What are the downsides of digital?

Summary

In this paper from The Strategy Unit, authors make no attempt whatsoever to dispute the upsides of digital. Time, experience and evaluation will show what gains digital technology has to offer. Instead, they focus exclusively on digital downsides, primarily from the perspective of ‘person-centred care’:

They used a wide lens. Rather than focusing down on specific digital technologies, they took a broad definition and sought to examine more general risks and challenges. 

Content

Cited downsides included: 

• Making care more transactional: ‘With triage through an algorithm you're only allowed to have one [problem]...It forces consultations to be very transactional’.
• Compounding disadvantage: ‘Having multiple interacting disadvantages makes it harder to keep with the pace that digital access to care is going at’.
• Creating disadvantage: ‘We are creating the inverse data quality law: the availability of high-quality data varies inversely with the need for healthcare’.
• ‘Blaming’ individuals: ‘We use digital products to say to people ‘you should lose weight’ or ‘you have a gambling problem’ - and this puts systemic issues back onto the individual’.
• Making Evidence Based Medicine harder: ‘When I tried to get data about how many people were using it [an app they were evaluating], and at what times of day, and then how much it costs to provide, how many staff were doing what - I was told I couldn't have this data because it was commercially sensitive’.
• Attraction to the ‘cutting edge’ rather than the basics: ‘You've got finite resources. Do you spend on bytes versus bricks, for example? So, where you invest in cutting edge technology, that might be expensive, and that means you've got less to spend on physical infrastructure to deliver care in’.
• Fuelling mechanical thinking: ‘I'm not so much worried about machines becoming more like us…what I worry about is people becoming more and more like machines…Our work [as clinicians] has become less fulfilling as it has been taken over by mechanistic thinking’.