Bob, an 82-year old retired engineer, has to take three tablets a day for his heart condition. But sometimes he forgets. When this happens his wellbeing is protected by a sophisticated system of sensors and alarms that connect his home to the health service, which prompts a nurse to call Bob to remind him. An electronic alert is sent to a central server and to his consultant at the local hospital, and the event is logged on his patient record.
Later that day Bob takes his own electrocardiogram (ECG) reading and sends the data electronically to his consultant or specialist nurse. The data is routinely reviewed and he can be called in for an appointment if an irregularity is picked up.
For Bob and thousands of patients like him, telehealth is not a vision of the healthcare system of the future, but one that already plays a crucial role in daily lives. Advanced digital technology has brought quite sophisticated care processes into their homes, helping them to carry on with family life while receiving treatment.
This ranges from ensuring that patients comply with their medication to the delivery of much more complex interventions, such as kidney dialysis or chemotherapy. Telehealth has the potential to keep patients out of hospital, away from the risk of infections, and support independent living in the community, where their recovery is likely to be aided by being in familiar surroundings.
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
Advocates of greater investment in telehealth also believe it has the potential to save the health service many millions of pounds in the long run, by helping to shift the burden of care away from hospitals into the community.
The government’s own estimate is that around three million people with long-term conditions could be supported at home. The Department of Health claims that trials have shown that the use of telehealth can lead to a 20 per cent reduction in emergency admissions, a 15 per cent reduction in A&E visits and a 14 per cent reduction in bed days.
Setting out a vision to make England the leading telehealth centre after the United States, Health Secretary Jeremy Hunt says: “People with long-term conditions see doctors and nurses more than most of us; £7 out of every £10 spent on the health budget go towards supporting them.
“I want to free people with long-term conditions from the constant merry-go-round of doctors’ surgeries and hospitals. 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.”
But as the NHS faces up to its biggest financial challenge, required to make savings of around £20 billion, the evidence on cost benefits remains less clear. The Nuffield Trust, which assessed pilot projects in East London, Kent and Cornwall for the Department of Health, found that savings were modest, cutting the cost of treatment by £188 to £2,260 during the trial period. This was hardly the ringing endorsement that commissioners of health services were looking for.
Telehealth schemes require significant investment in technology at a time when budgets are under huge pressure and there are competing demands for funding. The technology itself is evolving rapidly and nobody wants to be found making a long-term commitment to equipment that may become obsolete even before it is installed. But few would disagree with the potential benefits afforded by telehealth and there is a determination within the NHS and the private sector to find structures that work well for all parties, particularly through economies of scale.
Adam Steventon, senior research analyst at the Nuffield Trust, who led the study, says:
“It’s difficult to get clinicians and nurses to work differently, as they need to do with telehealth. Given the demands that are now being placed on the NHS and many patients wanting a face-to-face consultation with their doctor, the role for telehealth will have its place in long-term care.”
Dr Kiran Patel, a consultant cardiologist and associate medical director at Good Hope Hospital, Birmingham, uses telehealth facilities to monitor patients with heart failure. “Although the NHS is a national service, it has been up to individual trusts to implement a telehealth strategy and many of them have not had the support they need or the evidence on cost-effectiveness to show where it could be used successfully. With the new CCGs [clinical commissioning groups] in place, I hope more of them will make this a priority, but they can only do it with the right support.”
KPMG, the consultancy group, has urged the NHS to put telehealth at the heart of service reconfiguration, including a radical redesign of how hospitals provide care. Its report, Value Walks, argues that healthcare providers must create a new primary care system focused on supporting wellness and monitoring illness telemedically. There should also be better use of technology “embedded in local communities [to enhance] diagnostic capability and more integrated services for long-term conditions”.
Another KPMG report, Something to teach, something to learn: Global perspectives on healthcare, says evidence shows that, where patients are more involved in planning services, it can “dramatically reduce costs, improve satisfaction and enhance outcomes”.
A measure of the potential scale of telehealth is the interest shown by major companies previously focused on mainstream telecoms, such as O2 and Vodafone, which have developed mobile devices to support older people still living at home.
Start New entrants are also looking at the UK market.
“The UK has been using telehealth in a fairly primitive way so far, as data has been transmitted by normal telephone lines, but we can provide much more advanced technology to improve services and make them more efficient,” says Steve Schofield, Vitaphone country manager for the UK.
“We can now use Bluetooth technology to send test results received from patients directly to GPs, speeding up the process significantly and we have a technical centre which can offer support to GPs in interpreting the results. I think one of the factors blocking the expansion of telehealth is that many GPs do not feel confident about evaluating the results of patient checks as they are not generalists.”
The most likely scenario is that there will be no “Big Bang” explosion of telehealth in the UK, but its gradual introduction in different parts of the health service will ensure that it becomes entrenched in the delivery of care, with patients becoming increasingly familiar with the technology. In the longer term, the real advantage may not be cost-savings to the NHS nor even better outcomes, but the greater choice it can give patients in determining how and where they are treated in a way that will recast their relationship with clinicians.
Additional reporting: Paul Dinsdale
Services provided by telehealth
Direct patient monitoring using body sensors
ECG, blood pressure monitoring, INR, blood glucose, breath spirometer, weight monitoring
Personal health monitoring
Health programmes giving lifestyle advice and comparison statistics, such as weight and blood cholesterol levels
Drug adherence ensuring medication prescribed is taken
Pico automatic drug dispenser/notifier/monitor providing electronic alerts when medication is not taken
Medical surveillance service centres offering support for clinicians
Emergency services notification for automatic patient alerts
Hospitals, GPs and community networking connecting healthcare providers.