I was alerted to this a few days ago and believe it is worth passing on.
Evidence standards framework for digital health technologies
As digital health technologies develop at an increasing pace, we've worked with partners to develop standards that ensure new technologies are clinically effective and offer economic value.
The aim of the standards is to make it easier for innovators and commissioners to understand what good levels of evidence for digital healthcare technologies look like, while meeting the needs of the health and care system, patients, and users.
We created the standards as part of a working group led by NHS England. The group also includes:
- Public Health England
- MedCity
- DigitalHealth.London.
The standards
The evidence standards framework is made up of:
- effectiveness standards
- economic impact standards.
The framework supports the relevant principles of the Department of Health and Social Care code of conduct for data-driven health and care technology.
User guide
Download the user guide (PDF)
This covers:
- the background of the standards
- their development and use
- future priorities identified by stakeholders.
Supporting resources
Budget impact template
To support digital health innovators using the economic impact standards.
Download the budget impact template (Excel)
Budget impact guide
For more information on budget impact and cost consequences analysis.
Download the budget impact guide (PDF)
Case studies
The functional classification case studies show examples of how digital health technologies are classified for the effectiveness standards.
Download the functional classification case studies (PDF)
The effectiveness and economic impact case studies show examples of the available evidence for some digital health technologies.
Download the effectiveness and economic impact case studies (PDF)
We commissioned the Newcastle and York external assessment centre to develop the budget impact guide and case studies.
Here is the link:
The aims are very sensible and pragmatic:
The aim of the standards
Provide advice to digital health innovators:
- about how the NHS makes decisions
- about the standards of evidence they will be expected to produce for different types of digital technologies.
Help NHS commissioners:
- to make more informed and consistent decisions by providing a framework for the levels of evidence they should expect to see presented to them.
Improve the approach to developing and commissioning digital health technologies:
- by making it more dynamic and value driven, with a focus on offering real value to patients.
Having read through the evidence framework it seems to me this is work that is virtually directly applicable – and relevant – to all Digital Health projects. Application of these frameworks to what is going on with things like the myHealthRecord would be particularly interesting I believe.
Comments on the NICE approach to what has always been a difficult issue are more than welcome.
David.
7 comments:
To broaden the perspective and 'insight' into the UKs 'thinking' it might be worth adding to your 'information mix' the All Systems GP Tech Manifesto published by the RCGP April 2019.
https://www.rcgp.org.uk/-/media/Files/News/2019/RCGP-tech-manifesto-april-2019.ashx?la=en
The "evidence standards framework for digital health technologies" document says:
"Appropriate economic analysis
The economic impact of a DHT can be assessed using an appropriate analysis of the economic information collected. The type of economic analysis done should be determined by the financial consequences of adopting and implementing the DHT from a payer or commissioner perspective. The appropriate level of economic analysis depends on the type of decision needed and likely financial commitment. To reflect the range of commissioning decisions associated with DHTs, we have proposed 3 levels of economic analysis (see table 8).
Many DHTs will start at a basic economic analysis level but, with additional information and data about the technology and its comparators, a more robust economic analysis can be undertaken. The higher levels of economic analysis needed depends on the financial commitment required including, for example, the level of upfront investment, the likelihood of opportunity costs and the certainty of the realisation of the benefits."
Unfortunately this is rather narrow. The economic analysis only involves the "financial consequences of adopting and implementing the DHT from a payer or commissioner perspective"
DHT in the health environment impacts far more than just the payer or commissioner of the system.
For example, the myhr puts requirements on GPs and other health service providers. GPs have to talk with their patients, review whats in their myhr and upload appropriate data. Patients have to spend time managing their myhr (after all it is is theirs, isn't it?). Health service providers have to integrate myhr into their infrastructure and work practices.
Neither does the analysis include benefits and value from the perspective of health service provider or patient.
None of these costs, benefits and values are included in the economic analysis, even though, potentially they could be orders of magnitude greater than those of the payer or commissioner.
Table 1 in this document is interesting. The first row says:
"Evidence tier
Tier 1: DHTs with potential system benefits but no direct user benefits.
Functional classification
System service.
Description
Improves system efficiency. Unlikely to have direct and measurable individual patient outcomes.
Includes (for example)
Electronic prescribing systems. Electronic health record platforms. Ward management systems."
My reading of this row is that the National Institute For Health And Care Excellence believes that neither users (e.g. GPs) or individual patients will see any measurable benefits or outcomes from electronic health record platforms.
The NHS can probably use those sorts of measures as most work for the NHS umbrella corporation. Unlike the MyHR where no one works for the MyHR well no one practicing medicine or delivery health services resulting in patient outcomes.
Rest assured though, we will receive an almost identical replica as we did with the NDHS and FFA and sadly the CEO of Australia’s careless.data.
I was interviewed by the Guardian yesterday about Medicare cards being for sale on the dark web.
https://www.theguardian.com/australia-news/2019/may/16/australians-medicare-details-illegally-sold-on-darknet-two-years-after-breach-exposed
I checked into it and the Medicare Machine the journalist was interested in only provides details of a specified person's Medicare Card. You can order a fake Medicare card if you want but that's a transaction with a different person.
The view I expressed to the journalist was that it was not a big deal (the person selling hadn't sold any since September last year), it would be hard to track them down, it would appear to be someone with legitimate access to either the Medicare or the IHI system and that, in the scheme of things, the government has bigger problems.
I actually came across reference to the article on reddit, which is much more interesting in that it is a snapshot of (technology) informed opinion.
https://www.reddit.com/r/australia/comments/bp2dny/australians_medicare_details_illegally_sold_on/
FYI, I am a reddit lurker and did not contribute to the conversation.
On the subject of the Guardian- https://www.theguardian.com/australia-news/2019/may/16/naplan-online-failures-bring-more-calls-from-states-for-reform
Another example of the Fed bureaucracy making a mess. They even admit they knew the complexity and still pushed forward in a Hal-backed way. Come the results of the weekend, it is clear that it will be the same s*it even if it’s a different set of a**ses pushing it.
@10:33 AM. You should do an FOI request for the MyHR platform performance logs. We even have a standard set of responses to those who bother to contact us.
Not-fit-for-purpose platform forced onto users. Governance and corporate executive more apt at kissing each other behinds and politics than anything useful, placebo advisory groups that are all but ignored and testing a fantasy. Sounds like a standard Canberra rollout supported by the usual State and territory muppets.
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