Raising the standard in digital health

The Deputy Chair of the new Clinical Digital Council argues that for effective digital health services and systems to succeed across the NHS improving patient care, we need agreed digital health standards which cover evidence, regulation and clinical safety:

The global market for digital health is expected to reach almost £43billion by 2018 and £408billion by 2025.

Health IT systems represent the largest market both globally and in the UK, where they contribute 66 per cent of digital health sales. But the most promising market for growth is mobile health with sales of apps and wearables predicted to increase by 35 per cent in the UK by 2018.

With the increasing value of these markets comes increased focus on the policy around health IT systems and interoperability. This is key to enabling safe and effective data exchange, but unfortunately we have discovered a lack of interoperability with digital health tools such as devices, wearables and integrated apps which need to be addressed.

What has become clear is that the market has pushed on ahead in creating high cost health IT systems, with little focus on building application programming interfaces (APIs) or allowing smaller digital health players to integrate clinically effective tools into those larger electronic health records and IT systems.

In order to address this nationally, it is clear that a standard of what is ‘good’ needs to be developed and adopted. This would allow developers to create tools and products that not only impact clinical care and improve patient outcomes, but that can also connect to and talk to other clinical systems being used within the NHS.

As part of the NHS Five Year Forward View and Next Steps, a common standard across regulators, NICE, Public Health England and other central NHS bodies to review digital health tools was developed. However, in the fast changing world of digital health, it was clear that a cross stakeholder group was needed to maintain this standard and to ensure it changed accordingly with technology developments and advancements.

A group was also needed to address emerging questions around what amounts to good evidence in the digital health space, impacts of real world data, and how we change the narrative of healthcare delivery in the digital age. And while technology in healthcare does not yet truly make intelligent decisions independently, with the pace of change it is clear we need to address these questions now.

To help address these, under the leadership of the outgoing Chief Clinical Information Officer (CCIO), Professor Keith McNeill, the Clinical Digital Council (CDC) was set up at the end of 2017. Its membership includes senior clinical digital health leaders from across the arm’s length bodies – currently the MHRA, NICE, Care Quality Commission, Public Health England, NHS England, NHS Digital and the Department of Health.

The goal of the CDC is to ensure issues affecting digital health policy are raised in the right environment, and it acts as an advisory body to the governance and delivery groups informing the Digital Delivery Board – the governing body which decides NHS technology spending. It is a clinically-led forum for informed discussions and sharing of standards and policies relating to digital health and clinical implementation.

The CDC meets every other month under the chairmanship of the CCIO for health and care and is managed by me, as deputy chair.

Our focus this year is to:

  • Publish a digital health standard with a focus on evidence, regulation and clinical safety. This will inform the wider Health Standards and NHS Digital Service Standards Manual and procurement frameworks;
  • Create a common understanding of what is good evidence with respect to digital health, and use of real world data and trials to inform effectiveness of a product or tool;
  • Explore the challenges of machine learning and intelligent technology to policy and regulation, with an aim to creating a policy framework.

For more information on the CDC contact me at You can also see our recently published roadmap for patient-facing digital services at

Dr Indra Joshi is the Clinical Lead for NHS England’s Empower the Person Portfolio overseeing the national citizen facing digital initiatives within the NHS with a focus on evidence, data, digital health standards and policy for AI.

Indra has a unique portfolio with experience stretching across policy, governance, digital health and marketing, national project strategy and implementation; whilst remaining true to her professional training as an emergency medic.

She is the Clinical Director of One HealthTech – a network which campaigns for the need and importance of better inclusion of all backgrounds, skillsets and disciplines in health technology. Alongside she is a Vice Chair for the British Computer Society (Health), an international speaker and consultant on digital health, an expedition medic, and most importantly a mum to two wonderful little munchkins