DECODE
Research type
Research Study
Full title
Unexpected Consequences of Digital Health (DECODE)
IRAS ID
251382
Contact name
Jeremy Horwood
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
1 years, 9 months, 28 days
Research summary
Research Summary
NHS England advocate digital health tools to improve patient access, quality and efficiency of care. With the rapid development and adoption of digital health in primary care, unexpected consequences which disrupt healthcare processes and outcomes will increase. An understanding of these consequences is vital, so we can minimise the negative effects and harness the positive.What is the aim of the project?
To improve the appropriate adoption of digital health tools in primary care by identifying and understanding their unexpected consequences (benefits and harms).What are we doing?
The DECODE (unexpecteD consEquenCes Of Digital hEalth) study will examine the unexpected consequences of technology for patients, GP’s and other practice staff for three popular uses of technology in GP practices. 1) Smartphone apps that support the monitoring and self-manage of long-term conditions, 2) online consultations and 3) patients online access to their medical records.Interviews will be conducted with patients, practice staff, commissioners and industry representatives that have been involved in the implementation of digital health tools to examine their experiences, opinions and reflections. The study will investigate how technology affects access to health care, medical decision-making, patient safety, doctor-patient relations and GP practice workload.
Summary of Results
Health services are increasingly using digital tools to deliver care. Online consultations and online patient access to medical records are being increasingly adopted in general practices to increase patient access to care, promote patient autonomy, and increase the efficiency of care and general practice workload. The COVID-19 pandemic has also dramatically accelerated the adoption of digital tools in England and there is a renewed call from government that the future of healthcare should be ‘remote by default’.Project aims
The project aimed to identify and understand the unintended consequences of online consultations and online access to health records that had been experienced by patients and general practice staff.
What we did
We interviewed 25 general practice staff and 25 patients across 12 general practices in South West and North West England, who used online consultation tools or patient online access to medical records. These interviews took place in 2019, before the COVID-19 pandemic.
What we found and what this means
In many cases the unintended consequences were as much about how the tools were implemented by general practices as they were consequences of the technologies themselves. This means they can be avoided if recognised in advance. Recognition of these unintended consequences may help those implementing online consultations maximise the benefits and minimise the harms.
(1) Online consultations
We found online consultations can make it difficult for some patients to communicate effectively with a GP. They particularly disadvantage patients with limited IT skills or access to IT. At the same time, using these new tools can generate additional work for GP practices and led to staff dissatisfaction.
Unintended consequences stemmed from patients being unsure about the processes for dealing with their queries and whether practices used online consultations as the preferred or an alternative method of contact. New processes created to avoid negative unintended consequences could themselves have negative unintended consequences. This was especially the case when they added to, or redistributed, practice workload, contributing to staff dissatisfaction.
(2) Online patient access to medical records
Online access generated unintended consequences that negatively impacted patients’ control over and understanding of their health, such as when patients discovered surprising information or information was difficult to interpret.
Online access impacted GP’s documentation practices, in some cases potentially aiding patient autonomy such as when GPs pre-emptively attempted to minimise potential misunderstandings, in other cases, negatively impacting the quality of the record when GPs avoided documenting their speculations or concerns, which could have negative medicolegal and patient safety consequences.
Contrary to assumptions that practice workload would be reduced, online access introduced necessary extra work, such as managing and monitoring access and taking measures to prevent possible harm to patients.
REC name
North West - Haydock Research Ethics Committee
REC reference
18/NW/0625
Date of REC Opinion
22 Aug 2018
REC opinion
Favourable Opinion