In his keynote address at the Health and Innovation Expo 2017, Jeremy Hunt challenged NHS Digital to deliver access to eight digital services through a single patient app by the end of 2018. Just a year on, the new NHS App launched its first pilot test in September.
At the 2018 expo Hunt’s successor, Matt Hancock, re-emphasised the need for the NHS to go digital in a big way, and the NHS App is meant to be a part of that.
Digital uptake across the NHS is unequal and at times contradictory. Whilst some GP practices have their own apps for booking appointments, you still have to register in person and the majority of doctor’s appointments are still booked over the phone.
A continued institutional reliance on paper records and fax machines is one symptom of the lack of connectivity between the various NHS and social care services. But paper and ink is a pretty universal standard and when each of the parts that make up the whole have their own bespoke systems, it is inevitable that they have to fall back on the old standards.
A unified approach to NHS IT services, one which drives digitisation and reaps the benefits of connectivity and information processing, should be a possibility for one of the world’s largest employers. Unfortunately the long shadow of the failed 2002 National Programme for IT in the NHS, aptly demonstrates why we should be careful to look before we leap. In this sense, the new app could be considered more of a preparatory hop before we take the long jump.
There’s an app for that
Developed for mobiles and tablets of both Android and IOS flavours, the NHS App is due for an early access release in December 2018. NHS Digital will continue to develop features and make changes to design and function until a planned version 1.0 release in May 2019.
The initial wish list of eight digital services has been boiled down into six, but the reduction in scope is probably for the best. When ‘fully launched’ the app will enable patients to:
- Use online symptom checking and triage service NHS 111
- Access their GPs medical record
- Book appointments at their GP practice
- Order repeat prescriptions
- Set data sharing preferences
- Set organ donation preferences
All of these functions are currently available through various online services, but the app will bring them all together into a single package.
Steps towards digitisation?
In theory, this all sounds pretty good, and as the project moves forwards into public testing, it seems that the main technical hurdles have been overcome, including the not inconsiderable problem of building an app that works with the four principal GP system suppliers. A freedom of information request by tech site Gizmodo revealed that developers were further along with the EMIS Health system than those of the three other suppliers, so depending on which system your surgery uses, access may not be available soon.
The greatest concern most people have about apps dealing with such sensitive data is probably going to be the security of the system. NHS Digital has promised that the app will be secure: adhering to standards set by the National Cyber Security Centre. As a web based application, transmitted health data will most likely be encrypted using something like the Transport Layer Security (TLS) cryptographic protocol, the same standard most banks use in their apps to protect the data (and money!) of customers.
Reduced workloads, or more appointments?
But one of the key benefits of digitisation and automation for the NHS is that it should make things easier: freeing up time from repetitive, slow and mundane tasks to allow staff to focus on the parts of their job which require a human intelligence and not an artificial one.
For most, the promise of a unified, mobile app for the NHS will be in streamlining the process of making appointments with their doctor. However, a recent NHS England survey reveals that only two in five patients are aware that they already can book appointments online, and only one in eight said they had used online services to book an appointment. The same survey found only 3.3% of patients used online services to access their medical records in the past 12 months.
Creating an app may be a better route to getting people to make appointments using digital services, but GPs are worried that encouraging people to go online could have a negative impact on practices.
One of the key functions of first line administrative staff is to attempt to manage patient expectations and ensure that patients make the right appointments. Accordingly, GP enthusiasm for the NHS App is low. Another survey found that 61% of the 1003 GP respondents believed that the overall impact of the app will be to increase the number of patients wanting to see their GP.
If the app is successful, but there is little scope for practice staff and GPs to triage appointments, the danger is that overstretched doctors will find themselves in even greater demand.
Linking health and data
In the development of the NHS app, NHS Digital are clearly looking forward, and the staged release allows them to test features and iterate on design and functionality. One addition due in 2019 is to integrate the NHS curated App Library, allowing personalised recommendations for health apps. If such a link between health records and apps and wearables can be forged, it would be another step towards realising the benefits of citizen generated data for healthcare.
Connecting patients more directly to their GP is great, but the real trick will be if the app can link up patients with other key services, such as clinic and hospital appointments, or social care.
Without widening access to those, can an app that takes existing services and combines them together truly describe itself as allowing people: ‘to take control and make more informed decisions about their own healthcare’?
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