“Let’s embrace the complexity and apply what we know”

Digital health adoption is the focus of a newly published set of journal papers, jointly curated by the HIN’s executive director of digital transformation Amanda Begley. Here she reflects on the role of complexity and evidence on digital health adoption and the practical steps available.

With thanks to Frontiers, my co-editors Yiannis Kyratsis, Harry Scarbrough and Jean-Louis Denis and our 74 authors, we have just completed the editorial for our Research Topic Digital Health Adoption: Looking Beyond the Role of Technology | Frontiers Research Topic (frontiersin.org).

With 50,000 views already and the research topic being in the top three in the journal section, digital health adoption is clearly a hot topic. So, I thought it important to let you know about the open-access articles available to read.

Do read our short editorial – it provides brief summaries of all the articles and has embedded links to help you navigate to which of the 10 in the research topic are of most relevance to your work and thinking.

The editorial also describes four key non-technology related aspects of digital health adoption (co-creation, stakeholder management, ethical and social factors and the need for transparency), and five key levers to adoption:

1. Understanding and responding to the needs and preferences of diverse individuals and communities
2. Early and active stakeholder engagement in both design and technology use
3. Building the capability and confidence of all actors to acknowledge and raise quality, privacy, security and safety concerns
4. Adopting a holistic, rather than a piecemeal approach to build a supportive ecosystem
5. Considering seriously the wider ethical implications.

I don’t want to repeat the content of the editorial here, so am instead sharing a couple of reflections:

• Let’s embrace the complexity: We are increasingly realising the breadth of considerations and capabilities required to implement digital health technologies ethically, equitably, efficaciously, and economically. Although this may feel at times overwhelming, one of the many things I love about the health and care system is that it’s complex, requires careful thought and partnerships – change can be unpredictable, hard won, and takes time. With the growing research and practical insights accumulating, we are now better informed about how to enable technology adoption. Also, national policy work continues, like NHS England and National Institute for Health and Care Excellence’s (NICE) current work on a policy framework for defining the assurance pathway for digital health technologies and NICE’s Early Value Assessment
• Let’s apply what we know. As an assistant and trainee clinical psychologist and when completing my PhD, reviewing the evidence-base was second nature to me. However, as I moved into commissioning and operational management, I got so busy fire-fighting that I forgot to draw on the evidence (like implementation-, complexity- and behavioural sciences) to inform my efforts to implement innovation and transform care. It’s only been in the last 15 years that I’ve drawn on the rigorously captured findings of the authors included in this series and utilised the vast knowledge that sits in our open access journals like Frontiers, BMJ Open and Implementation Science to name but a few. I know how hard it is to make time for this but doing so gives greater rigour to our efforts.

So digital transformation is not easy, quick or straightforward – but perhaps I’d be bored if it were… 

However, if we continue listening to our users and staff, openly sharing and actively learning from others, and working with colleagues across care settings and sectors then anything’s possible – including digital health adoption at scale for our patients, populations and staff.