Dr Malte Gerhold, CQC’s Executive Director of Strategy and Intelligence talks about CQC’s regulatory sandbox work.
New digital technologies hold exciting opportunities to improve people’s experience of health and social care services: they can provide faster, more accurate diagnoses, and replace manual record keeping and processes with easy to use, supportive tools for people working in health and social care. But they also hold risks that need to be managed to keep people safe.
This is why the Care Quality Commission has such an important role in both encouraging new technologies and innovation, while looking carefully at how it is implemented.
One exciting opportunity emerging across different healthcare services is the use of digital triage. Services can use an online tool that asks people questions about their symptoms; then, based on their answers, the tool uses an algorithm to make a decision on what service to direct them to, or it could be a tool that supports non-clinical staff to make triage decisions.
The non-digital examples of triage that most of us are familiar with are when you call your GP and talk to somebody who asks questions before they decide to give you an urgent appointment, or the initial assessment in A&E that decides whether we get seen straight away or later. Digital triage moves this process online.
Although it has many benefits, digital triage also holds risk. Its development is based on previous decisions and existing clinical guidance, and the way information is provided and recorded affects its success (what isn’t provided isn’t taken into account — including all the face-to-face observations you’d get from a GP practice or A&E nurse). Some people also can’t use or feel uncomfortable using online tools.
So, one thing we need is a description of what a good use of digital triage tools in health care looks like. This can then be used by developers, care providers and their staff, and the public so that they can assure themselves that things are done right. As the quality regulator, CQC can also use this when assessing the quality of services.
To help us produce this description of ‘good’, we just completed CQC’s first ‘regulatory sandbox’ on digital triage, as part of a host of initiatives to enhance the way in which CQC can encourage innovation. This was supported by the Department of Business, Energy and Industrial Strategy’s (BEIS) Regulators’ Pioneer Fund.
A regulatory sandbox (the term comes from the financial industry, no actual sand involved!) is a collaborative approach that brings together care providers, tech developers, people who use services, and the regulator, so they can develop ideas in a common, open and safe space.
For digital triage, we started by inviting applications from providers and developers to join our sandbox, based on the type of product they delivered, and whether they were currently using digital triage. We then spent 12 weeks working with this group to describe what good looks like, develop CQC’s regulatory approach to digital triage tools where services are using them, and to highlight issues that other stakeholders (like NHSX or MHRA) can address to help make sure digital triage is used safely.
You can read more detail about this in our full sandbox report on digital triage services, or check out our podcast on innovation and regulation everywhere you get your podcasts (coming on 27th January).
We are completing two more regulatory sandboxes in the next couple of months: one looks at how machine learning algorithms can support diagnostic and imaging services, such as delivering and interpreting imaging (X-rays), physiological measurement, blood samples, endoscopy, sonography and other clinical data. The other sandbox looks at new ways in which people who need care are connected with a personal assistant (and traditionally employ them directly), an area currently not within CQC’s remit but growing in its offer to people as an alternative to home care services.
After each phase we will publish a description of what good looks like, which will guide other providers, innovators and people using services, and identify what changes CQC may have to make to assess them in the best possible way.
This is exciting work — and it’s part of how we are adapting as a regulator to a world in which technological innovations are not just introducing changes to care much faster, but are also much more complex to understand. We are looking to do more such work in the future, in partnership with providers, innovators and the public (and other national bodies like NHSX, NICE and MHRA) to make sure we have the right regulatory approach as services develop. The future of technology in care is exciting, and by using iterative, collaborative regulation will help keep it safe for people using services.