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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


NHE Magazine March/April 2017 Issue Connectivity and Behaviour Key to Unlocking Wireless Adoption

  • 01.03.2017
  • Julia Manning
  • NHE Magazine March/April 2017 Issue

Julia Manning, founding director of 2020health, analyses the opportunities and challenges facing mobile & wireless tech development and adoption in the NHS.

How many articles have you read over the past year, decade or even more that painted a picture of the seamless delivery and experience of data-driven, IT-enabled healthcare? Everything the physician and patient needs is immediately available and comprehensively informed with the happy ending of ‘disease defeated’ or ‘prevention performed’. It is an easy story to write – ‘we have the technology’ – as I was reliably informed a while ago while watching the Six Million Dollar Man as a child. 

You only have to see the movie ‘Hidden Figures’ (which should have won the best picture and best female actress awards at the Oscars) to see how far IT has come in power, size and automation. Yet whilst processing speeds have reached warp velocity, and miniaturisation has turned smartphones into a hand-held Tardis, the complexities of and between health IT systems resembles known but unmapped galaxies. 

Connectivity and behaviour 

There are only two challenges worth talking about that face mobile and wireless technology adoption in the NHS: connectivity and behaviour. All else, the history of NHS IT, lack of understanding, plurality of systems, lack of pathways, evidence base, market, tariffs, big data, apps and wearables are important, but if the technology isn’t connected, and if we haven’t thought through the relevant behaviour changes, the vision for what technology could achieve will remain just that – a vision, not a reality. 

There are many experts who have written about the system connectivity issues within the NHS, but my interest is in how the public connects to the NHS, and how NHS professionals connect with the public. Unless professionals are personally convinced that health record access is helpful to the patient, that personally generated health data has validity and utility, and that personal digital health technologies have a role to play in prevention, detection and treatment, then they won’t be interested in facilitating connections. 

In the past three years, through our Health Tech and You Awards programme in partnership with Axa PPP and the Design Museum, I have seen over 500 consumer-friendly health technologies. Everything from smartphone ECGs, to headphones for insomnia, to personal allergy testing kits and apps to intervene with self-harm, paranoia and anxiety. Life changing, life-enhancing, life-saving innovations. Yet unless the technology syncs with Apple’s Health app (and is then synced with an EMIS GP record), or with an enabling platform such as that provided by Patients Know Best, the information remains disconnected and, for the majority of professionals, irrelevant. 

It doesn’t have to be this way. A recent study in Finland of 16 nurses undergoing depression nurse specialist education used a therapy app for five weeks for themselves. Not only did the nurses find the app suitable as a self-management tool, they identified three models of using it in clinical practice. They were eager to take it into use with various client groups and had insight on the effort needed in familiarising oneself with the content, and pointed out specific client groups for whom the benefits of the app should be carefully weighed against the potential risks.

Connectivity and behaviour overlap, of course. Whilst information remains fragmented, it is harder to create meaning from it, and from that to promote, motivate and capture behaviour change – of professionals or the public. But there is another issue: trust. The explosion of health apps and wearables has been very exciting, but even if they were connected, what can we trust? NHS bodies continue to work on this conundrum, which is fascinating if we compare it with medicines. 

There never will be a fail-safe approach, as daily adverse reactions to clinically-approved medicines demonstrate, but we happily prescribe them every day. Most apps have not been through clinical trials, but confidence is beginning to appear. A recent freedom of information request by the University of Sheffield showed that 13 web apps and 35 mobile apps for mental illnesses are already being recommended by professionals in NHS mental health trusts. Apple’s response to ‘trust’ has been to tighten their inclusion criteria for being listed on their health store, and we are beginning to test more effectively the evidence for technology-enabled behaviour change in the real world. 

It is up to all of us to engage with the potential of personal digital health and demand better connectivity; meanwhile, let’s start educating our professionals and children with these fabulous new tools.


The 2017 AXA PPP Health Tech and You Awards Exhibition opens at the Design Museum on 26 April.