Findings
Our aims in this project were to identify what determines whether and how technology is adopted in the NHS, what work had already been undertaken, and how barriers could be overcome.
As a starting point to addressing the factors that influence decision-making, our project team followed the pathway from the laboratory to the GP’s surgery or patient’s home – the decision to develop, the decision to buy and the decision to use – and identified a range of internal (to the NHS) and external factors that can influence the adoption of technology.
The internal factors that can have an impact on decision-making include: government policy, management leadership, the effectiveness of assessment, the efficiency of information-sharing and decision-making. The external factors are: funding, the level of engagement between suppliers and the NHS, agreement on standards, consumer demand (and also consumer concerns).
The study identified four models of how decisions to implement technology can be made and what barriers can impact on each model.
In the top-down model the decision to implement technology is made at the top (the Department of Health) and the large-scale implementation requires significant investment and risk. The barriers identified in this model include: difficulty in gaining funding; lack of strong leadership and direction; limitations of the assessments; consumer fears about data protection; the devolving of purchasing decision to the primary care trust (PCT) level.
In the second model – uptake by local management – decision-making is devolved to commissioners in health and social care trusts. This is the most common model in the NHS and can be slow because of the different people involved in the process and the level of risk the investment represents. In this model, the barriers are: lack of resources (including finances); complexities of the financial and planning models at local level and the fact that there is no economy of scale at the purchasing stage; lack of awareness of the benefits and few incentives to invest.
In the third model, individual medical professionals can decide to purchase or use a new technology. Implementation occurs on a small scale and the value of the investment is quite small. Barriers in this model are: clinicians may have difficulty presenting a business case to managers and have little guidance on standards; there are few incentives; patients may be resistant.
Finally, consumers can decide to purchase and use a technology themselves, buying direct from the supplier; in this case there may be a limited number of options available and little support offered.
The report of the study presents an ideal scenario for the use of technology in health care and lists technologies that could possibly be in use in 2018. These include technologies that can provide information and advice – for example, text information about pharmacy locations; remote personal trainers; technologies that cater for administrative transactions – for example, appointment reminders by text message, electronic prescription service; and technologies that help to monitor patients’ conditions – for example, alarms that monitor falls, telecare home equipment.
If the ideal scenario is to be achieved there would need to be active involvement of everyone in the health care system from the Department of Health to the consumer. The report recognises that overcoming the barriers to adoption of technology is not straightforward but identifies important benefits. It makes the following recommendations.
- The role of the Department of Health is particularly important: it must provide clear and consistent leadership on the use of technology in health care, co-ordinating and supporting the activities of various agencies who have a remit to develop technologies and reviewing processes for funding and purchasing new developments.
- Active steps should be taken to increase the number of assessments of technology carried out by the National Institute for Health and Clinical Excellence (NICE), to speed up the process, to implement the results, and to roll out the technologies from successful trials.
- Strategic health authorities should promote new technologies and should adopt appropriate funding mechanisms, recognising that investment in technology may need to be paid back over a long period, for example.
- Better communication is needed between the NHS and patients. At a local level, the use and benefits of technologies should be actively promoted where they are likely to improve the outcome and the patient’s experience.
- The partnership between the NHS and the technology industry should be strengthened. The NHS should support those producing new technologies in how best to present their case, and the industry should be aware of the need to demonstrate value to NHS purchasers.
