Jeremy Wyatt

How can we develop more fundable NIHR digital healthcare proposals?


Jeremy Wyatt DM FRCP ACMI Fellow, Professor of Digital Healthcare, University of Southampton and Clinical Advisor on New Technologies, RCP London


Date: 28 June 2018

I’m sure that all of us working in digital healthcare strongly welcome this cross-programme funding opportunity from the NIHR. Contrary to the beliefs of some applicants, NIHR boards do actually want to spend their allocated funds and welcome proposals on all topics relevant to the NHS and social care. However, they have not always found it easy to fund digital health proposals in the past. I understand this may be because the proposals they received have been technology-led rather than focusing on a health problem, attempted to evaluate a specific commercial product in a way that failed to generate useful generic insights for the NHS, lacked a strong theoretical basis for the intervention or did not demonstrate good understanding of research methods appropriate to the question  – and sometimes showed all four of these defects.

So, this welcome funding opportunity brings an obligation on digital healthcare researchers to submit a compelling set of proposals that makes the selection task easier for NIHR boards and helps move our field forwards. To support this process, here are some personal suggestions for how to make your digital healthcare project more rigorous and relevant, and therefore one that NIHR may be more likely to fund.

  1. Start with a real health or social care problem that matters – not an obscure condition or rare disease that only affects 50 people in the UK
  2. Build a research team that includes all relevant expertise including patients or service users, clinicians and methodologists (statisticians, health economists and / or health psychologists), as well as digital health experts
  3. Review previous work on and theories relevant to your chosen problem area (eg. Michie’s COM-B model of behaviour change) and ensure that the digital technology you choose is justified by reference to user characteristics, the scenario of use (“use case”) and our theoretical understanding of why the problem occurs.
  4. Use the MRC Complex Intervention Framework or a recent variant of that for digital interventions to structure the development and evaluation pathway for each component of your intervention, and how they are combined.
  5. Develop an evaluation plan that includes testing of the usability and accuracy or appropriateness of the digital intervention’s output, ideally in both lab and field settings, as well as its impact on healthcare structure, process and outcome, taking account of known biases in studies of digital technologies.
  6. For your impact study, ensure that study participants, outcome measures and the control are clearly defined and justified with respect to the main study question. Add a process evaluation and any other measures that may be necessary to understand why the study failed to show the expected result and how the intervention can be improved.
  7. Consider how your new technology supports existing care pathways or models, and what changes might be needed in these to maximise the benefits of your innovation. Are there implications for patients, carers, clinical skill mix or education that could ultimately make your new approach infeasible? Are you evaluating a new digital healthcare technology or a new clinical service supported by that technology? Sometimes, drawing a logic model showing how your proposed intervention or activity achieves its objectives can be a helpful way to identify intermediate outcomes, leading indicators or process measure .
  8. Consider how the intervention might be supported and improved once NIHR funding stops. One practical question here is, what data would NHS organisations need to write a successful business plan for this digital pathway, and can you collect this data during the NIHR funded project? Another is, does this digital intervention come under the revised EU regulations for medical devices and if so, at what stage to seek the CE marking this requires?

A final personal comment on including commercial organisations in your consortium. While entrepreneurs and commercial start-ups have a great reputation for agile development, innovation and providing long term support, the innovator’s mantra of fielding the minimum viable product then responding to risks as they arise is not really compatible with our “safety first” approach in healthcare. It is also at odds with the staged approach to complex intervention development and fixed study protocols expected by NIHR funding Boards. So, while collaboration between NHS clinicians and academics seems likely to generate an NIHR-fundable research project, commercial collaborators will often need to be educated about the different safety culture around healthcare and the need for independent evaluation before they can usefully contribute.

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.
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    In our latest blog, Jeremy Wyatt discusses the new digital technologies funding opportunity.
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    Jeremy Wyatt DM FRCP ACMI Fellow, Professor of Digital Healthcare, University of Southampton and Clinical Advisor on New Technologies, RCP London


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