, Dr Ula Chetty, Dr Tracy Finch, Prof Sally Wyke, Prof Nicholas Watson and the wider dallas Evaluation Team • The dallas communities. • Advisory Board
Background Digital Health has great potential Large Translational Gap
METHODS Longitudinal 3 Year Qualitative Study • Interviews (n=125) with key stakeholders; • Focus groups (n= 7) with professionals and public using dallas services; • dallas leads meetings (N=12); • Ethnographic field work/participant observation in one community (n=16); • Health professional survey responses (n=48) • Cross programme documentary evidence (N=215) • Framework Analysis Approach
NPT Thinking about doing Coherence Cognitive Participation Collective Reflexive Action Monitoring Doing the doing http://www.slideshare.net/KateODonnell6/npt-in-restore
LESSONS LEARNED Lennon MR, et al. Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the UK. J Med Internet Res 2017;19(2):e42
MACRO ISSUES • Market Readiness – Interoperability – Risk and liability – Clinical Endorsement – Complexity of the Market • Political Readiness and National Policy – Information Governance – Infrastructure
MACRO ISSUES Information Governance “ … There is a real problem in that all … .health data is in a Vault that’s owned by the NHS. You can’t, at the moment, view it and when you can view it, i.e., when we get our online patient records, it will be a view which is not in a form that can be used by technology outside of the NHS in any real useful way. I think the biggest issue is Information Governance and letting people take ownership of their own data and their own risk appetite, and until that happens all we are doing is allowing the market to develop outside of the true record. ……… The barrier is the NHS and their vault mentality on our data. ” [DHACA Research Interview 3, 2015]
MACRO ISSUES Accreditation and clinical endorsement “ what our experience brought us to realise is that people will only use a kind of Personal Health Journal and plan around serious conditions or long term conditions if it’s something that they can engage with their Clinicians on and that was kind of a back-to- front approach. You’re not really going to persuade people to go out and buy it as a consumer product if it’s not something that their Clinicians will engage with them on and look at and share the information that they’ve been collecting.” (Implementer interview)
Meso Level Issues • Industry Readiness – Lack of Market Coherence – Collaboration, Competition and co-design • Health Service Readiness – Information Technology Infrastructure at a Local Level – Discontinuity and Organisational Culture – Resource Constraints
MESO ISSUES • IT Infrastructure at an organisational level “Well things like legacy systems, fire walls, when we are adopting new technologies, eHealth capacity, e-health priorities within the internal infrastructure is stretched”. C1 Final E-Hit Interview
MESO ISSUES • Incoherent Market - Market stability and maturity were key themes for industry readiness. “… locally we really, really tried to get into, to encourage the Retailers to take an interest so conversations with ‘Tesco’s’, conversations with ‘Maplin’, with ‘Argos’ more recently but again we didn’t manage to, there was interest in Maplin and Argos but them taking that next step and doing some piloting with us didn’t happen….” [C2, Leads Research Interviews, June 2015]
Micro Level Readiness • Health professionals – Workload and Professional Confidence – Training and Alignment with Professional Roles and Identities – Access to Digital Resources • Public and Patients – Digital Literacy and Access – Agency of individuals and their perceptions of “consumer” digital health tools – Trust in consumer facing digital technologies
MICRO ISSUES “…. I think the whole system about IT, I feel first and foremost I am a Nurse and that’s what I was trained to do, so before IT came in, we were doing everything on paper, and now things are changing for us, and we’ve never really been given training, we’re only doing it on the job, and we’ve had a new IT system called ‘x’ coming in, that’s created an absolute nightmare for everybody, because we’re not necessarily that skilled in IT processes to be able to do that. So generalised IT training would be good, as well as then tailoring it to the things that we’re doing. …” [C3 Health Visitor, eRB Focus Group, April 2015]
MICRO ISSUES • Agency of individuals “….People don’t prioritise health, so if you are economically deprived, what you prioritise is feelings of physical safety and financial safety so you could be worried about paying your rent, keeping the debt collectors off the door, anti-social behaviour in your neighbourhood. If you’re more economically active then other things are a priority, ah, holidays, kids, schooling, housing, or next house, mortgage.” [C2 implementer interviews, June 2015]
Concluding Thoughts………. Concluding Thoughts • Readiness issues are ubiquitous across macro, meso and micro level and across sectoral boundaries : market, organisational, professional and consumer • Not necessarily insurmountable challenges – but their existence does need to be ACKNOWLEDGED and ADDRESSED if deployment at scale to the widest population is to be realised.
Lots of challenges but not insurmountable !
Recommendations 1 • Increased investment in both national and local infrastructure reqd • Guidance relating to ownership and control of personal health data as well as data privacy regulations reqd to mitigate current uncertainty. • Accreditation and official endorsement of products and services crucial
Recommendations 2 • Need to invest in awareness raising and upskilling of both public and professionals • Incentivise technical/service interoperability • Increase digital health accessibility (e.g. language)
Questions? Frances.Mair@glasgow.ac.uk @FrancesMair Online MSc Primary Care E-mail: primarycare@glasgow.ac.uk Lennon MR, et al. Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the UK. J Med Internet Res 2017;19(2):e42 Devlin AM, et al. Delivering Digital Health and Wellbeing at scale: Lessons Learned during the implementation of the dallas program in the UK. Journal of the American Medical Informatics Association (JAMIA) 2016: 23(1): 48-59.
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