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The Growing Value of Digital Health in the United Kingdom: Evidence and Impact on Human Health and the Healthcare System

Over 318,000 health apps and 340 consumer wearable devices are now available worldwide. The value of these Digital Health tools to human health and the healthcare system is still evolving. There has been continued adoption by various stakeholders, exploration of innovative ways to apply these tools to health and growing evidence of their impact on human health outcomes. Since our study in 2015, over 153,000 new Digital Health apps were introduced to the Apple Store and Google Play, nearly doubling the number available, with more than 200 health apps being added each day. General wellness apps still account for the majority of health apps available to consumers, but those focused on health condition management — often associated with patient care — are growing and now account for 40% of all apps.

Although the range of health apps available present an overwhelming amount of options for consumers to choose from without guidance from their healthcare provider, there are now established leaders among apps for consumers to use. Just 41 apps with over ten million downloads each account for nearly half of all app downloads while over 85% of all health apps have fewer than 5,000 installs. There is now also at least one high-quality app for each step through the patient journey. The importance of Digital Health to healthcare is defined by such apps that are the leaders in their respective use category, and the value they deliver, while the plethora of lesser apps have little impact. These leading apps may have high patient ratings, frequent updates, connectivity to sensors, inclusion in healthcare institutions’ app formularies, endorsements and promising clinical evidence.

The overall body of clinical evidence on app efficacy has grown substantially, including randomised controlled trials (RCTs) and meta-analysis studies. Particularly strong evidence now exists for use in diabetes, depression and anxiety, making these categories strong candidates for incorporation into standard of care recommendations by clinical guideline writers. An additional 24 categories have one or more RCTs with positive results making associated apps strong candidates for adoption by healthcare stakeholders (e.g., provider organisations and payers).

The use of Digital Health apps in just five patient populations where they have provided some evidence of reductions in acute care utilisation (diabetes prevention, diabetes, asthma, cardiac rehabilitation and pulmonary rehabilitation) could save the U.K. healthcare system — including the public and private sector payers in England, Wales, Scotland and Northern Ireland — a conservatively estimated £170 million per year. This represents about 1.1% of total costs in these patient populations. If this level of savings could be extrapolated across total national health expenditure (not just these first five disease areas), annual cost savings of £2 billion could be achieved.

While the quality and clinical value of a leading group of Digital Health apps is becoming clear on a global basis, challenges remain in terms of how this value is realised in the United Kingdom. While the NHS Apps Library (Beta) has now listed 42 apps that have successfully navigated the new Digital Assessment Questions (DAQs), thereby endorsing them for use by patients and clinicians, this list only includes 2/26 Top Apps identified in this report (MyCOPD for pulmonary rehabilitation and OWise for breast cancer). While there are many anecdotal reports of pilots of Digital Health apps within the NHS, a minority of worldwide Digital Health efficacy studies have taken place in the United Kingdom. These figures indicate that while the United Kingdom — and specifically the NHS — have growing enthusiasm for Digital Health apps, routes to improve access to high-quality apps and facilitate more local studies of their benefit may be needed.

Despite progress to date, a number of barriers still exist to widespread adoption by patient care institutions, and only a limited level of adoption has yet occurred. Barriers to further use by physicians surround app selection, concerns around privacy and security, malpractice liability, financial incentives and workflow integration. Few condition management apps — which offer the greatest potential impact on human health care and healthcare costs — have reached the level of workflow integration necessary to gain widespread physician adoption.

Before healthcare can be more fully supported by apps and sensors, a new fit-for-purpose infrastructure must evolve to support their delivery and incorporation into the standard health toolkit, similar to the type of ecosystem that exists to disseminate safe therapeutics. A variety of industry and policy initiatives have now emerged to address these barriers and accelerate the ongoing adoption of Digital Health tools by care facilities. Critically, app curation initiatives are facilitating the creation of
formularies of high-quality apps; privacy and security guidelines are being published; patient access is being addressed by programmes such as the NHS England Innovation and Technology Tariff, efforts are underway to align Digital Health programmes with providers’ existing and emerging incentive structure; and interoperability initiatives create the potential for streamlined integration of Digital Health apps into physician workflow.