Digital Health and Medical Adherence

At its recent meeting on 5th November the CfBI Medical Adherence and Digital Health consortium considered opportunities, obstacles, and possible approaches relating to the use of digital health to improve adherence.The questions considered were: How can Digital Health help improve adherence? What are the obstacles? How can we overcome these? The results of the workshop are recorded below.

How can Digital Health help improve adherence?

  • Improved feedback
    • Digital technology can enable better feedback – and so improved understanding – of therapy adherence to patients and HCPs.
  • Individualised care
    • Digital technology can enable care to be cost effectively tailored to the specific needs of the individual (including broader needs than clinical). Aligning therapy with these broader needs will help increase their relevance and ‘fit’ with patient’s lives in turn leading to greater adherence.
  • Stratified interventions:
    • There are many possible approaches to improving adherence, but it is accepted there is no ‘one size fits all’ solution. Through the use of digital technology (including Artificial Intelligence) it may be possible to stratify patient populations so that they receive the optimum adherence intervention.
  • Sharing of patient data
    • Broader understanding of the patient ‘healthcare journey’ by all HCPs and the patient themselves will be facilitated by (and will require) the seamless sharing of patient data (subject to privacy and consent issues). This informed perspective will enable HCPs and patient to better understand each others perspectives leading (it is hoped) to improved therapy adherence.

What are the obstacles?

  • Technical issues
    • There are many technical obstacles to the successful uptake of digital health including the limited: adoption of appropriate standards, availability of appropriate and robust infrastructure, data-level integration of the proliferation of information systems used to deliver healthcare. In addition the addressing of these is costly. It should be noted that progress is being made in all these areas.
  • Acceptance / engagement / exclusion
    • There are issues of the varying levels of acceptability of digital technology to different groups of patients and the degree to which they will engage with it. The broader uptake of digital health may lead to ‘exclusion’ of patient groups who cannot or do not wish to use digital technology.
  • Privacy / management of consent
    • The ability to provide and withdraw consent for information sharing (and treatment) is guaranteed by law: the technical solutions making this simple to manage are lagging behind. It is currently not easy to either explicitly provide or withdraw consent such that this is widely understood, respected, and acted on.
  • Healthcare system inertia
    • Healthcare systems are very complex – it takes a great deal of time and energy to align the required stakeholders so that technical systems can be implemented. There is also, occasionally, hostility to the idea of plentiful sharing of patient information and a lack of embrace of the opportunities afforded by digital technologies amongst senior (and older) professionals.
  • Commercial issues
    • As is often the case in healthcare systems, there can be a lack of connection between the funders of an activity and its beneficiaries. These leads to an unclear answer to the question: “who should pay?”. In addition to the allocation and extent of legal liabilities for poor performance is complex and occasionally inequitable. It is recognised that healthcare data has significant value as an input into the development of digital solutions. It is not widely understood how patient data should be correctly valued and how that value should be realised.

How can we overcome these?

  • Technical advances
    • New technology can enable new opportunities. However, in digital health it is often the incremental improvement of established technologies that can yield the greatest benefits. Progress is being made here: international standards for healthcare data exchange are increasingly adopted, (affordable) secure robust infrastructure is becoming widely available, integration between systems is steadily increasing: all technical obstacles are being addressed and will be overcome in time.
  • New business models
    • The complexity of healthcare systems is such that rapid progress needs innovation in business models as much as technical innovation. Identification, promotion, and promulgation of successful new business models (with clear ROI) will help here.
  • Harness ‘Patient Power’
    • The drive to improve can come directly from patients used to the widespread use of technology in other areas of their lives and frustrated by its slow uptake in healthcare. Patient organisations and other patient advocacy groups should promote the effective use of digital health and the concerted tackling of the obstacles preventing its uptake.
  • Regulatory / policy evolution
    • Regulators and policy makers have a major role to play to enable widespread innovation and digital health uptake while minimising risks. Regulators and policymakers should consider the wider benefit of the increased use of digital health when balancing risk and reward in the drafting of regulations.
  • Support for and use of community care
    • All parts of the health care system need to promote, use, and benefit from digital health systems: community care has a particularly important role to play is reaching patients in their home lives. Pharmacists in particular have a major role to play in the increased uptake of specifically patient focussed digital technologies.
  • Learn from other sectors
    • Other sectors have wrestled with similar issues to healthcare in the introduction of digital technology. The financial sector in particular has worked with regulation, privacy and consent concerns, a complex eco system and is now highly supported by digital technology.