Towards a framework for the appraisal of digital products for mental health

Abstract

Introduction: Mental health disorders are the largest cause of disability in the UK, affecting 1 in 4 people over their lifespan and demand for services already exceeds NHS resources. Advances in digital information and communication technology (ICT) offer the potential to transform mental healthcare through improved detection and access to services and more effective and flexible treatments. There are, however, unique risks associated with digital mental healthcare products that must also be considered. The huge potential that these products promise to deliver services in new ways and to hand more control to patients – is also the greatest barrier to their adoption. Services may need be reconfigured, and users must be assured about safety, security and effectiveness. A number of national, strategic initiatives are looking at this topic and this work is essential. Also required, however, are smaller projects that start to use these products in order to learn: • What patients, practitioners and commissioners want from digital products. • What information they need when considering using or purchasing them. • What barriers exist to adopting these technologies. • What should the role be of regulators, policy makers and initiatives such as the NHS Apps library. This paper describes such a project. Aims: This paper will describe: • The development of an initial framework for the appraisal of digital mental health products being considered for use in the NHS (complete). International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116559– http://www.ijic.org/ • How this framework was applied by the mHealth Habitat (a city-wide initiative in Leeds) and what was learnt from this (March – July 2014). • How the framework was refined following its use in mHealth Habitat and other clinical areas (July-August 2014). Results: In March 2014 a workshop brought together 20 individuals (practitioners, researchers, service users, technology developers, clinical and information governance managers and a digital health policy expert) from a range of organisations including MindTech, Leeds and York Partnership NHS Foundation Trust, The University of Leeds and Nottinghamshire Healthcare NHS Trust. Findings of workshop: A staged, proportionate approach to appraisal required. This should begin with basic requirements such as safety and quality and move to more advanced requirements such as clinical and cost-effectiveness if and when appropriate. There is not currently an effective marketplace for digital products that clearly defines NHS requirements and allows developers to demonstrate how they meet and exceed these. This could drive innovation and raise standards. An initial framework was developed, consisting of four categories, each with 7 10 ‘essential criteria’: Information Governance, Information technology and interoperability; clinical validity, research and evidence; safety and regulation; design, accessibility and usability. This is currently being applied by practitioners and service users across a number of trusts and will be refined based on the results of this. Conclusion: As the adage goes, necessity is the mother of invention. This project developed as a result of a number of organisations wanting to use digital mental healthcare products and discovering no existing guidance or leadership on how to appraise these. Our findings will have implications not just for practitioners and users but also for policy makers, regulators and developers. Many of the issues addressed in this project are not unique to mental health and are therefore relevant to other clinical areas.