The unexpected consequences of digital health: Lessons from a stakeholder workshop

Conference: 
SAPC ASM 2019 - Exeter
Talk Code: 
7B.4c
Presenter: 
Fiona Hamilton / Lorraine McDonagh
Co-authors: 
Lorraine McDonagh, Jeremy Horwood, John Powell, Sarah Blake, Fiona Stevenson on behalf of the DECODE team
Author institutions: 
University College London, University of Bristol, University of Oxford

Problem

The use of digital technology is promoted as having the potential to improve patients’ access to healthcare, improve the quality of care, and reduce GP practice workload. However, despite the increased use of digital technology in GP practices, the unexpected consequences (both benefits and problems) for patients and staff remain unknown.

Approach

A stakeholder workshop was held in London in September 2018 with GPs, researchers from the field, technology developers and members of the public, to identify research priorities for the DECODE project (unexpecteD consEquenCes Of Digital hEalth). Specifically, we explored:

1) Smartphone apps that support the monitoring or self-management of long term medical conditions

2) Patients’ online access to their electronic medical record (EMR)

3) Alternatives to face-to-face consultations, including online consultations.

Findings

Apps

- Stakeholders felt that apps can support self-management for long term conditions and may be particularly helpful with respect to ‘hard to reach’ groups who do not attend clinics, yet they may exclude others (e.g., those with learning disabilities)..

- GPs noted that few patients share data from apps during consultations, and that they can feel overwhelmed when patients do. Concerns were also expressed about data-security, the quality and trustworthiness of apps.

Electronic Health Records

- Some GPs felt that access to full EMRs may improve patient outcomes, reinforce information given in consultations and have the potential to empower patients and challenge paternalistic views of healthcare.

- Concerns were expressed about potential risks to privacy by parents/carers having access, and the removal of the consultation as a safe, confidential space for those suffering abuse.

Alternatives to face–to-face consultations

- Alternatives to face-to-face consultations were viewed as potentially helpful for sensitive issues, and/or routine simple health problems. However, they were seen as introducing inequity by excluding those who are medically and/or social disadvantaged.

- Concerns were also raised in relation to the use of this technology regarding: (1) the lack of physical examination could affect patient satisfaction, impact patient-provider relationships and have medico-legal consequences, (2) difficulties establishing who the consultation is being held with, and (3) delivering test results by text may falsely reassure patients into assuming no further investigations are needed.

Consequences

All three technologies were seen as inherently a ‘good’ thing, but concerns were expressed in relation to GPs and patients feeling ‘forced’ into using these technologies and the populations who may be left behind, potentially increasing inequality in healthcare access. These concerns, as well as the opinions presented above, are currently being explored in interviews with stakeholders focusing on the unexpected consequences of digital health. A further more extensive workshop to contribute to policy and practice is planned.

Submitted by: 
Fiona Hamilton
Funding acknowledgement: 
This abstract presents independent research funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.