Sheena Asthana, Rod Sheaff, Ray Jones and Arunangsu Chatterjee
In an article published in Evidence & Policy last year, ‘eHealth technologies and the know-do gap: exploring the role of knowledge mobilisation’, we described the eHealth Productivity and Innovation in Cornwall and the Isles of Scilly (EPIC) project, which aims to support the development of a sustainable innovation ecosystem. We found that, in order to build practically useful links between user (and/or carer) groups and those developing new eHealth technologies, the EPIC team had to invest significant resources in knowledge sharing, one-to-one networking, building focused linkages and capacity building; that financial support can play a key role in supply-side dynamics; but that the contextual and organisational barriers to eHealth innovation in England should not be underestimated.
Covid-19 hit as our EPIC project, run from the University’s Centre for Health Technology, was coming to the end of its first three years and transitioning to a further three. The pandemic has accelerated the launch of technologies that support the vision of a digital-first NHS as well as encouraging social connectivity. For example, video calling with friends and family doubled during Covid-19 with seven in ten UK adults online making weekly video calls. Against that background, how do we re-interpret our previous and ongoing research on digital health implementation?
Notwithstanding the rolling out of technology, our observations about the need to focus on people, not the technology and to overcome organisational barriers to innovation still hold true. In care homes, for example, technologies such as video calling, smart speakers, care robots and remote monitoring and consultation can be successfully implemented within care settings if barriers such as a lack of basic infrastructure, need for training, workloads and reluctance to change working practice are overcome. However, the Covid-19 pandemic has exposed the digital divide between care homes and the community health services that support them and rest of the health care landscape. With some 70% of care homes still reliant on paper systems and differences between systems with respect to encrypting data, interoperability and shared record keeping remains a problem. Furthermore, WiFi access to residents is poor, many care homes either having no WiFi, or only providing access in communal areas. In such contexts, the use of digital technologies (including the use of video technologies to remain in contact with relatives) has been disappointedly low.
There are also ambitions to improve people’s access to digital healthcare services in their own homes. Yet, the risk factors for diseases such as chronic obstructive pulmonary disease (COPD), diabetes and other conditions that increase risk of severe illness from Covid-19 are the same risk factors for digital exclusion. While virtually all adults (99%) aged 16-44 years in the UK were recent internet users in 2019, that figure drops to 47% among adults aged 75 and over. There is, moreover, a close correlation between digital exclusion and social disadvantage. According to the 2019 Oxford Internet Survey, 95% of those with a higher education reported being online, compared to only 36% of those with no educational qualifications. Thus, while wearable technologies and apps are becoming ubiquitous among the young and more affluent, older and more disadvantaged groups may require more support in developing the confidence to monitor and manage their care.
In the Centre for Health Technology, we have been drawing on from questionnaires (soon to be an app) and wearable sensors to develop data management systems that feedback information to patients with Parkinson’s and let clinicians know when a patient needs assistance. We have also been working with ‘breathers’ groups across Cornwall to support the roll-out of the myCOPD app. Our experience suggests that developing trust and overcoming technophobia can take time, but offers real benefits. Given the fragmentation of the NHS and particularly the care sector, it is important that such findings are shared to further accelerate the acceptance and use of technologies that are particularly needed by those who have been isolated by Covid-19.
You can read the original research in Evidence & Policy:
Asthana, S. Sheaff, R. Jones, R. and Chatterjee, A. (2020). eHealth technologies and the know-do gap: exploring the role of knowledge mobilisation. Evidence & Policy, DOI: 10.1332/174426420X15808912803267.
Sheena Asthana is Director of the Plymouth Institute of Health and Care Research. Her interests in digital exclusion are part of a wider focus of her research on health and health care inequalities.
Rod Sheaff is Professor of Health and Social Services Research at the Peninsula Medical School at the University of Plymouth.
Ray Jones is Professor of Health Informatics in the School of Nursing and Midwifery at the University of Plymouth.
Arunangsu Chatterjee co-leads the Centre of Health Technology and is the Head of Digital Education for the University of Plymouth. His research is around ecosystem development to incubate, accelerate, embed and export innovative technology solutions in health and care, coalescing around internationally-recognised technologies and data standards.
Image credit: Getty Images.
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