honesty in signageWe have written before about the potential of ehealth or telehealth in an ageing world. But is it actually working in practice? We take a look at some recent developments to find out.

A mixed picture

Last year saw the collapse of several of the UK Government’s flagship telehealth policies, including the disbanding of the 3millionlives industry group amid the perception that it was all about the telehealth industry selling equipment, rather than improving patients’ lives. It also witnessed the end of the Department of Health-funded ‘Whole systems demonstrator’ project, on the grounds that it was not cost-effective.

However, more optimistically, David Furness, from BT Global Health, wrote in the Guardian in January 2014 that we might just see some movement towards telehealth in 2014. He hoped that wider development of ‘Bring Your Own Device’ (BYOD) policies might be the outcome of Microsoft ceasing to provide support for Windows XP, which many NHS organisations are still using. However, comments on the article suggest that many of those working in the NHS are much less optimistic.

Small steps

There are, however, several organisations starting to see the benefits of telehealth and telecare in supporting patients to manage their own care. The huge benefit of telehealth to patients is that they don’t have to visit healthcare facilities so often. For patients with rare conditions, or who live in rural areas, and would need to travel quite large distances  to reach a suitable healthcare provider, this is great news. It should also be good news for healthcare providers, because it eases pressure on facilities.

One organisation that is piloting the use of telehealth for remote monitoring of patients is County Durham and Darlington NHS Foundation Trust. It has teamed up with technology provider Inhealthcare to provide a service for patients on long-term anti-coagulant medicine, perhaps following a stroke. These patients used to have to attend the clinic weekly or monthly for blood tests.  Inhealthcare now provides a digital platform, the Patient Information Portal, to connect them from home to nurses at the warfarin clinic. The patient carries out a blood test, and is then called by the system. He or she enters the results of the blood test, plus other information about their condition, into the keypad. This information is sent direct to the clinic, where it is reviewed, and decisions made about whether any changes are necessary to the medication. This information is then communicated to the patient. Although the number of patients involved is still small—around 200—for these patients, it represents a huge leap in their quality of life, and has the potential for much wider roll-out.

An unexpected bonus

Royal Derby Hospital, in Derbyshire, was one of the first healthcare organisations in England to use Skype to communicate with patients with chronic illness. It uses a BYOD approach to ensure that patients are familiar with the technology, for example, allowing them to use Kindles to communicate with healthcare staff.  The Times published an article on 21st March 2014 about a life saved by telehealth, linked to Royal Derby’s approach. One patient, Brenda Griffin, had been given a kidney dialysis machine at home, rather than spending three days per week at the hospital. She communicated with the doctors via Skype while operating the machine. On this particular occasion, she was hooked up to the dialysis machine talking via Skype to the healthcare staff, when her husband, sitting beside her, suddenly collapsed. Mrs Griffin was unable to help, as she could not move away from the machine. The hospital staff called for an ambulance, then helped her to disconnect herself from the dialysis machine, by which time the paramedics had arrived to assist her husband. It may not the conventional way in which telemedicine is expected to save lives, but it worked in this case!

Looking ahead

Telehealth is currently the subject of mixed reviews. It certainly seems to be good for patients. And in a truly patient-centred world, this ought to end the argument. But this isn’t a patient-centred world, it’s one of rising pressure on healthcare resources around the world. The key to successful implementation of telehealth seems to be keeping costs low by use of familiar technology, such as Skype, via patients’ own devices where possible, and off-the-peg platforms to manage access to data. This places patients firmly in the driving seat to manage their own care, with support from healthcare professionals. More complicated systems are greeted with cynicism by patients and healthcare workers alike, and are much less likely to be successful.

Image credit: Matt Jones

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