What is the Current State of Digital Health “Readiness” in the UK?: Findings from the Delivering Assisted Living Lifestyles at Scale (dallas) Programme

Problem: Digital health has the potential to support wellbeing, preventive care, and care delivery for those with chronic illness and multimorbidity. However, despite many demonstration projects and trials, and positive evidence from localised implementations, new technologies have proven slow to become accepted, integrated and routinized at scale. Previous studies have examined implementation issues in relation to single digital health products/interventions and/or single geographies but no studies have yet explored the full ecosystem readiness of a nation from stakeholders (professionals and public) to health care organisations (primary and secondary care), and wider commercial market, infrastructure, and policy environment to the deployment of a wide range of digital health products and services ranging from telecare services to web portals and apps. Here we have examined the readiness of the UK health system and wider environment to implement digital health at scale, through the evaluation of a national digital health and wellbeing programme called ‘Delivering Assisted Living Lifestyles at Scale’ (dallas, 2012-2015, £37M). The aim of this study was to identify barriers and facilitators to digital health and to make clear recommendations about key steps to help promote uptake and utilisation of digital health. Approach: Qualitative study involving Interviews (n=126) with key stakeholders; Focus groups (n= 7) with professionals and public using dallas services; dallas leads meetings (N=12); ethnographic field work/participant observation in one community (n=16); and cross programme documentary evidence (N=215) were used to evaluate the implementation of the dallas programme. We used a sociological theory, Normalisation Process Theory, and a longitudinal (3 years) qualitative framework analysis approach to identify emerging barriers and facilitators to the uptake and mainstreaming of digital health. Findings: Issues influencing readiness for digital health were noted at three levels: Macro (market; infrastructure; policy), Meso (organisational) and Micro (professional/public). Factors hindering implementation included: lack of IT infrastructure both locally and nationally; uncertainty around information governance; lack of incentives to prioritise interoperability; lack of precedence on accountability within commercial sector; a market perceived as difficult to navigate; inadequate implementation resources; low IT skills and access across users (professional and lay); and concerns surrounding security and safety. Factors enabling implementation included: clinical endorsement; digital health champions; and public and professional willingness to embrace digital health. Consequences: There is receptiveness to digital health, but substantial barriers to widespread use remain. Our work has enabled us to produce ten clear recommendations to ensure progress in this sphere. These include: greater investment in national and local infrastructure; implementation of clear systems for accreditation and quality assurance; incentivisation of interoperability; and investment in upskilling of professionals and public would help support normalisation of digital health.