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Written by Dr Jeremy Horwood, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol and NIHR CLAHRC West, and Dr Andrew Turner, Senior Research Associate, NIHR CLAHRC West. First published as a Centre for Academic Primary Care blog.

Researchers from the DECODE study hosted a workshop late in 2018 to explore the unintended consequences of digital health tools used in primary care. The workshop was attended by members of the public, technology developers, GPs and key researchers in the field.

Digital health tools, such as health monitoring apps and online patient portals, are becoming commonplace, with NHS England supporting their use to improve patient access and care. But this increase in their use could lead to unintended consequences, both positive and negative. An understanding of these consequences is vital, so we can minimise the negative effects and harness the positive.

DECODE aims to improve how digital health tools are used in primary care by investigating the unintended and unexpected consequences of these technologies for patients, GPs and practice staff for three popular applications in GP practices.

What we’ve found so far


Smartphone apps that support patients to monitor and self-manage long-term conditions with their GP

  • Some patient groups who don’t often access primary care may be better served by apps, but the technology may exclude others.
  • GPs may need new expertise to evaluate the quality, safety and trustworthiness of apps.
  • Patients collecting and bringing their own data may be valuable, but GPs need new ways to validate, record, and act on it.

Online GP consultations

  • Lack of face to face contact may help people disclose sensitive issues, but contribute to social isolation.
  • Some systems may cherry-pick the simplest medical enquiries, leaving other patients with reduced access to care.
  • Not being able to conduct a physical examination for diagnosis may impact on patient satisfaction and  have medical and legal implications.

Online patient access to medical records

  • Patients could be coerced to reveal their login details, putting their privacy  at risk and removing the consultation as a safe and confidential space.
  • Patients may be able to act on information in their medical records, reinforcing what said in consultations and improve health outcomes.

The unexpected and unintended consequences raised by workshop participants highlight the far-reaching impacts that these digital health tools can have. The challenge now is to understand how these tools can be implemented and used in ways that stand the best chance of doing more good than harm.

Take part

We’re keen now to get as many views as possible on potential unintended consequences to investigate. If you have any further ideas related to these three types of technology or if you would like to comment on the ones identified above, please contact Andrew Turner or leave a comment at the end of this post.

You can also take part in discussions on Twitter using the hashtag #DECODEstudy.

Next steps

Interviews are now being conducted with patients, practice staff, commissioners and industry representatives that have been involved in the use or implementation of digital health tools to examine their experiences, opinions and reflections.

The outcome from DECODE will be guidance on the unexpected consequences of digital health tools for patients, primary care, policy makers, technology industry developers and digital health researchers, to improve the development, implementation and evaluation of digital health tools in primary care.