Dr Anne Blackwood, chief executive & Dr Karen Law, head of innovation, Health Tech Enterprise discuss the multitude of factors causing the slow process of mass adoption and integration of new technologies in the NHS, and how to resolve the issue.
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National Health Service (NHS) Concept. Medical Care Insurance Public Department.
In the face of unprecedented and significant pressures throughout the COVID-19 pandemic, the NHS heroically maintained exceptional standards in healthcare provision. In some areas, particularly in primary care provision, the opportunity and capacity for the service to maintain this standard was created through the rapid uptake of new digital healthcare innovations and technologies. While emergency procedures created a framework for this transformation, beneath the surface are a multitude of root issues making it extremely tough to accelerate the adoption of new innovation and technology. Restraints on available funding, a reallocation of resources, workplace culture, capacity and capability, data safety and the overarching complexity of clinical pathways have all contributed to blocking the delivery of new innovation in our health service. As a result, innovation has not had the priority within a system already operating at maximum capacity. This has led to a lack of local responsibility for driving overall innovation in the UK health market.
Due to the lack of accountability amongst NHS executives and decision makers to drive innovation, the resources and existing technology - which have the potential to streamline the service - have fewer access opportunities for being adopted into the NHS at scale. Transforming clinical pathways at scale to take advantage of new digital technologies requires digitisation of data, connecting the system so that data flows freely across silos (interoperability of systems) and new digital pathways where technologies are embedded with service provision. While there are pockets of excellence, such as the new Global Digital Exemplars recognised by NHS England, historically, many areas of the NHS function still function from paper-based systems.
There are some examples of successful adoption and integration of new technologies at scale in the health care market worth highlighting. Previously, at least three hospital trusts in England were piloting the electronic prescription service (EPS), which was initially developed during the pandemic and has since been successfully scaled to enable mass adoption. Focussed on driving efficiencies in the challenging climate, applications for AI-enabled innovations are making positive waves in certain settings. Moorfields Eye Hospital’s work with the UCL Institute of Ophthalmology has seen machine learning technology be successfully developed to analyse thousands of eye scans to identify signs of eye disease and recommend how patients should be referred for care. This has resulted in a correct referral rate of 94% for patients suffering from more than 50 different eye conditions. Similarly, NHS England recently introduced a new AI-enabled HeartFlow Analysis system, which has significantly reduced hospital wait times. The AI-technology processes data from angiograms and uses deep learning technology to analyse and create personalised, digital 3D models of patients’ coronary arteries; the models help doctors to assess the functional impact of any blockages and reducing the need for unnecessary invasive procedures.
It is clear to see that these developments are making strides, not steps, in taking the NHS forward - saving not only time and resources, but potentially thousands of lives. Why then, is the process of mass adoption and integration of new technologies still so slow?
As well the endemic cultural challenges that are listed above, looking at the entire health and care infrastructure, it is not always clear which department, individual, or working group holds the responsibility for driving innovations forward. For example, NHS Trust boards review a specific hospital’s performance each month, but innovation is rarely discussed around the boardroom table; currently there are few metrics in place to measure the adoption of new technologies locally. On top of this, different care trusts cannot easily share information across all of the NHS’ digital systems; the interconnectivity of systems falls vastly behind the progress of similar sized corporate and commercial enterprises. So much so, it is estimated that the NHS is currently 14 years behind most Scandinavian countries in digital software standards, including Estonia where nearly 95% of internal and patient interactions are digitised.
Conversely, it can be argued that it is incumbent of the technology developers to be considerate of these challenges when planning and developing new innovations for the market. Although it can be complex, innovators and medtech developers should seek to understand routes to market and the procurement processes they will eventually be working into when they are conceptualising their new technologies. This can be a particular challenge for SMEs who will be operating within strict localised procurement and have limited benefit for future scaling. This is where Health Tech Enterprise can add real value to the process as a partner to developers, helping clients to navigate these challenges early, assisting in everything from market analysis and IP regulation to economic evaluations.
To successfully navigate the procurement process and secure an NHS contract, companies need to gather enough evidence to demonstrate improved health outcomes and cost-effectiveness. In the current climate, securing a CE mark safety certification is not enough to secure adoption; product developers must secure enough evidence through pre- and post-clinical trials to satisfy NHS requirements. For this, there is often no consistent standard or benchmark to guide developers about the type and quality of evidence required.
This means that SMEs need to consider how to evaluate their innovation long before it has reached the procurement stage. They should ask the question: “what clinical, patient and payer insights will help to support and strengthen our product’s credibility?” Health Tech Enterprise assists businesses with this stage, helping its clients to extensively prepare and plan by implementing usability studies, which include designing and conducting formative evaluations and summative testing, and building cost-effectiveness models to review economic viability.
There is no one size fits all approach to driving innovation in today’s medical market. As a result, the NHS and innovators have a shared responsibility to drive wide scale adoption of new medical devices. The goal for medical technology developers should be to first understand their product suitability for use in different indications and settings and how they can best be streamlined to generate optimal impact in terms of health outcomes and budget savings. Once this has been done, developing strong relationships and partnerships with the right teams of people is of crucial importance to successfully launch these products into the market. At Health Tech Enterprise, we are able to help steer product developers and make connections that provide clinical, patient and buyer insights through a developed network of clinicians who support care pathways and conduct primary research to evaluate how a product will provide clinical and operational benefits.
