Evidence standards framework for digital health technologies

Evidence standards framework for digital health technologies
NICE, PHE, MedCity, DigitalHealth.London, March 2019 updated 23 April 2021

• The framework describes standards for the evidence that should be available, or developed, for DHTs to demonstrate their value in the UK health and care system. This includes evidence of effectiveness relevant to the intended use(s) of the technology and evidence of economic impact relative to the financial risk.
• The evidence standards framework is intended to be used by technology developers to inform their evidence development plans, and by decision makers who are considering whether to commission a DHT. Section A comprises evidence for effectiveness standards. Section B comprises evidence for economic impact standards.

See also: What is an appropriate level of evidence for a digital health intervention?

The Lancet v392(10165), p2665-2667, 22 December 2018 [Free registration to access full article]

Report of The Independent Review of Adult Screening Programme in England

Report of The Independent Review of Adult Screening Programme in England
NHS England 16 October 2019

• A review of the adult screening programme makes a number of recommendations around governance, IT systems, uptake and delivery, performance, financial incentives, creating capacity to change, improving audit and research.
• A key change is that NHS England should take responsibility for the delivery of all screening programmes, integrating the delivery of targeted and population screening previously split between NHS England and PHE.
• Around uptake and coverage the report recommends high priority to implementation of evidence based initiatives to increase uptake – including us of social media, engagement with people with disabilities, wider community engagement and equalities awareness for staff.
• Around information systems the report recommends that NHSX sets out a roadmap for the delivery of new targeted and population screening IT systems as soon as possible, and that IT developments should focus on the functionality needed to support improvements in the uptake and coverage of screening.

ArtemusICS

ArtemusICS

• "a population health intelligence solution, collating data from GP, acute, community, social, mental, ambulance and remote care settings. ArtemusICS enables commissioners to assess the needs of local populations, identify gaps in care and impactable pathways, view trends, prioritise care delivery and monitor the impact of early intervention and prevention initiatives, including telehealth supported interventions. Supporting community and multidisciplinary teams to identify and keep patients out of hospital, stopping preventable A&E admissions and in-patient stays through earlier detection and intervention."
• Selected as an NHS Accelerator Innovation

Health Data Research Hubs

Health Data Research Hubs announced
Health Data Research UK 12 September 2019

• Led by Health Data Research UK, seven data hubs will be rolled out in October 2019. The hubs will enable cutting-edge research for health discoveries and aim to give patients across the UK faster access to pioneering new treatments They will link up different types of health data and make it more easily accessible and user-friendly for research, while maintaining strict controls around data privacy and consent.
• The hubs are cancer, eye health, inflammatory bowel disease, acute care, clinical trials, respiratory and long term conditions (starting with diabetes type 2).

iHuman perspective: Neural interfaces

iHuman perspective: Neural interfaces
Royal Society 10 September 2019

• This Royal Society Perspective takes a future-facing look into possible applications of neural and brain-computer interfaces, exploring the potential benefits and risks of the technologies and setting out a course towards maximising the former and minimising the latter.
• For more information on the public dialogue and to download a selection of in-depth science papers on neural interfaces, visit: iHuman Supplementary Material.
• Click here to see an interactive timeline of the history of neural interfaces.

Health Secretary announces £250 million investment in artificial intelligence

Health Secretary announces £250 million investment in artificial intelligence
DHSC News 8 August 2019

• A new National Artificial Intelligence Lab will use the power of artificial intelligence (AI) to improve the health and lives of patients.
• The AI Lab will bring together the industry’s best academics, specialists and technology companies to work on some of the biggest challenges in health and care, including earlier cancer detection, new dementia treatments and more personalised care.
• The lab will sit within NHSX, the new organisation that will oversee the digitisation of the health and care system, in partnership with the Accelerated Access Collaborative.
• Among other things the AI Lab’s work could:
• use predictive models to better estimate future needs of beds, drugs, devices or surgeries
• identify which patients could be more easily treated in the community, reducing the pressure on the NHS and helping patients receive treatment closer to home
• identify patients most at risk of diseases such as heart disease or dementia, allowing for earlier diagnosis and cheaper, more focused, personalised prevention
• build systems to detect people at risk of post-operative complications, infections or requiring follow-up from clinicians, improving patient safety and reducing readmission rates

Digitally enhanced care pathway development using DeepMind

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions
npj Digital Medicine V2(67) 31 July 2019

• Development of a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application (Streams, DeepMind Technologies Ltd, London, UK see below) specialist clinical response team and care protocol at the Royal Free Hospital, London.
• The care pathway improved the timeliness and reliability of key aspects of AKI care, but definitive conclusions regarding the clinical impact of the pathway cannot be made at this stage and are limited by the scope and nature of the evaluation.

For a description of Streams see:
Using AI to give doctors a 48-hour head start on life-threatening illness
DeepMind 31 July 2019

• "Streams doesn’t use artificial intelligence at the moment, but the team now intends to find ways to safely integrate predictive AI models into Streams in order to provide clinicians with intelligent insights into patient deterioration. "

Streams in NHS hospitals "Streams is a secure mobile phone app that aims to address what clinicians call “failure to rescue” – when the right nurse or doctor doesn’t get to the right patient in time."

How can 5G support the transformation of health and social care services?

How can 5G support the transformation of health and social care services?
techUK, Liverpool 5G Testbed July 2019

• This joint report highlights how 5G can support the transformation of future healthcare applications and services. Building on the experiences of the Liverpool 5G testbed, the report highlights how 5G can benefit the sector; from transforming some ways patients interact with their own healthcare management, to enabling healthcare professionals to remotely monitor patients.
• The report contains six recommendations to Government on how to effectively harness 5G in health and social care:
• 1. Accelerate the deployment of 5G to the majority of the country, enabling UK consumers and businesses to take early advantage of the benefits.
• 2. Support the uptake of digital health tools to the general public by a) utilising government data and communication channels to promote the benefits of digital health tools and b) reviewing how the personal budgets programme could better support the uptake of personal digital technology.
• 3. Foster knowledge exchange between DCMS and the Department of Health and Social Care to embed knowledge, experience and expertise on the potential of 5G into the newly formed NHSX.
• 4. Ensure that the new NHS England app allows the public to access data beyond that held in primary care – and promote the ability to do so.
• 5. Provide health and social care professionals in the community with 5G technology, particularly in rural areas with limited health and social care provision, where consumer options for getting online are also limited.
• 6. Ensure the NHS can capitalise on developments in AI, Genomics, 5G, and Blockchain technology.
• Led by Sensor City, the project includes Blu Wireless Technology, AIMES, DefProc, CGA Simulation, Liverpool City Council, Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), University of Liverpool and Liverpool John Moores University and the eHealth Cluster.
• 5G Testhbed programme, 
• 5G Testbed Programme update (July 2019)
• Press: Digital Health

Using logic models to assess digital health products

Using logic models to assess digital health products
NHS Digital 9 July 2019

• How digital delivery teams from NHS Digital and Public Health England used a logic model to assess whether the NHS website is fit for purpose.

Improving Cyber Security in the NHS

Improving Cyber Security in the NHS
Institute of Global Health Innovation Imperial College London, 2 July 2019

• This report, Led by Lord Darzi, suggests a combination of out-dated computer systems, lack of investment, and a deficit of skills and awareness in cyber security is placing NHS hospitals at risk.
• The report outlines a number of key measures for NHS trusts to implement in order to increase cyber resilience. These initiatives include employing cyber security professionals in their IT teams, building ‘fire-breaks’ into their systems to allow certain segments to become isolated if infected with a computer virus, and having clear communication systems so staff know where to get help and advice on cyber security.

Making the right choices: using data-driven technology to transform mental healthcare

Making the right choices: using data-driven technology to transform mental healthcare
Reform July 2019

• This report examines the current landscape of data-driven technologies and their applications in mental healthcare, highlighting areas where these tools offer the most potential for the NHS and its patients. It discusses what makes mental health different from other areas of health, and the implications this has for the application of data-driven tools. It examines barriers to implementation, including the limited access to high-quality data and the need to build trust with patients and practitioners. Finally, it proposes ways to move forward.

NICE data and analytics statement of intent [consultation]

NICE data and analytics statement of intent
NICE consultation 13 June - 13 September 2019

• NICE is looking to extend the use of data that will help inform its independent committees who produce its guidance. They are proposing to extend its use of data, from sources including:
• audits of procedures such as operations
• registries which collect data on how particular treatments are used
• surveys of people using services
• data collected on national trends, such as how many people have a condition.
• Statement of intent outlines when and why should broader types of data be considered.

Digital-First Primary Care Policy

Digital-First Primary Care Policy: consultation on patient registration, funding and contracting rules
NHS England 27 June 2019

• This document describes the proposals to reform patient registration, funding and contracting rules to ensure patients have both choice as well as access to integrated care; and to harness the potential of digital providers to help with our workforce shortages in a way that helps our most under-doctored and deprived communities. It sets out options and proposals for reform and invite views.
• Consultation closes 23 August 2019

NHS Apps Library Guidance

NHS Apps Library Guidance

• Information for developers, assessors and commissioners to empower patients and improve health outcomes by helping to get more trusted apps published on the Apps Library. Outlines the assessment process, how get a product assessed, information and advice on commissioning products from the Apps Library and on becoming an assessor.
• See also the Digital Assessment Roadmap for the NHS Apps and wearables programme.

Internet First policy and guidance

Internet First policy and guidance
NHS Digital updated 24 May 2019

• Internet First means that externally accessible health and social care digital services must be securely accessible over the public internet by default.
• This document will help health and social care organisations make their digital services accessible over the internet. It will help describe how to make them secure, scalable and where possible consistent.

The Internet First principles

GP at Hand evaluation

GP at Hand evaluation
Ipsos Mori and York Health Economics Consortium for Hammersmith & Fulham CCG 23 May 2019

• GP at Hand is a primary care practice that incorporated a ‘digital-first’ service model into an existing practice in 2017. The practice operates in North West London, commissioned through a GMS contract through NHS Hammersmith and Fulham CCG. The practice now offers a ‘digital-first’ model of primary care, primarily through use of a mobile app and video consultations provided by their subcontractor, Babylon.
• This evaluation discusses the impact of GP at Hand on registered patients, on the wider health system and on the workforce.
• Press: Digital Health 29 May 2019: Funding model for GP at Hand ‘not appropriate’, Ipsos Mori review finds

The Electronic Asthma Management System (eAMS) improves primary care asthma management

The Electronic Asthma Management System (eAMS) improves primary care asthma management
European Respiratory Journal 2019 53: 1802241, 29 April 2019

• An electronic clinical decision support system - Electronic Asthma Management System (eAMS) improved asthma quality of care in real-world primary care settings.

See editorial: Electronic clinical decision support system (eCDSS) in the management of asthma: from theory to practice, European Respiratory Journal 2019 53: 1900339

Abstract

Use of age-specific hospital catchment populations to investigate geographical variation in inpatient admissions for CYP in England

Use of age-specific hospital catchment populations to investigate geographical variation in inpatient admissions for children and young people in England: retrospective, crosssectional study.
BMJ Open 2018;8:e022339. doi:10.1136/bmjopen-2018-022339

• A technique to understand hospital catchment populations for children and young people by modelling the historical flow of emergency admissions from each local area. This allows the population each hospital serves to be identified and their demographic characteristics to be estimated. These catchment populations for children support work to understand if differences are related to how different hospitals manage a condition or because they serve a unique population.
• See also "There’s no longer a catch: a new way to measure how children and young people are treated”, Nuffield Trust comment, 25 April 2019

Abstract

Reporting of artificial intelligence prediction models

Reporting of artificial intelligence prediction models
The Lancet; London Vol. 393(10181), 20 April 2019 [NHS OpenAthens]

• The number of prediction model studies is increasing rapidly, with hundreds of different models being developed for some of the same targeted populations and outcomes.
• "Therefore, the clinical community must not get mesmerised by the artificial intelligence and machine learning revolution, and artificial intelligence and machine learning prediction models must be appropriately developed, evaluated, and—if needed—tailored to different situations before they are used in daily medical practice."

Abstract

Comprehensive Investment Appraisal (CIA) Model and guidance

Comprehensive Investment Appraisal (CIA) Model and guidance
DHSC 9 April 2019

• The CIA Model is for use by the NHS to support economic appraisals in business cases. It replaces the Generic Economic Model (GEM). The user guide shows how the CIA Model can be used to support economic appraisals in business cases. It provides guidance on the key economic principles, how these are used in economic appraisals and how the outcome of these appraisals is interpreted.