Impact case study database

The Test of Change approach used by DHaWG in the three programmes discussed (dallas, ScotCap and the National Atrial Fibrillation Programme) ensured that implementation and evaluation were embedded throughout the programmes, from procurement through to implementation, and that evidence was generated to support the adoption of new digital health services within the local context. Real life and real time experiences with patients and clinicians were also captured in order to provide usable insights for others to inform their adoption of services within different clinical sites and contexts. By doing so, Lennon, McCann and Macguire’s research has:

• Informed healthcare policy by raising awareness of digital health and real-world evaluation in policy debate, and through direct advice to the Scottish Government;

• Influenced the delivery of healthcare practice and services, leading to an improved patient experience;

• Informed expansion of the digital health industry, by increasing visibility and supplying evidence for deployment business cases.

Informing healthcare policy

The dallas programme reached over 169,000 consumers, businesses, patients and healthcare professionals during its three-year lifespan, and has been repeatedly cited as having significantly raised national awareness of both digital health and real-world evaluation methods throughout the UK [ S1- S3, S6, S7]. Director of Innovation and Deputy Chief Executive of the Digital Health and Care Institute (DHI) confirms that dallas ‘engaged and inspired others by providing a large scale working example of “how to do innovation in a complex environment”’ [ S2]. As a result, the findings of the project, in particular the recommendations stemming from it [e.g. R3], Lennon was invited to present the key findings to the Scottish Government’s Digital Health and Care Strategic Oversight Group and lead a workshop on how dallas might inform the key strategic priorities for the Scottish Government’s Digital Health and Care Strategy [ S3]. Head of eHealth Strategy and Policy for the Scottish Government highlighted how ‘these recommendations resonate with the Scottish Government’s direction in this area and the workshop and presentation given by Dr Lennon were extremely timely in helping to ensure that Scotland continue to be among the global leaders in the future of digital health and care’ [ S3]. R3 was also cited by the Scottish Government in 2018 in two national policy documents on the future strategy for digital health and care delivery in Scotland; for example, the research was used in the Technology Enabled Care: Data Review and Evaluation Options Study (2018) to highlight issues related to implementation of digital health platforms, including ‘disempowerment felt by health staff, inequalities of access because of different levels of digital/IT skills, and fears around data safety, especially where platforms are run by non-NHS bodies’ [ S4]. Continuing this engagement, Lennon was invited to present these recommendations to the Scottish Government’s Digital Health and Care Strategy Advisory Board in 2018, and these recommendations have since been used to directly inform Scotland’s Digital Health and Care Strategy [ S5].

Influencing the delivery of healthcare practice and services

The evaluation methods developed in the underpinning research have provided the NHS Scotland and other healthcare providers with quicker and easier ways to evidence and procure new digital health technologies. Indeed, the work of DHaWG in documenting and evaluating examples of digital health innovation in complex environments has been acknowledged as contributing significantly to increased digital innovation in Scottish healthcare over the past five years [ S2, S6]. As the Director of Innovation and Deputy Chief Executive of DHI confirms, the dallas programme ‘influenced the integration of design-led innovation and citizen engagement as fundamental components of health and care service redesign in Scotland’ [ S2]. Components of this have also been adopted by regions in Spain, the Netherlands and Norway as part of their service transformation agenda [ S1].

DHaWG’s report on the National Atrial Fibrillation (AF) Programme [ R5] was used by NHS Lanarkshire and the Scottish Government to assess how AF screening devices can be scaled nationally to improve AF screening and reduce the number of strokes. As highlighted by the CEO of DHI, funder on the Programme:

‘[Lennon and McCann]’s engagement with NHS Lanarkshire in support of the service redesign in the detection of atrial fibrillation was a key factor in business case development to improve national screening service using digital technologies. This will improve the patient experience, reduce demands on in-patient beds and, in the medium to long term, improve outcomes for patients by reducing the risk of profound disability or death through stroke’ [ S1].

Likewise, the DHaWG evaluation conducted for the ScotCap programme [ R6] formed the foundation for a business case on colon capsule endoscopy (CCE) and enabled the industry partners to improve patient experience by responding to feedback in the evaluation to enhance the comfort and wearability of the recording device and belt worn to transmit images from the capsule [ S7]. CorporateHealth International, a Danish Company and partner in the ScotCap project whose specialists provide readings of images from the video capsule, confirms that: ‘The service evaluation phase of ScotCap created the foundation for the roll-out of CCE in Scotland’ [ S8]. By December 2020, ScotCap had been launched in NHS Highlands & Islands, Greater Glasgow and Clyde, and Tayside (comprising 35% of the Scottish population) [ S1, S7, S8]. By reducing the need for in-hospital colonoscopies across Scotland, use of ScotCap significantly reduces waiting times for bowel cancer screenings [ S7]. Speaking in media coverage at the time, Chief of Medicine for NHS Greater Glasgow and Clyde stated: ‘This exciting development will help cut waiting times and will mean that many patients will avoid the need for more invasive tests’ [ S9]. Similarly, the NHS Lanarkshire Associate Medical Director summarised the benefits of the new service: ‘It enables us to conveniently explore the entire colon and can help us to detect or exclude cancer more quickly, as well as reducing the waiting time for colonoscopies’ [ S9]. This impact has even more significance since the COVID-19 pandemic in Scotland, which has led to widespread delays to health and care practices and the need for telemedicine has become more apparent, as the Managing Director for CorporateHealth International highlights:

‘Even though the pandemic complicated the administrative side of the roll-out, the shortfalls of traditional methods have been broadly exposed. To efficiently diagnose patient for GI symptoms, we expect that 5000-10,000 patients will be using the managed service in the next 9 months. Cancers that would have stayed hidden until the waiting list had been cleared will have been detected’ [ S8].

A collaborating partner from NHS Highlands confirms that, as a result of DHaWG’s evaluative work, ‘new service models are being adopted… and patients have a greater choice of technology for improving their quality of care’ [ S7].

Informing expansion of the digital health industry

For small to medium-sized digital health enterprises, participation in these three digital health implementation programmes has increased their visibility among potential healthcare clients and other clients, and established connections which have led to commercial growth for industry partners [ S6]. As the CEO of DHI makes clear:

‘DHaWG are working with DHI and procurement teams in the Scottish Government, NHS National Services Scotland and the enterprise umbrella organisation Connected Scotland to allow Scotland to ‘procure innovation’. Strathclyde are helping pioneer this ‘Innovation Partnership’ approach, allowing a competitive R&D process to result in the setting up of a procurement framework, meaning those businesses contributing to innovation have a clearer route to large-scale deployment of digital health technologies’ [ S1].

This acknowledgment is echoed by CorporateHealth International, who described their Innovation Partnership as ‘pivotal’: ‘the group from DHI and Strathclyde provided scientifically sound patient and service insights. This together provided the evidence needed to convince stakeholders from all functions in healthcare, government, academia, and industry to move forward with the roll-out’ [ S8]. As a result, businesses are now realising faster routes into the care market [ S7].

As an example of this, Sitekit Ltd, a Scottish small and medium-sized enterprise (SME), collaborated with Lennon on the dallas programme, during which time Lennon’s research evaluated barriers and facilitators to the adoption of digital personal health records, which was one of Sitekit’s core interests [ S10]. This provided Sitekit with the necessary know-how to identify commercial opportunities in the emerging Digital Identity market and ultimately set up a new business division within Sitekit for this purpose. Sitekit has since launched the eRedbook, a digital record of a child’s growth charts, vaccination data and other NHS health records, which was launched in Liverpool in 2014 and in London in 2017. By late 2020, an estimated 30,000 children had held an eRedbook account [ S10]. In 2019, Sitekit became a development partner in the development of the ‘Share2Care’ Local Health and Care Records (LHCR), a collaborative programme in North West England NHS and Local Authorities, which sees health and care records shared electronically between health and care providers. Currently there are 11 NHS organisations and 9 Local Authorities using the Share2Care LHCR [ S10]. In 2020, Sitekit became the prime contractor for the NHS Covid-19 Digital Staff Passport, which enables NHS staff to move more safely and efficiently between NHS organisations to support the COVID-19 response and is used by 67 organisations in NHS England [ S10]. Through the development and delivery of digital identity services, Sitekit has grown from 21 employees in 2014 to 72 employees in 2019 and has increased in turnover from GBP1,564,636 in 2014 to GBP8,413,604 in 2019 [ S10]. It has delivered digital identity services for NHS, National, Regional and Local Government and the private sector, and in 2019/20, Sitekit’s digital identity division was contracted by a major multi-national client in the finance sector to build the prototype of a global-scale digital identity service, which is currently in pilot in Australia [ S10].