Comment: ‘Pilotitis’ and bureaucracy are stunting healthcare advances

Matt Hunt of Apadmi and Dr Farid Khan of eLucid mHealth argue that an urgent step change in procurement processes will enable mHealth to thrive in modern-day healthcare

Matt Hunt

In this article, MATT HUNT of Apadmi and DR FARID KHAN of eLucid mHealth argue that the benefits of mobile technology are being held back by the public health sector’s reliance on ‘pilotitus’ and that an urgent step change in procurement processes will enable mHealth to thrive in modern-day healthcare

The mHealth market has never been in better shape, with a flurry of start-ups and established players developing hardware and solutions that will change the face of modern day medicine

The mHealth market has never been in better shape, with a flurry of start-ups and established players developing hardware and solutions that will change the face of modern day medicine. The drivers for change include better managing the increasing burden of ageing populations, the need for improved healthcare in remote and developed geographies, and the opportunities that technology brings for diagnostics, preventative medicine and patient monitoring.

The returns promise to be high, with the European Commission estimating in April of this year that €99billion in healthcare costs could be saved across the EU through the use of mobile technologies and solutions.

The innovators and suppliers in the sector are generally agile SMEs working at a fast pace to bring new products to market. The target market for mHealth technology is a different animal, however - public bodies with multiple management layers and complex and lengthy decision-making processes.

Many tech firms with great mHealth solutions are daunted by the size of task and cost involved in getting their ideas in front of the right people

The hurdles to selling into public health organisations are high, with some NHS trusts only engaging with companies with established trading histories and large employee numbers – factors at odds with the make-up of small technology businesses. Many tech firms with great mHealth solutions are daunted by the size of task and cost involved in getting their ideas in front of the right people.

Spending restrictions, a risk-averse nature to change, and old-school procurement frameworks are putting the brakes on getting innovative and life-changing technology into the hands of health practitioners.

Global trends

The rate of adoption of mHealth technology differs on a global scale. Necessity breeds invention and the developing world has a fast uptake of a wide range of solutions, many aimed at getting the best-possible outcome in acute life –or-death situations. The need for affordable, quickly-implemented solutions that work in remote locations and maximise limited resources are fuelling uptake. Remote diagnostics using technology such as image recognition, ‘dip-stick’ testing and video consultation are already enabling better outcomes for third-world problems such as HIV, malaria and TB. Healthcare organisations are also less developed and hierarchical, meaning that there is less red tape to impede progress.

It is interesting to see how closely the few innovators are being watched by their peers, in a kind of ‘you go first and I’ll follow’ mentality

The developed world has a different set of needs with ageing populations, chronic diseases and illnesses borne from unhealthy lifestyles creating a massive health overhead. Individuals are taking more responsibility for monitoring their own health and this is an area where apps and wearable technologies are significantly increasing in use. There is an opportunity for big data analysis to be used to bring ‘bio-status’ updates, pulling information from a wide range of sources to assess individuals’ biochemistry and psychology and suggest ways of improving holistic health.

However, much of this adoption is being driven by consumer uptake and where developed countries arguably have more money to spend, they also have established systems and procedures that make the adoption of any new solutions a lengthy and bureaucratic process. That said, mHeath providers understand why applications need to be ‘authorised’, but it is often a challenge to comprehend the process and the associated costs and risks.

At a tipping point

So what will the tipping point be in getting mHealth technologies through the doors of public healthcare organisations? The opportunity costs are already significant when you consider the savings that can be made in terms of early diagnosis and the monitoring and management of chronic diseases.

However, public authorities are generally secondary or tertiary adopters of technology. They want complete market validation and this takes years within healthcare environments, by which time the cost of not implementing the solution is high and the technology has often moved on – so the process starts again.

Full technology strategies shouldn’t just be about ‘point solutions’, but interoperable programmes that enhance inter-professional team working, patient experience, outpatient monitoring and communications

The former US surgeon general, Everett Koop, said: "Drugs don't work in patients who don't take them".

The European Federation of Pharmaceutical Industries and Associations estimates that medication non-adherence in Europe costs €125billion and contributes to 200,000 premature deaths each year, and this is an area where mHealth technologies can make a significant impact.

The scale of financial return, coupled with better patient experiences and health benefits, must at some point soon override the barriers to health organisations changing their approach to sourcing and adopting mHealth technology. Some forward-thinking organisations with pro-active chief technology officers are initiating this change, but it is slow and, in our experience, they are in the minority. It is interesting to see how closely the few innovators are being watched by their peers, in a kind of ‘you go first and I’ll follow’ mentality.

Technology at the heart

There is an urgent need for public health authorities to scrap outdated purchasing and pilot practices and engage in collaborative partnerships with private sector businesses. This should have a discovery approach that looks at the opportunities that technology can bring, how it can be adopted, and the real-life needs of the health sector and its service users.

Until public health bodies address their approach to not just procuring, but participating in the development of, mHealth technologies, its growth and potential will continue to be stunted

Full technology strategies shouldn’t just be about ‘point solutions’, but interoperable programmes that enhance inter-professional team working, patient experience, outpatient monitoring and communications.

The returns promise to be high and initiatives such as the Small Business Research Initiative have been launched to fund innovative technology solutions that optimise patient health and social care outcomes. This initiative is supported by the Department of Health, social services and public safety in partnership with the Technology Strategy Board (TSB) and suggests that there is a push coming from the public sector to spark innovation in the NHS.

However, until public health bodies address their approach to not just procuring, but participating in the development of, mHealth technologies, its growth and potential will continue to be stunted.

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