On MedTech, digital and unintended consequences

On MedTech, digital and unintended consequences

I was recently invited to give a keynote speech at the launch of Grow MedTech –  a major UK programme providing specialist support for innovation in medical technologies, involving a consortium of six universities across the Leeds and Sheffield city regions. With the programme’s interest in convergence between MedTech and digital technologies, I shared some thoughts about the dangers of unintended consequences along with the role of human-centred design in creating a future we want for ourselves as individuals, our families, communities and wider society. Below is a summary of my talk. I began by posing a few questions: Who would have thought that one of the consequences of the phenomenal global success of AirBnB would be protests related to lack of affordable accommodation and the rise in homelessness? How many of us would be surprised to know that the introduction of driverless cars in Leeds is projected to result in a 50% increase in car travel by 2050 along with associated reduction in walking and cycling? And if robots are the answer to the social care crisis for older people – what is the question? And what might be a different or even better question? I asked these questions not to be provocative, but to illustrate that we cannot easily anticipate the consequences of technology innovation. As we have seen in the case of data driven algorithms, technologies have all sorts of social norms, biases, beliefs, values, assumptions and consequences baked into them. By way of a health related example, this recent article in the New Yorker describes how American physicians in one Massachusetts hospital are hiring India-based...
What is the case for more women in health tech?

What is the case for more women in health tech?

Recently I was delighted to give a presentation at a Leeds Women in Health Tech breakfast event hosted by Health and Wellbeing Board chair, Councillor Rebecca Charlwood and Director of City Development, Martin Farrington. This forms part of a regular breakfast series in which senior council leaders and councillors bring together experts on a topic of importance to the city. I started by noting that, with a background in humanities and social sciences, I am an accidental woman in technology. My working life started in homeless charities followed by a qualification in social work. Hardly an obvious route to health technology. It was through my PhD research on the theme of mental health and online social networks that my interest in digital technology began to develop. Whilst we need more women with technology skills, the field of digital also needs people with a more diverse skill set than simply coding. This post from Rachel Coldicutt at Dot Everyone neatly makes the case for arts and social scientists in tech: “The arts and social sciences must become essential voices both in the technology industry and in the predictions that guide investment and entrepreneurship. Knowing what to do with tech must become at least as valuable a skill as knowing how to make it” It is for this reason that I am not apologetic about my non-tech background – I see it as an asset rather than a liability. In my talk, I recalled how in the early days of mHabitat I was asked to speak at an almost exclusively male event which, as someone new to the tech scene, took...
Mental distress is on the increase for young people – what part has digital technology got to play?

Mental distress is on the increase for young people – what part has digital technology got to play?

Children and young people’s mental health has been centre stage in the media this week, in the light of a recent survey published by NHS Digital. The report shows a rise in mental health difficulties, coupled with increased waits for contact with mental health specialists. A perfect storm of rising demand and reduced capacity in the system. The report precipitated a flurry of reports in the media calling for the Government to put more resources into young people’s mental health services. A Guardian article identified social media, along with other factors, as potential sources of pressure on young people’s mental health. Another focused on the role of mobile apps such as Calm Harm, and the online counselling service Kooth, in helping young people cope with distress. So what is the role of digital technology in young people’s mental health? Should we be increasing the availability of online services? And are social media good or bad for children? In a recent post I summarised findings from a representative survey of teens age 13-17 entitled Social Media, Social Life: Teens Reveal their Experiences (Common Sense Media 2018) which found that despite adult assumptions, most teens report social media have a positive effect in their lives, such as making them feel less lonely. And whilst vulnerable teens are more likely to report negative effects of social media (such as bullying) they are nevertheless more likely to report positive benefits, such as feeling less lonely and depressed. Whilst this is an American study, it has parallels to findings from the UK. Social media appear to have a heightened effect (both good and bad)...
Creating a digital citizen blueprint

Creating a digital citizen blueprint

One of the many challenges of using digital technology in health and care services is a lack of interoperability – we’re all using a slightly different lego set and the pieces don’t quite connect together. Every time we want to do a particular task we have to swap over to another lego set and start again. This is a well rehearsed and entrenched challenge in the NHS and my home city of Leeds and the wider region has a new initiative to help connect those lego pieces together through common standards and open source technologies. But what about citizens? In a way we have the opposite challenge. We are not standardised lego pieces and never will be. Each of us has differences in our use of digital technologies – these may be influenced by our attitudes, our aptitude, our access and particular barriers that we may experience. There are some commonalities but there are also particular factors that can be easily overlooked. If we don’t understand and pay attention to those differences then we risk designing and deploying digital technologies that entrench the inverse care law – that is, those who already have the most get more and those who have the least lose out further (you can read an excellent BMJ article from Margaret McCartney on this topic here). In Leeds we have a commitment in the Health and Wellbeing Strategy that people who are the poorest improve their health the fastest. This is easy to say but hard to do. This is where the blueprint comes in. At mHabitat we are helping the NHS and council in...
What really counts – keeping humanity at the heart of digital innovation

What really counts – keeping humanity at the heart of digital innovation

Digital innovation is going to save the NHS. We use digital in every other aspect of our lives so why not the NHS? So the hyperbole and the mantra goes. But what if, in our fetishisation of digital, we get too focused on shiny products and forget what really counts? This moving blog post by health economist Dr Chris Gibbons about his family’s interactions with health services, when his dad was very ill, made me pause and reflect on how we keep values of humanity at the heart of efforts to innovate and improve health services. Here is a section of the blog post which emphasises that it was person-centred  and goal-orientated care that made the biggest difference to Chris’ dad: “Innovation has many guises. Innovative ways of thinking about the hospital system. From the point of admission to the successful discharge and rehabilitation of people in a place of their preference then linking up that system seamlessly with health and social care system. We need to emphasise the importance that people doing Neil’s [care worker] job have in linking that all together as a person centred, goal oriented approach to recovery and rehabilitation. That’s where the real value in innovation sits. It doesn’t fit neatly into a Markov model, or have fancy branding and the backing of a pharma company that’ll send you to Honolulu for a conference. But it is the kind of innovation that we should be judging against all the other “innovations” that do” How do we assess what really counts and what is going to make the biggest difference to patients when we have...
Frameworks, lyrics and non-adoption of technology

Frameworks, lyrics and non-adoption of technology

You know that feeling when a piece of music (or a book or film) resonates so strongly that it helps you understand something about your life? In my late teens it was The Smiths who did just that. I suspect that teenage hormones may have been a factor, but every lyric from Morrissey’s pen seemed to speak to me directly. Fast forward to 2018, and minus the heady mix of adolescent intensity and the tunes, I had a not altogether dissimilar sensation reading Beyond Adoption: A New Framework for Theorizing and Evaluating Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability of Health and Care Technologies by Trisha Greenhalgh et al (2017). This paper felt like reliving the first four years of my journey into the digital health technology sphere – every challenge, mistake, obstacle we have encountered is captured in this compelling paper on why technology doesn’t get adopted in the NHS. It felt a bit like the life story of mHabitat but minus the highs… NASSS is an evidence based and theory informed framework that endeavours to set out the interrelated factors that influence the non-adoption abandonment, scale-up, spread or sustainability of technology. It aims to be a tool that can easily be used in practice. The rich blend of research methods comprising case studies with qualitative interviews and ethnography, along with a review of the literature, elicited the seven framework themes (see the diagram above). Our tacit experience of non-adoption could have easily have been one of these case studies – everything from poor clarity of the problem the technology is meant to solve; poor...