“I would like to see a shift in healthcare where both sets of users, the patients and clinicians, are the focus of digital change – says Professor Sam Shah, Chief Medical Officer for Numan, Founder and Director of the Faculty of Future Health with Ulster University. We talk about trends, digital health inequalities and sustainable digital future.
You are a digital health technology advisor to several healthcare and technology companies. Which values do you consider as fundamental for developers of IT solutions?
I have worked with lots of healthcare and technology companies and prefer to work with those interested in promoting safety, security and privacy. Fundamentally, healthcare IT will impact on people’s lives often when they are most vulnerable. IT developers in healthcare need to be committed to sharing good practice, promoting clinical safety and inspiring trust and confidence through operating in a transparent way. The same values in healthcare around equity, equality, and availability need to be reflected in developers of IT solutions.
Which tendencies are you most worried about when you look at this fast-growing sector?
I am most concerned about artificial growth, a focus on superficial solutions that may not really solve an underlying problem. There is a risk that the health system seeks vanity metrics, such as coverage or uptake, but unfortunately, this can drive the wrong type of growth.
You often raise the problem of digital inequalities. Is there a way to reduce them? How?
Digital inequalities are unlikely ever to go away; this will probably always be a difference in society between access to technology, access to the internet and affordability. It’s doubtful that digital health services will meet everyone’s needs, which means health care providers, commissioners and technologists need to be realistic. Reducing inequalities is always multifaceted; it means those designing and implementing digital health services need to consider the wider social determinants and have a relentless focus on service and system design. For example, it’ll require investment in infrastructure, education, training and creating accessible digital services.
Don’t you think that all the wearables or newest technologies entering the market make healthier only those who are already healthy, leaving behind people who really need help?
There is a risk that wearables and the newest technology will continue to help those who can afford to access these products or those who have the existing skills to get value from them. It could widen inequalities as it means those who can’t access or use this newest technology will get little benefit if any. This is why we need affordable technology that is made available to those who can benefit. Where that technology improves long term outcomes and reduces costs, there is a good reason to invest in these products as a public health measure.
Before the COVID-19 pandemic, digital interventions were implemented very carefully in healthcare. In 2020, we see greater use of telemedicine or mobile health applications. Is such rapid digitalisation, which is not the result of a long-term strategy but rather the need for the moment, sustainable?
I don’t think it’s necessarily sustainable; it becomes a reaction to politics and immediate problems that may not be long term problems. There are some things that clearly have helped however the lack of strategy means that once the COVID-19 issues have subsided, there will be a lot of technology in place that may not have long-term use and may not offer benefits. For example, mobile-based screening tools to support demand management make sense in a crisis but aren’t really useful when thinking about long term outcomes.
The historian and philosopher Yuval Noah Harari claims that one of the XXI’s biggest battles will be between privacy and health. The fact is that in order to improve the prevention and quality of healthcare, more data is needed. How do you see this conflict and dilemma?
There are an intricately related set of conflicts when it comes to health, privacy and freedoms. There’s a strong argument that data should be shared more freely to allow better decision-making and enable more people in society to benefit. Some would even argue that health data is a public good. However, the challenge is that organisations have not yet demonstrated they can maintain privacy or safely handle data in a way that won’t lead to abuse. I expect most people would want others to benefit from their health data, but at the same time, they want their data used in a way that is either detrimental or in a way that could cause a breach of their privacy. To address this, there need to be greater protections for individuals alongside technical mechanisms where citizens can transparently see how their data is being shared and how it’s being used.
What lessons should be learned from the challenging year 2020 for digital health?
Digital health needs to become more inclusive. It’s great to have lots of pilots and proofs of concepts. Still, when moving into implementation, we need to work harder on increasing digital inclusivity and improving the method of evaluating digital products and services. Digital health is as much about people as it is about technology; we need a much greater focus on tackling some of the cultural issues in healthcare. The year 2020 has also shown how much can be achieved through collaboration and thinking laterally. Taking a “digital-first” mindset doesn’t mean that all in healthcare can be digitalised but digital as part of the design services. We have also seen the benefits of international collaborations and knowledge sharing globally. Both through the use of technology but also about technology.
How has the pandemic changed your thinking about digitalisation?
The pandemic has made me even more determined to focus on the citizen and aim towards providing frictionless healthcare that offers citizens value. It’s also left society with a challenge which is to help people use digital tools to self-care and self-manage wherever safe to do so.
What changes in healthcare would you like to see in the coming years?
I would like to see a shift in healthcare where both sets of users, the patients and clinicians, are the focus of digital change – not so much with short term outcomes but more with long term benefits, better results for people, reduction in access inequities but also improving the conditions in which clinicians operate. It would be even better if we moved from a healthcare system that is almost entirely focused on illness to one which supports wellness. This won’t be an easy change and will require investment as well as a culture shift. We also need policymakers to move their focus from vanity metrics and short-termism to more meaningful ways of measuring progress.
Professor Sam Shah is the Chief Medical Officer for Numan and Director of the Faculty of Future Health with Ulster. He continues to work with a number of accelerators with digital health and tech companies. Sam was previously Director of Digital Development for NHS England and NHSX, and he works clinically in primary care.
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