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“The more we can all learn collectively, the better it is for everyone” – Spirit Health’s Bruce Adams on international digital healthcare

Recently at HTN, we had the pleasure of speaking with Bruce Adams, the commercial director at Spirit Health, the company behind Clinitouch remote monitoring apps. Bruce talked to us about his role in delivering digital health solutions on a large scale, the subsequent challenges and learnings this journey brings, and how the NHS could evolve through the advancements digital technology has to offer.

We heard that Spirit Health have recently been taking more of an international scope with Clinitouch – what inspired this change? 

We’ve been delivering Clinitouch and digital health technologies into the NHS at scale for over ten years now, so we are very experienced not only in terms of how to design the technology, but equally how to implement it successfully to achieve engagement and utilisation.

One of the things I often talk about with my teams is that we’re implementing change arguably more than we’re implementing technology. Over the years we’ve made all the mistakes, we’ve got many things right and thankfully we seem to have got more things right than we have wrong – and then have learnt from that. We realised that we were at a place where we had both the expertise and the technology to go and support other organisations who are similar in values, cultures and ambition to us, to take Clinitouch and replicate the success we’ve had in the UK in their own countries.

There is a huge digital health boom taking place globally; there are a lot of healthcare organisations and non-healthcare organisations that are wanting to join that revolution. We wanted to take our learning and support them to achieve this, and ultimately benefit other health populations internationally. We also want to go out into the world and learn about the different challenges and approaches in healthcare systems globally so we can feed that back into our existing projects and partners in the UK and beyond. We think that this learning will bring huge benefit for health systems and patients in the short, medium and long term.

How does the digital landscape differ internationally and the UK in general?

Essentially, all health systems globally are facing very similar challenges: ageing populations, increasing demand and strains on capacity and so on, but there are nuances between different health systems and cultures.

Where you have a predominantly private insurance dominated market, they naturally are very customer-focused in their approach. What we see is that they work really proactively to keep people healthier from a much earlier age. Insurers have an incentive to keep people healthier, but they also want people to feel more proactively cared for and minimise the risk of health complications longer-term, which promotes a much more positive ‘customer’ experience but also keeps costs down, as the cost of hospitals stays on private insurance companies is very high.

From a digital perspective, the international digital landscape is very interesting; in some countries, especially in developing nations, they haven’t needed to invest in wired internet and therefore they’ve pushed forward their investment in mobile coverage. The smart phone boom is really accelerating and the coverage for internet connected devices is really fantastic – probably better than some rural parts of the UK! That gives a real opportunity for connectivity and supporting people to lead healthier lives through digital technologies. Equally, the scale of the NHS presents challenges and trying to modernise such a huge, complex organisation will take time.

Meanwhile, in some international companies and markets, they don’t have that same challenge and are dealing with much smaller projects which can help drive digitisation a lot quicker. Those are probably the main differences that we see.

What are the main learnings from other industries or places that the NHS could benefit from?

I think the NHS is still a touch more ‘reactive’ than ‘proactive’ in how it manages peoples’ health. If I refer to back to what I was saying earlier about the insurance companies being customer centric and super proactive – the NHS is generally still reacting to people getting ill rather than proactively, at scale, trying to keep them well.

The surge in digital technologies can support people to keep healthier and to spot deterioration much earlier, with little impact on capacity and resource. That’s a a real opportunity for the NHS. This would encompass monitoring of long-term health conditions at scale; in the last 18 months we’ve seen an increase in virtual wards which has been fantastic, but we see it as only a small piece of the puzzle. It’s still more about increasing capacity rather than trying to stem demand and keep people healthier.

The other key element is keeping the technology really simple. Internationally, we see that health systems are less interested in the really high tech; they want to reap the benefits but keep it as simple as possible for their patients. In the NHS, at times we see more of a ‘technology first’ perspective and that means that we have some really fantastic but quite complicated technology being placed into the hands of people who are either managing one or more health conditions, or not 100 percent tech confident. Internationally, we see a focus on simplicity in order to ensure adoption and engagement, and a focus on the outcomes.

How can we export/import best practice into the NHS?

I think there are huge amounts of value in going out to other health systems and countries and learning about their approaches. Our main driver in doing that is to create as many opportunities for shared learning as possible. We genuinely want a global community of health partners, all of whom are digitally ambitious and pushing together to improve access to digital healthcare technologies. That community we’re trying to build in the long-term is essentially to create what we call ‘collisions’ of thought and experience – and our goal is to try to create as many collisions of thought and experiences as we can.

The world as we know it is becoming an increasingly small place. If you have a patient with a long-term health condition in the UK – COPD, for example – it is exactly the same condition in India, Australia, Canada, South Africa and so on. We are all dealing with many of the same pressures in the healthcare systems globally, so the more we can all learn collectively, the better it is for everyone.

What are your expectations for digital technology over the next five years, both in the UK and internationally? 

We will continue to see the acceleration of digital technology, as more tech native generations enter the system – and digital healthcare becomes an expectation – it’s happening already. I would hope to see us collect more data that is increasingly shared between systems and providers, and that will give us the ability to learn and proactively predict conditions, condition deterioration and therefore provide a more connected service to healthcare citizens.

I also hope and expect that we will see more research extracted from that data – for example, around the effectiveness of digital technologies in supporting people with long-term conditions and the benefits of such. It can be difficult to invest in technology, especially when it supports people with long-term conditions, because the benefits are often seen much further down the line.

In the next five years, we will start to see the data that proves the outcomes that our published research shows, and that will direct more and more funding into digital technology. I also think it will be increasingly expected as the norm, especially with tech-native generations; it will be expected rather than as an option. With that expectation comes an onus of health systems globally to respond to that and I’m confident that they will.

I also believe that we will revert to a more simplified approach to technology. For example, if you look at the evolution of search engines over the last two decades and the ‘Ask Jeeves’ of this world – overly complicated, too much information, too many links, widgets, and ultimately Google won the day with a white page and a search bar. I think that we are at the risk of being in the ‘Ask Jeeves’ stage of digital health technology whereby some of the technology is too complicated for us to reap the benefits of scale and mass adoption. The key will be in focusing on a simplified approach to tech design that achieves the benefits and outcomes of population level adoption, always placing clinicians and patients at its heart.

Thanks again to Bruce for an insightful conversation into the realm of digital healthcare, if you would like to read similar interviews with other professionals within healthcare and technology, please click here.