The UK dallas initiative – reporting on

lessons learned from a national digital

health deployment

Professor Frances S Mair

Head of General Practice & Primary Care

Institute of Health & Wellbeing

Acknowledgements

• Our Funder: Innovate UK

• Co-Investigators: Dr Marilyn McGee-Lennon, Dr Matt-

Mouley Bouamrane, Dr Alison Devlin, Prof Catherine

O’Donnell, Siobhan O’Connor, Ruth Agbakoba, Eleanor

Grieve, Dr Sarah Barry, Prof Emma Macintosh, Camilla

Baba, Annemieke Bikker, Dr Ula Chetty, Dr Tracy Finch,

Prof Sally Wyke, Prof Nicholas Watson and the wider dallas

Evaluation Team

• The dallas communities.

• Advisory Board

Background

Digital Health has great potential

Large Translational Gap

Longitudinal 3 Year Qualitative Study

• Interviews (n=125) with key stakeholders;

• Focus groups (n= 7) with professionals and public using

dallas services;

• dallas leads meetings (N=12);

• Ethnographic field work/participant observation in one

community (n=16);

• Health professional survey responses (n=48)

• Cross programme documentary evidence (N=215)

• Framework Analysis Approach

METHODS

Coherence Cognitive

Participation

Collective

ActionReflexive

Monitoring

Thinking about doing

Doing the doing

NPT

http://www.slideshare.net/KateODonnell6/npt-in-restore

LESSONS LEARNED

Lennon MR, et al. Readiness for Delivering

Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in

the UK. J Med Internet Res 2017;19(2):e42

MACRO ISSUES

• Market Readiness– Interoperability

– Risk and liability

– Clinical Endorsement

– Complexity of the Market

• Political Readiness and National Policy– Information Governance

– Infrastructure

Information Governance

MACRO ISSUES

“ … There is a real problem in that all ….health data is in

a Vault that’s owned by the NHS. You can’t, at the

moment, view it and when you can view it, i.e., when we

get our online patient records, it will be a view which is not

in a form that can be used by technology outside of the

NHS in any real useful way. I think the biggest issue is

Information Governance and letting people take ownership

of their own data and their own risk appetite, and until that

happens all we are doing is allowing the market to develop

outside of the true record. ………The barrier is the NHS

and their vault mentality on our data.”[DHACA Research Interview 3, 2015]

Accreditation and clinical endorsement

MACRO ISSUES

“what our experience brought us to realise is that

people will only use a kind of Personal Health

Journal and plan around serious conditions or long

term conditions if it’s something that they can

engage with their Clinicians on and that was kind of

a back-to-front approach. You’re not really going to

persuade people to go out and buy it as a consumer

product if it’s not something that their Clinicians will

engage with them on and look at and share the

information that they’ve been collecting.” (Implementer

interview)

Meso Level Issues

• Industry Readiness– Lack of Market Coherence

– Collaboration, Competition and co-design

• Health Service Readiness– Information Technology Infrastructure at a Local Level

– Discontinuity and Organisational Culture

– Resource Constraints

MESO ISSUES

• IT Infrastructure at an organisational level

“Well things like legacy systems, fire walls,

when we are adopting new technologies,

eHealth capacity, e-health priorities within the

internal infrastructure is stretched”. C1 Final E-Hit

Interview

MESO ISSUES

• Incoherent Market - Market stability and maturity were key

themes for industry readiness.

“…locally we really, really tried to get into, to encourage the

Retailers to take an interest so conversations with ‘Tesco’s’,

conversations with ‘Maplin’, with ‘Argos’ more recently but

again we didn’t manage to, there was interest in Maplin and

Argos but them taking that next step and doing some piloting

with us didn’t happen….”

[C2, Leads Research Interviews, June 2015]

Micro Level Readiness

• Health professionals– Workload and Professional Confidence

– Training and Alignment with Professional Roles and Identities

– Access to Digital Resources

• Public and Patients– Digital Literacy and Access

– Agency of individuals and their perceptions of “consumer” digital

health tools

– Trust in consumer facing digital technologies

MICRO ISSUES

“….I think the whole system about IT, I feel first and

foremost I am a Nurse and that’s what I was trained to do,

so before IT came in, we were doing everything on paper,

and now things are changing for us, and we’ve never really

been given training, we’re only doing it on the job, and we’ve

had a new IT system called ‘x’ coming in, that’s created an

absolute nightmare for everybody, because we’re not

necessarily that skilled in IT processes to be able to do that.

So generalised IT training would be good, as well as then

tailoring it to the things that we’re doing. …”[C3 Health Visitor, eRB Focus Group, April 2015]

MICRO ISSUES

• Agency of individuals

“….People don’t prioritise health, so if you are

economically deprived, what you prioritise is

feelings of physical safety and financial safety so

you could be worried about paying your rent,

keeping the debt collectors off the door, anti-social

behaviour in your neighbourhood. If you’re more

economically active then other things are a priority,

ah, holidays, kids, schooling, housing, or next

house, mortgage.” [C2 implementer interviews, June 2015]

Concluding Thoughts

• Readiness issues are ubiquitous across macro,

meso and micro level and across sectoral

boundaries : market, organisational, professional

and consumer

• Not necessarily insurmountable challenges – but

their existence does need to be ACKNOWLEDGED

and ADDRESSED if deployment at scale to the

widest population is to be realised.

Concluding

Thoughts……….

Lots of challenges

but not insurmountable!

Recommendations 1

• Increased investment in both national and

local infrastructure reqd

• Guidance relating to ownership and control

of personal health data as well as data

privacy regulations reqd to mitigate current

uncertainty.

• Accreditation and official endorsement of

products and services crucial

Recommendations 2

• Need to invest in awareness raising and

upskilling of both public and professionals

• Incentivise technical/service interoperability

• Increase digital health accessibility (e.g.

language)

Questions?

Frances.Mair@glasgow.ac.uk

@FrancesMair

Online MSc Primary Care

E-mail: primarycare@glasgow.ac.uk

Lennon MR, et al. Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of

a National Digital Health Innovation Program in the UK. J Med Internet Res 2017;19(2):e42

Devlin AM, et al. Delivering Digital Health and Wellbeing at scale: Lessons Learned during the implementation of the

dallas program in the UK. Journal of the American Medical Informatics Association (JAMIA) 2016: 23(1): 48-59.