Institute of Epidemiology & Health Care



Project Title: The UnintenDEd (or Unexpected) Consequences Of Digital HEalth Tools in Primary Care (DECODE) Study

Principle Investigator: Dr Jeremy Horwood University of Bristol

UCL Co-Investigators: Prof Fiona Stevenson; Dr Fiona Hamilton; Dr Lorraine McDonagh

Collaborators from Universities of Bristol, Manchester, Oxford and Warwick; and the West of England Academic Health Science Network (AHSN): https://arc-w.nihr.ac.uk/research/projects/exploring-the-unexpected-effects-of-digital-health-tools/


Start date: 1 May 2018

Finish date: 29 February 2020

Main aim:

The DECODE Study aims to explore the unexpected consequences of digital health technologies for patients, GPs and general practice staff. We are particularly interested in smartphone apps, online consultations with GPs, and patients having access to their medical records.


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 explosion in their use could lead to unexpected consequences, both positive and negative.

Study Methods:

This project aims to understand the consequences of using digital health tools in primary care, and includes:

  • Reviewing the existing research on the unexpected consequences of using digital health tools
  • In-depth interviews with patients, GPs, practice staff, commissioners and industry representatives on their perceptions and experiences of digital health
  • Development of three case studies on:
    • Smartphone apps that support patients to monitor and self-manage long-term conditions with their GP
    • Online GP consultations
    • Online patient access to medical records
  • Workshops with stakeholders

Our Team:

UCL Researchers: Prof Fiona Stevenson; Dr Fiona Hamilton; Dr Lorraine McDonagh

Patient and Public Involvement (PPI): Patient representatives have been involved in designing the research and have taken part in the workshops. 

Commercial Company: Technology developers have contributed to the research through the workshops.

Healthcare professionals and policy makers: GPs and policy makers have contributed to the research through the workshops.


Funded by:

NIHR School for Primary Care Research.


Contact details: fiona.hamilton@ucl.ac.uk or L. McDonagh@ucl.ac.uk


Project links and documents:








Ethics approval:

This project has been granted ethical approval by NHS ethics team