Healthcare is undergoing a quiet revolution. Paper trails are giving way to digital records, and AI scribes are becoming official note-takers of patient–clinician conversations. This shift from analogue to digital promises precision, speed, and access to the latest innovations. However, in a society that spans multiple generations with vastly differing levels of digital literacy and access to resources, one question looms large: who benefits from this transformation, and who risks being left behind?
It was this theme, the importance of equity in digital health, that I spoke about at the Cambridge Wearables Innovation Forum launch event. Beyond the novelty of the innovations, what stood out to me was the display of shared passion and ambition to solve today’s most pressing health challenges through technology.
What is needed?
In my talk, I explored several questions including:
- What evidence truly proves that digital health tools work?
- How should the NHS decide which technologies to adopt, and who gets a say?
- How can patients be more involved in shaping the tools meant for them?
In healthcare, evidence remains the currency of trust. Take wearable monitors for Parkinson’s disease as an example. Despite several such devices being developed, for example STAT-ON, and PDMonitor, they were only conditionally approved for clinical use by NICE in 2024, pending further evidence on their impact and real-world use within the NHS. But an understanding of what constitutes – and how to generate – the ‘right’ data that produces the necessary evidence for regulatory and clinical assessments, remains a challenge in the wearable space.
Bringing a healthcare-focused wearable to market is rarely a linear journey. It is often a maze that requires the combined effort of various stakeholders: technology developers, regulators, policymakers, the NHS, think tanks, and the often-forgotten patients. But patients are not merely end-users, they often define the very problem a technology should solve. Unsurprisingly, technologies that truly cater to patient needs are more readily adopted.
Building the right evidence
Useful signposts do exist. The UK Government’s good practice guide for digital technologies and NICE’s Evidence Standards Framework (ESF) for digital health technologies outline what evidence and considerations regulatory bodies and the NHS look for in assessing new innovations. Support is also available through initiatives such as the NHS Accelerated Access Collaborative that aim to help innovators overcome barriers in product deployment and NHS procurement and bring new technology to market faster.
Beyond regulatory approval, innovators face another hurdle which is the complexity of NHS procurement processes. A centralised system could help standardise products across NHS Trusts, while a decentralised model allows suppliers to engage directly with local Trusts and often enables faster and tailored adoption. However, expansion across other Trusts can then require restarting the process which can slow progress. Which approach is best remains unclear, but promising developments such as the anticipated roll out of an ‘innovator passport’, where a technology approved by one NHS organisation can be deployed across others without repeat compliance assessments, could help fasten the process.
No one left behind
Then there is the issue of access. A one-size-fits-all approach doesn’t work in healthcare, and it certainly does not work in digital health. It’s not enough to make technology available; it must be made available equitably. Equality and equity are often used interchangeably, but they are not the same. Equality offers everyone the same tools; equity ensures everyone has the right tools to reach the same outcome.
This is important because digital exclusion is very real and certain groups remain especially vulnerable. For example, of those with no basic digital skills:
- 69% have a disability or impairment
- 47% have no formal qualifications
- 77% are over 65
The NHS England Framework for Inclusive Digital Healthcare already lays the foundation for addressing these gaps. It prioritises user-centred digital products that are accessible to every intended patient group and promotes leadership committed to reducing digital inequities. Moreover, as in other areas of healthcare, patient representation is needed to ensure such equity-focused frameworks are effective. Without such consideration, innovation risks deepening the very divides it hopes to bridge.