Liz Ashall Payne, founder and CEO of ORCHA (Organisation for the Review of Care and Health Apps), has spent her entire career focusing on one central question: how can you help as many people as possible to become healthier? That motivation arose long before technology came to play a prominent role in healthcare.
‘I became a doctor, but I was frustrated that I could only help a limited number of patients,’ she said on the second day of the ICT&health World Conference. ‘I wanted to provide more care for more people.’ Digital technology offered opportunities to do so, but at the same time raised a new problem: trust. ‘Without trust, there is no adoption.’
This issue of trust is becoming more urgent as the range of digital healthcare services grows. Every day, around five million people worldwide download an app or use new technology to monitor or improve their health. This need exists in all age groups: 65 per cent of people over 65 want to use digital healthcare, while 93 per cent of healthcare professionals see technology as a means of improving healthcare and making it more accessible.
No one knows what works
Yet widespread adoption is lagging behind. According to Ashall Payne, this is because both healthcare professionals and potential users can no longer see the wood for the trees. ‘People simply don't know what really works.’ That's why ORCHA was launched about 10 years ago. This UK-based organisation assesses and certifies eHealth applications on aspects such as safety, clinical validity and usability.
Analyses by ORCHA and others show that only about 20 per cent of the 350,000 apps assessed meet minimum requirements for safety and effectiveness. ‘This means that many people are using technology that does not work properly or may even be harmful. This fuels negative experiences — and undermines trust.’
Ashall Payne likes to compare digital healthcare to medication. ‘There is an extensive system of governance for medicines: from development and distribution to monitoring and adjustment. It's a continuous process of checks and balances.’ In the world of digital healthcare, that chain is often missing. ‘We do work with standards, but that alone is not enough. It's about actual implementation.’
Supporting roll-out
Over the past ten years, ORCHA has therefore developed a five-step model to support practical roll-out, based on continuous monitoring and up-to-date information. ‘People don't want to know whether an app was safe three years ago, but whether it is safe now.’
The model consists of:
- Pre-market assessment and evaluation
- An expert workforce
- Clear positioning: prescription versus over-the-counter
- Reimbursement
- Tracking and governance
Because ORCHA applies this model internationally, the organisation sees a lot of overlap in requirements for safety, interoperability and user-friendliness between regions such as the US, Canada and Europe. ‘By streamlining these requirements, we can prevent developers from having to go through the same process over and over again when they enter a new market.’
Training is crucial
A crucial factor in this is training. Healthcare professionals need to develop the right digital skills, tailored to their own field. ‘One size doesn't fit all,’ emphasises Ashall Payne. ‘The better professionals understand which technology is effective in their practice, the faster they will use it responsibly.’
She also believes that distribution is still receiving too little attention. ‘The focus is strongly on regulation, less on how technology actually reaches patients.’ Suppliers want to comply with regulations, but they also need support with implementation. Without that, an app quickly fades into obscurity, waiting for approval or connection.
ORCHA is therefore committed to improving interoperability with EPDs and automated distribution, for example by enabling healthcare professionals to deploy appropriate digital tools more quickly on the basis of a diagnosis, including in the period prior to treatment or surgery.
Reimbursement helps with scaling up
Ultimately, reimbursement is also essential to enable scaling up. ‘As long as digital tools are not structurally reimbursed — like medication and medical devices — widespread application will not happen.’
According to Ashall Payne, this creates a chain of trust: patients are more likely to trust technology when it is recommended by a healthcare professional, used correctly and reimbursed. That trust ultimately rests on a solid system of monitoring and governance, so that problems can be addressed quickly. ‘Only then,’ she concludes, ‘can you make digital healthcare a sustainable and safe part of the healthcare system.’
