A model for healthcare delivery that leverages technology can maximise resources, and better engage clinicians and patients, as Corinne Swainger reports
Although healthcare systems around the world are diverse, a growing number are turning to telehealth, telecare and m-health technology to manage the cost and quality of common challenges.
Demand for this “connected health” is primarily driven by a higher incidence of chronic disease and disability, due to an ageing population.
Access to high-speed broadband, wi-fi internet connections, mobile devices and new software applications (apps) have been instrumental in expanding the use of this technology for various healthcare services.
Telehealth – or remote patient monitoring – uses electronic equipment to monitor patients’ vital signs, such as pulse, weight, glucose levels, respiration and blood-oxygen levels, in real time while a patient is at home or on the move. The data is automatically transmitted to another device, for example at a nursing call centre, to allow ongoing monitoring and early medical intervention, if required, reducing the need for patient travel.
Telecare refers to a wider range of remote healthcare, such as the transmission of images and clinical data from one hospital to another. Video-conferencing can also allow consultants to communicate to staff and outpatients remotely. In the United States, telecare has been critical in reducing stroke complications, one of the most expensive costs to the healthcare system. Physicians in small, rural US hospitals can connect with a neurologist in larger specialist hospitals remotely to review a patient’s symptoms and make vital life-saving decisions on delivering critical treatments.
This technology can empower patients by moving them into the role of producers and deliverers of healthcare services rather than just recipients
Closely associated with telecare is m-health, which uses mobile devices, such as smartphones and tablet computers, to help physicians find and refer to reliable medical information, instead of committing vast amounts of data to memory. Healthcare professionals can also use m-health to consult with medical colleagues and deliver information directly to patients via the patient’s mobile phone.
“These technologies offer opportunities to interact with the patient while they are in the community, to maintain patient health, to focus on preventative measures that not only improve the quality of lives, but also reduce the burden on the healthcare delivery system, since fewer patients require services for acute episodes,” explains Kevin Lynch, head of healthcare at software provider SAP UK and Ireland.
Early results from the UK’s Whole System Demonstrator trials – the largest randomised control trial of telecare and telehealth in the world – recently showed that use of this technology can reduce patient mortality by 45 per cent, emergency admissions by 21 per cent, elective admissions by 24 per cent, A&E visits by 15 per cent, days in hospital by 14 per cent and tariff costs by 8 per cent.
In Europe, Scotland is leading the way in the successful employment of telecare and telehealth. However, some patients in the UK have voiced concern that the future routine use of this technology might reduce the amount of personal contact between GPs and their patients.
In response, Professor George Crooks, medical director for NHS 24, and director of the Scottish Centre for Telehealth and Telecare, explains that connected health should be used an “enabler” rather than the “prime focus” of future healthcare. This technology can empower patients by moving them into the role of producers and deliverers of healthcare services rather than just recipients, he says, but must fit with the patient’s needs inside and outside their homes
“Face-to-face care will always be the mainstay and the most important thing that health and care organisations can provide. We must be wise. If we actually use technology to keep people in their own communities, but only allow them to be prisoners behind their own front door we have failed everyone,” he says.
However, the expansion of telehealth and telecare involves various challenges. “The main challenge is adoption,” says SAP’s Mr Lynch. “Patients and healthcare trusts will need to see the value of their participation in these services, beyond quality of care.”
Loretta MacInnes, marketing manager at Telecare Services Association, adds: “Hospitals will also need to work with primary care and social care partners in ensuring that the patient is at the centre of the care package, and that each package covers not only the patient’s immediate health needs, but also their longer-term health and social care needs.”
Other major issues include privacy and security. As such, healthcare professionals who use m-health will need to keep patient privacy and confidentiality in mind, especially if they text patients or access medical records on an unsecured device.
Meanwhile, connected health continues to expand. In January 2012, the NHS launched the 3millionlives campaign to roll out the use of telehealth and telecare on a large scale. This campaign aims to improve service delivery for at least three million people with long-term conditions and/or social care needs.
- The International Telecare and Telehealth Conference 2012, the largest event in Europe focusing exclusively on telecare and telehealth, takes place at the Hilton Birmingham Metropole, November 12-14.
CONNECTING DOCTORS AND PATIENTS
USING APPS TO ACCESS PATIENTS’ RECORDS ELECTRONICALLY
In the United States, AirStrip Technologies recently expanded its patient monitoring technology and has launched a new mobile app that doctors can use to access patients’ electronic health records (EHR) in real time through their smartphones and computer tablets. Using such apps, physicians can open charts at anytime, anywhere, regardless of where the records are held. Doctors can quickly review this data, making fast on-the-go decisions, as well as advising patients and healthcare professionals on treatment or medication, and use electronic prescribing (e-prescribing) to send new prescriptions to pharmacies.
VIDEO-CONFERENCING WITH PAEDIATRIC HEART SPECIALISTS
The Royal Belfast Hospital in Northern Ireland supplements its traditional care with telemedicine. Parents of infants with heart problems, who are discharged but need ongoing monitoring, are given laptops with built-in video-conferencing technology. Parents use this for face-to-face appointments and, if worrying new symptoms arise, to contact cardiologists for further advice. Local paediatricians can also scan a newborn baby’s heart and transmit data to experts at the hospital via video-conference for accurate diagnosis. Making a diagnosis within the first 24 to 48 hours is crucial for babies born with heart problems.
CHECKING SUSPECTED SKIN CANCER SYMPTOMS BY IPHONE
In Sweden, where skin cancer is a major problem, doctors are using apps designed specifically for the iPhone to diagnose and prevent skin cancer. These apps encourage patients to perform self-checks for any unusual moles or suspected skin changes and photograph these lesions using their iPhone. The app then transmits these images to the patient’s doctor for regular analysis. Patients only need to attend the clinic for cancer screenings if recommended by their doctors. This telemedicine helps to prevent harmful lesions forming on the skin before they become lethal.
MOBILE PHONE PROVIDERS CAN SUPPORT REHAB AND RECOVERY
In Spain, Telefonica recently launched a new wireless knee brace embedded with motion sensors, designed for patients who have had a total knee replacement. This allows patients to carry out physiotherapy at home. If the patient is moving during exercise, the motion is simulated via a 3D avatar on a remote computer. This data is then sent to doctors for review on a PC or smartphone. Trials started in Spain and Chile in 2009, followed by tests in the UK, and Telefónica is now selling the service to hospitals and healthcare providers.
DISTANCE NO OBJECT: BRINGING THE PATIENT TO THE DOCTOR
In India, around 70 per cent of the population live in rural areas, while 80 per cent of doctors live in and around large towns and cities. Now telecare services are helping to reduce the extensive distances patients have to travel to receive hospital care. Cisco Systems, a US-based company, has recently launched several public-private partnerships (PPPs) with regional governments in India. This technology will connect rural clinics with their nearest district hospitals. Local practitioners will check a patient’s vital signs, while a hospital doctor provides consultation and real-time diagnosis through a video connection.