• American cardiologist leading NHS review says there should be no “exceptionalism” for digital health technology
  • Warns that poorly-tested algorithms can “hurt a lot of people really fast”
  • Part of wider review considering how digital technology will transform the NHS workforce

A major review of new technologies and workforce in the NHS will “come down hard” in favour of stronger evidence before new digital treatments are rolled out, the lead reviewer told HSJ.

American cardiologist and digital medicine researcher, Dr Eric Topol, was commissioned by the health and social care secretary earlier this year to carry out an independent review of how the NHS, and specifically its workforce, will need to change “to deliver a digital future”.

It will also inform Health Education England’s wider long term health and care workforce strategy. 

Speaking to HSJ, Dr Topol said he did not support the argument, sometimes offered, that digital health products did not need to meet the same rigorous standards of evidence expected of traditional medical treatments.

“There should be no exceptionalism,” he said.

“We are going to come down really very hard on that. The priority is getting the evidence base before going forward, putting in the resources to nail it. It’s so important.”

What is the Topol review?

It is one of five independent reviews commissioned earlier this year to inform the health and care workforce strategy, focusing on digital technology.

The review specifically considers the emergence of digital medicines, such as wearables, artificial intelligence and genomic over the next 20 years and how the NHS, and its workforce specifically, will need to adapt to these technologies to deliver better care.

Dr Topol and his review board published its interim report in June, with a full report scheduled by the end of the year.

The review is being facilitated by Health Education England and will be accepting public evidence until 29 August.

You can read the interim report and submit evidence here.  

Dr Topol said there already some “questionable early starts” in delivery digital health in UK, but scandals in US, such as the Theranos blood test, showed the risk of deploying innovation new technologies without rigorous evidence.

“We can’t skip this, you design an algorithm that’s got a glitch in it and you hurt a lot of people really fast.

“All these tools have particular dangers.”

In early July, HSJ revealed rising concerns about the fragmented regulation of medical software, a market that has seen rapid growth over the past three years with little independent oversight.

A week later, the Lancet published an editorial, calling for a clearer assessment framework in the UK for digital health, “to differentiate efficacious digital products from commercial opportunism”.

”Continuing to argue for digital exceptionalism and failing to robustly evaluate digital health interventions presents the greatest risk for patients and health systems”, it said.

Dr Topol said the review panel were still examining the details of digital health regulation in the UK, but the final report would include a section assessing regulation in detail.

More broadly, the review is expected to argue for greater resources to train staff in the use of new technologies, with growth in specialist roles such as clinical bioinformatician and “AI-enabled future ophthalmologist”.

Dr Topol said executed properly, technologies such as genomics, digital medicine and AI should not lead to reduction in any one group of health workers, but rather free them to spend more time with patients and less on administrative and procedural tasks.

“We’ve got to eke out much better productivity, and humanity in medicine, that has been degrading over time.”