Telehealth: let's hear from those who have used it

'Patients and carers should be asked what they want telehealth to do for them,' argues Lynn Young, ' … how they think it can enhance their lives.' Photograph: Alamy

Few people working in the highly charged world of healthcare will be surprised – or sad – to learn that the 3millionlives group has been disbanded. Since its inception in 2011, despite its original claim that three million people could benefit from the informed and appropriate use of telehealth, the widely held view is that any significant added value and health improvement has not yet been achieved.

Perhaps the problem – and, therefore, the cause of lack of progress – is that its structure and focus was misguided, although it held the very best of intentions. It was made up entirely of people working in industry, which resulted in polarised views, rather than the action required to promote telehealth successfully.

We are now told that the 3millionlives group will be replaced by another structure with the grander title of Integrated care for 3millionlives stakeholder forum. Apparently, it is likely to include clinical leaders, representatives from healthcare provider organisations, the third sector and local government. There is, however, an obvious absence – the most important people of all: patients and carers.

Genuine and effective grass roots engagement and the development of integrated care pathways can only be achieved if all parts of the multi-disciplinary and multi-agency team work together with a common purpose – the proper use of telehealth technology. From day one, within this team, there must be the patients and carers who have the strong desire and motivation to transform their lives through the use of modern technology.

The 3millionlives campaign aimed to recruit patients to telehealth, yet, two years in a row, research commissioned by the Telehealth Forum revealed that 90% of people are unaware of what telehealth is, and what it can do in terms of individual health improvement. Among the over-55s, who are statistically more likely to have a long-term condition, 92% have no understanding of what telehealth is. We cannot expect people to use telehealth to help manage their long-term condition if they are completely unaware of the available technology, and therefore ignorant of its potential benefits.

It is important to understand that telehealth is not appropriate for all people who live with one or more long-term conditions, but it is essential for the people who could benefit from it to be identified and encouraged to use it. Patients and carers should be asked what they want the technology to do for them, what they like and dislike about it and exactly how they want it to enhance their quality of life. Telehealth services can easily be adapted and tailored to meet the individual preferences and needs of the people using it.

If telehealth is to achieve its potential, we must develop a network of patient advocates. Telehealth cynics are advised to listen to patients such as Terry, who offered a most compelling argument for the widespread use of this technology at an event in Newham in east London. He eloquently described using telehealth as "having angels in the house", and how since his epiphany, has recommended it to his friends whom he thought could benefit from it.

Terry has also taken on the role of teacher to those who have been persuaded to "have a go" at telehealth. Word of mouth and recommendations from an experienced friend or relative is the surest route to expanding its proper use.

The Department of Health needs to be ambitious in terms of telehealth becoming the norm, rather than the extraordinary, and understand that a change in culture can only happen if enthusiasts, such as Terry are given a public platform to extol its virtues. So, my plea is that we must hear more from the people using telehealth and maybe a little less from those who produce and sell it.

Lynn Young is a former district nurse and primary care adviser to the Royal College of Nursing. She is also a member of the Self Care Forum

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GPs continue to do battle with government over telehealth

Health secretary Jeremy Hunt supports telehealth which could be a catalyst for service integration and patient empowerment. Photograph: Graham Turner for the Guardian

The greatest benefits from telehealth are yet to come – as a catalyst for service integration and patient empowerment. But these will only be realised if doctors stop looking for opportunities to reject it.

The development of telehealth has been dogged by politicisation of the issue and the way the conclusions of the "whole system demonstrator" programme were interpreted and debated.

Health secretary Jeremy Hunt is firmly committed to telehealth. The day after the publication last November of the first NHS Mandate, identifying its priorities for the coming years, he confirmed that seven pathfinders run by the NHS and councils would be signing contracts to provide access to telehealth for 100,000 people this year.

In the poisonous relationship between the Department of Health and GPs, ministerial support for a big expansion in the technology is interpreted by some doctors as yet another attempt to impose politically motivated change on the way GPs work.

The whole system demonstrator programme showed that telehealth secured significant reductions in mortality and emergency admissions. However, London School of Economics researchers concluded that "telehealth does not seem to be a cost-effective addition to standard support and treatment", claiming that quality adjusted life years provided by the programme cost £92,000, compared with the National Institute for Health and Clinical Excellence ceiling for cost effectiveness of £30,000.

Pitched as the biggest telehealth research project to date, and with a name that gave the misleading impression that it was a definitive answer, the conclusions provided sceptics and cynics with ample ammunition. In particular, some GPs resistant to signing up to telehealth programmes have been citing the demonstrator as evidence that it is a wasteful diversion of scarce resources.

But the weight that has been given to the LSE researchers' analysis is a mistake. It is all but a certainty that the cost for each person will fall as use of the technology becomes far more widespread, and that its effectiveness will increase. Improvements in performance will be driven by targeting its use to the patients who will benefit most and, crucially, by more sophisticated use of the information which it provides.

Telehealth technology is not particularly clever – the really clever part is the human system within which the technology is used. Community nurses, paramedics, GPs, consultants and above all the patients themselves are the essential tools of telehealth. As they become more experienced in analysing and acting upon the information which the technology provides, and different services around the telehealth patient become more integrated, patient benefits and cost effectiveness will rise.

Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff. It offers the prospect of ending the drudgery for both patients and clinicians of thousands of pointless outpatient check-ups which daily clog up hospitals. Users should require fewer GP appointments.

But the biggest benefit will come from providing patients with long term conditions with the encouragement and information to manage them more effectively. Patient empowerment must be central to any plan to exploit this technology.

Talk of "expert patients" and "patient empowerment" far outstrips improvements in the involvement of patients in managing their own care. But telehealth is an opportunity to improve people's understanding of their own health, give them a greater voice in decisions – such as deciding the right response to a particular reading – and perhaps most importantly encourage them to be less dependent on meeting clinical staff.

Telehealth has much to offer a financially constrained and struggling health system which is looking for better ways to meet the needs of older patients and others with long term conditions.

Concern among GPs that the primary care system is being overwhelmed is not matched by a willingness to explore new models of working. Telehealth deserves a better hearing from many doctors than it has had so far.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

GPs continue to do battle with government over telehealth

Health secretary Jeremy Hunt supports telehealth which could be a catalyst for service integration and patient empowerment. Photograph: Graham Turner for the Guardian

The greatest benefits from telehealth are yet to come – as a catalyst for service integration and patient empowerment. But these will only be realised if doctors stop looking for opportunities to reject it.

The development of telehealth has been dogged by politicisation of the issue and the way the conclusions of the "whole system demonstrator" programme were interpreted and debated.

Health secretary Jeremy Hunt is firmly committed to telehealth. The day after the publication last November of the first NHS Mandate, identifying its priorities for the coming years, he confirmed that seven pathfinders run by the NHS and councils would be signing contracts to provide access to telehealth for 100,000 people this year.

In the poisonous relationship between the Department of Health and GPs, ministerial support for a big expansion in the technology is interpreted by some doctors as yet another attempt to impose politically motivated change on the way GPs work.

The whole system demonstrator programme showed that telehealth secured significant reductions in mortality and emergency admissions. However, London School of Economics researchers concluded that "telehealth does not seem to be a cost-effective addition to standard support and treatment", claiming that quality adjusted life years provided by the programme cost £92,000, compared with the National Institute for Health and Clinical Excellence ceiling for cost effectiveness of £30,000.

Pitched as the biggest telehealth research project to date, and with a name that gave the misleading impression that it was a definitive answer, the conclusions provided sceptics and cynics with ample ammunition. In particular, some GPs resistant to signing up to telehealth programmes have been citing the demonstrator as evidence that it is a wasteful diversion of scarce resources.

But the weight that has been given to the LSE researchers' analysis is a mistake. It is all but a certainty that the cost for each person will fall as use of the technology becomes far more widespread, and that its effectiveness will increase. Improvements in performance will be driven by targeting its use to the patients who will benefit most and, crucially, by more sophisticated use of the information which it provides.

Telehealth technology is not particularly clever – the really clever part is the human system within which the technology is used. Community nurses, paramedics, GPs, consultants and above all the patients themselves are the essential tools of telehealth. As they become more experienced in analysing and acting upon the information which the technology provides, and different services around the telehealth patient become more integrated, patient benefits and cost effectiveness will rise.

Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff. It offers the prospect of ending the drudgery for both patients and clinicians of thousands of pointless outpatient check-ups which daily clog up hospitals. Users should require fewer GP appointments.

But the biggest benefit will come from providing patients with long term conditions with the encouragement and information to manage them more effectively. Patient empowerment must be central to any plan to exploit this technology.

Talk of "expert patients" and "patient empowerment" far outstrips improvements in the involvement of patients in managing their own care. But telehealth is an opportunity to improve people's understanding of their own health, give them a greater voice in decisions – such as deciding the right response to a particular reading – and perhaps most importantly encourage them to be less dependent on meeting clinical staff.

Telehealth has much to offer a financially constrained and struggling health system which is looking for better ways to meet the needs of older patients and others with long term conditions.

Concern among GPs that the primary care system is being overwhelmed is not matched by a willingness to explore new models of working. Telehealth deserves a better hearing from many doctors than it has had so far.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

How telehealth can improve patient care

Telecare should involve interaction as well as technology, says Simon Fradd. Photograph: Murdo Macleod

The NHS is facing a £30bn hole in its budget by 2020 and Clare Gerada, chair of the Council of the Royal College of GPs has said that we are currently short of 8,000 GPs, and by 2021 we shall need an additional 16,000.

It's obvious that the current way of delivering healthcare within the NHS is not sustainable.

There is already wide recognition of this and the development of integrated care pathways is evidence of progress. However, the savings generated are limited and the shift of location of care simply puts an even greater burden on general practice and primary care. Real savings come through removing the need for NHS care.

Britain is not alone in facing this problem. In the US, the Obamacare changes will give an additional 70 million people access to healthcare. The issue there is not financial – they have allocated a budget of $400bn – but the lack of a trained and skilled workforce.

In China the problem is even greater, as more than one billion people move from traditional forms of healthcare to western-style services. So it's no surprise that the annual international self-care day started in China last year on 24 July 2012.

What is interesting is the different focus that is emerging. In Europe the prime target for self-care has been around the management of minor self-limiting conditions, which account for 20% of GP consultations. However, the focus of the international self-care day movement is non-communicable diseases, which account for over 60% of NHS spending. It is this element of expenditure which is ballooning.

The initial focus is on illness prevention: living healthy lifestyles to improve quality and quantity of life. This only defers the need for healthcare, however. All our bodies start to fail at some point. The big issue in terms of self-care is full involvement in the management of one's own illness, especially long term conditions.

I have never understood why clinicians believe themselves to be the experts. Diabetics spend on average 3.5 hours a year with a clinician. For the remaining 8,756 hours they are on their own with minimal support. I have just been involved in an audit of readmissions to a major London teaching hospital within 28 days of discharge. The results were fascinating: a common theme was the lack of a clear ongoing care plan agreed with the patient and communicated before discharge to the GP and the patient's carers. I even came across a chronic bronchitis discharged without rescue medication.

Even where best practice is initiated, it is not always followed. I have been a patient in the past three years and am aware just how disempowering it is. Even as a GP who has been practising for 40 years, I waited to be told what to do rather than acting on my own initiative. What every patient needs is their own healthcare professional who can give reassurance and advice as soon as it's needed.

That scenario is now available, with telecare and telehealth. It astounds me that it is taking so long to become the norm. Placing this technology in a patient's home as part of a complete package of care can revolutionise their wellbeing as well as reduce hospital admissions. It does this at the same time as reducing GPs' workload, by interactively monitoring individuals in their home.

The vital thing here is interaction. As well as the technology, there must be a skilled, trained individual monitoring the data and interacting with the patient. If a chronic obstructive pulmonary disorder sufferer's breathing deteriorates, early advice to use rescue medication can avoid hospital admission. The same can apply to heart failure patients who gain weight as a result of fluid retention.

We are not going to get another 16,000 GPs or an additional £30bn. It's time to support patients in their role as experts in their own health. A prime plank of this should be telehealth.

Dr Simon Fradd is a GP in Southwark

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here