Evidence generation is essential to communicate impact, raise credibility and prioritise development areas. It is also an essential piece of the innovation jigsaw needed to attract investment, succeed in grant applications and ultimately scale any digital health innovation in healthcare.
I am a GP and co-founder of Cognitant Group. We are on a mission to democratise health information and provide people with accessible, visual and trustworthy health content through our information prescription platform, Healthinote, empowering them to better self-manage their care and improve NHS efficiency.
Healthcare services globally are overwhelmed; demand is outstripping supply and poorly managed long-term conditions (LTCs) in our ageing population comes at huge economic cost.
- People in the general population struggle to understand their health.
- Clinicians don’t have enough time to provide personalised, preventative and meaningful health education.
The result? Sub-optimal use of prescribed medications, complications of long-term conditions, avoidable hospital admissions and poor health outcomes. Language and literacy barriers further exacerbate these challenges and widen health inequalities.
There is a body of evidence to suggest that enhanced support in self-management of long-term conditions can reduce hospital costs by 5% and hospital attendances by 12%. When you consider that stroke, a cardiovascular complication, costs the NHS £3 billion a year – that’s a potential hospital cost saving of £150 million from stroke patient self-management alone. (1)
What evidence do we need?
Cognitant’s aims have always been to:
- Improve the patient experience – providing multilingual, culturally adapted, visual health content, for improved understanding of health.
- Save clinician time / improve appointment efficiency
- Reduce avoidable emergency admissions through improved self-care and medication adherence.
Now we need to prove it.
With my clinician hat, we are trained to practise “evidence-based-medicine”. Healthcare practitioners are used to only prescribing medication and recommending treatments that have been through rigorous Randomised Controlled Trials (RCTs) and have shown statistically significant improvements in “intervention groups vs control groups”.
Any digital health technology (DHT) needs to show it is efficacious and effective, that it can save money or improve health outcomes. Now, although RCTs are considered the gold standard of research, they are complex to design and deliver, require substantial resources (time and money) and participant recruitment, engagement and retention is a big challenge.
What else can we do to generate effective and objective evidence?
DigitalHealth.London Evidence Generation Bootcamp
One of the first golden nuggets we picked up on the DigitalHealth.London Evidence Generation Bootcamp was that there is more to evidence than RCTs! In fact, what can be more valuable when considering DHTs is a spread of evidence, in relation to usability, implementation and economic analysis.
Mixed method studies are encouraged; combining qualitative and quantitative data within the same study gives a more panoramic view of the data being collected and looks at it from different viewpoints.
The bootcamp was exactly what we needed to help us navigate the map of evidence generation, learn about the different types of evidence/ research studies, review the Digital Health Technology Evidence Standards Framework (DHT ESF) and undertake a gap analysis to highlight what areas of evidence we needed to focus on gathering. Furthermore, we had the opportunity to hear from inspiring innovators who had trodden this path with their shared learnings, like Concentric Health and GetUBetter.
Bootcamp take home messages
The bootcamp was an excellent crash course in evidence generation and how to present that evidence to all the different stakeholders. Here are the top tips I gleaned from the bootcamp:
- Think about accessibility and evaluation from the outset of product design
- Engage with the NHS early, work in partnership with them and run feasibility studies asap
- Identify an academic partner for evaluation (NIHR Clinical Research Networks)
- Pitching: Know your audience and adapt accordingly (different outcomes are important to different stakeholders)
- Health economic evaluation – to support your value proposition and enable adoption and scaling
At Cognitant we have already gathered useful qualitative and quantitative PREM and PROM (patient-reported experiences measures and patient-reported outcome measures) data from patients using our programmes which would appeal to NHS commissioners. For example, patients using our programmes showed high levels of patient satisfaction, significantly improved self-reported knowledge of their condition and an average engagement of 10-13 minutes per session.
Participating in various exercises, small group work and pitches on the Bootcamp highlighted the need for more robust clinician feedback around prescribing our digital programmes and feedback on how usable the information prescription platform, Healthinote is. It also underscored the need to ensure any patient feedback collected is reflective of the diversity of different cultures, ethnicities and underrepresented groups in the population.
Going forward on our evidence generation journey, we plan on making greater use of mixed method studies including the next big step of health economic evaluation to assess the impact of our educational programmes. This will start with our SBRI-funded second phase “My Stroke Companion” at UCLH where we will be measuring the impact of the programme on patient outcomes, clinician time and healthcare optimisation.
I would highly recommend the Bootcamp to any digital health company from the outset as it can help inform what evidence you collect, when you collect it and how you evaluate it.
If you are interested having a chat about the above or in learning more about Cognitant, the Healthinote platform or how we are working with the NHS then please reach out to us on Linkedin or at email@example.com.
- Veroff D, Marr A and Wennberg DE. Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Affairs 2013;32(2):285-93
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Cognitant was part of the first cohort of the DigitalHealth.London Evidence Generation Bootcamp programme.
The DigitalHealth.London Evidence Generation Bootcamp is a collaborative programme funded by two of London’s Academic Health Science Networks – UCLPartners and the Health Innovation Network – MedCity, CW+ and receives match funding from the European Regional Development Fund.