We are entering a period that historians will one day call ‘the technological ages’; a time when everything was done at the flick of a switch; when children knew how to use iPhones before they had learnt to walk; perhaps one in which they needn’t have learnt at all. Now, with the emergence of telehealth, comes an opportunity for healthcare to ride this powerful wave into the future. The question of the moment: will the NHS be able to keep up?

The Department of Health defines telehealth as any service that ‘uses equipment to monitor people’s health in their own home…[monitoring] vital signs such as blood pressure, blood oxygen levels or weight.’ It also covers any use of information or communication technology for remote consultation between a patient and a health professional. The department’s claim is that telehealth will be the solution to the “confused, disjointed, fragmented mess” into which the health and social care system has dissolved, saving the NHS up to £1.2bn over five years. This potential, however, has been thus far largely untapped. In May 2012, Estonian President Toomas Hendrik Ilves, Chair of the European Independent High-level eHealth Task Force, said this:

“We know that in healthcare we lag at least 10 years behind virtually every other area in the implementation of IT solutions. We know from a wide range of other services that information technology applications can radically revolutionise and improve the way we do things.”

The beneficial applications of telecare and telehealth, particularly in facilitating self-management for the elderly and those with chronic conditions, are profound and far-reaching. As Health Secretary Jeremy Hunt affirms, 70p out of every pound spent on the health budget goes towards providing care for those with long-term conditions. He suggests that “technology can help people manage their condition at home, free up a lot of time and save the NHS money…In a world where technology increasingly helps us manage our social and professional lives, it seems logical that it should also help people manage their health.”

A clear evidence base is needed to direct successful implementation of such telehealth technology and inform vital investment decisions. In order to fill this void, the Department of Health announced in 2006 the establishment of three pilots; known as the ‘Whole Systems Demonstrators’. Their purpose was to assess the clinical and cost effectiveness of integrating telehealth and telecare into current public health services.

The Whole System Demonstrator (WSD) programme was one of the most complex studies of its kind and the largest randomised trial of telehealth and telecare in the world. Initially, headline results from the trial seemed positive. The Department of Health released statistics suggesting that, if used correctly, telehealth can offer a 15% reduction in A&E visits, a 20% reduction in emergency admissions and, perhaps most ‘strikingly’, a 45% reduction in mortality rates. A more thorough inspection of the evidence, however, revealed otherwise. After adjusting for quality of life measures, Henderson et al. found that the telehealth intervention resulted in beneficial, but largely insignificant health outcomes at dramatically higher costs. Cartwright et al also found that it was not conducive to positive psychological outcomes . This second flaw illuminates a potentially devastating failing of telehealth as a concept. Is it possible that physiological health, particularly in the elderly, is not the only (or even primary) reason for the frequency of their health service use?
The days of the great avuncular doctor figure are fading away, but the importance of health professionals as holistic carers, rather than merely clinical problem-solvers, is far from diminished. Sometimes people just need someone to talk to, and this interaction can be as remedial as the accompanying prescription.

Nevertheless, for many, health consultations are nothing but a burden, and for these patients, telehealth bears enormous potential. The WSD trials are so confounded by a lack of specificity as to be almost worthless in their findings, and the criticism that such technology is cost-ineffective demonstrates a tragic lack of foresight. The problem of health service overuse is only likely to get worse. In our radically ageing population, the proportion of patients with chronic conditions is set to increase, and this is the patient care that is most costly to the NHS. The technology that could alleviate this burden, however, will not suffer the same difficulties. The capabilities of telehealth will broaden and diversify at a rate faster than we realise, and the associated costs will inevitably go down. If there is any possibility of teleheath becoming a viable alternative to conventional face-to-face medicine, then it is a worthwhile investment. The cost of such a solution will soon become insignificant, but its advantages are only likely to grow.

There will always be those who are suspicious of new methods, and when it comes to technology, unreliability will be chief among their concerns. Certainly, we must be sensitive to these suspicions, but we cannot allow them to direct our future. Imagine if we all used maps simply to placate our grandfathers who do not trust GPS. The idea is embarrassing. If the NHS does not soon jump onto this technological bandwagon, it will find itself in a landslide of archaism from which it may never recover.

BY: David Salisbury

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