UK government signals its support for telemedicineBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7792 (Published 30 November 2011) Cite this as: BMJ 2011;343:d7792
The UK government is backing wider use of telehealth and telecare to help people live independently and monitor their health, delegates attending a telemedicine conference heard this week.
Stephen Johnson, head of long term conditions at the Department of Health for England, told the eHealth and Telemed 2011 conference that commissioning groups had been given a very clear message about telemedicine in the NHS operating framework for 2012-13, published last week (BMJ 2011;343:d7712, doi:10.1136/bmj.d7712).
The framework says, “PCTs [primary care trusts] working with local authorities and the emerging CCGs [clinical commissioning groups] should spread the benefits of innovations such as telehealth and telecare as part of their ongoing transformation of NHS services. They should also take full consideration of the use of telehealth and telecare as part of any local reconfiguration plans.”
It continues: “Telehealth and telecare offer opportunities for delivering care differently but also more efficiently. Use of both of these technologies in a transformed service can lead to significant reductions in hospital admissions and lead to better outcomes for patients.”
Telecare uses a combination of alarms, sensors, and other equipment to help people live independently. Telehealth uses equipment to monitor people’s health, such as measurement of blood pressure or blood oxygen concentrations, in their own home.
Trevor Single, chief executive of the Telecare Services Association, said that the period of “stop-go” and uncertainty for the development of telecare and telehealth development could soon be over. “The lights are green or at least starting to turn green. We are getting real engagement from politicians, with both Andrew Lansley [England’s health secretary] and Paul Burstow [the minister for care services] speaking positively about telemedicine. And we now have a clear statement in the operating framework,” he said.
The long awaited results from the whole systems demonstrator pilot scheme are expected in the next few weeks. The trial, which cost more than £30m (€35m; $47m), is believed to be the largest randomised controlled trial of telehealth and telecare globally, with more than 6000 patients at three sites in England. The trial tested the capability of new technologies to support the remote management of people with long term conditions. If the results are positive in terms of patients’ experiences, care outcomes, and costs then it will give a much needed evidence boost to support the wider use of telemedicine.
Preliminary results from the scheme, reported at a King’s Fund conference in March, showed that remote healthcare technologies may reduce the number of emergency admissions to hospital among patients with certain long term conditions such as chronic obstructive pulmonary disease (BMJ 2011;342:d1499, doi:10.1136/bmj.d1499).
Cornwall, one of the poorest counties in England, with a dispersed rural population and poor transport links, is one of the sites. Helen Lyndon, a nurse consultant and clinical lead for telehealth services at Cornwall and Isles of Scilly Primary Care Trust, told the conference how telehealth had improved the quality of care. “We can monitor trends much earlier than we would have done otherwise. It enables us to proactively manage rather than crisis manage,” she said.
The pilot programme, which started in 2009, has installed telehealth equipment in the homes of more than 1050 patients in Cornwall. Currently the service monitors nearly 700 patients on a daily basis. The original conditions included as part of the pilot were diabetes, chronic obstructive pulmonary disease, and heart failure. Since then it has been expanded to help manage patients with repeat urinary tract infections, stroke or transient ischaemic attacks, falls or instability, and Parkinson’s disease.
Ms Lyndon said that the programme had produced many benefits for patients, particularly on measures of quality of life. “It can provide peace of mind and give them a much better idea of how to adjust their medication better to combat symptoms,” she said. Seeing their own biometrics had prompted some patients to give up smoking or to lose weight, she added.
A survey by the trust of 500 telehealth users, which had a 54% response rate, found that 90% reported some benefit and that 89% thought that the equipment was easy to use. In addition, 78% believed that the equipment helped to manage their condition and that they benefited from clinical monitoring.
George Crooks, medical director at Scotland’s NHS24 health information website, told the conference that 12 of 14 health boards in Scotland now have telestroke thrombolysis in place or in development. In addition, he said a project on remote pulmonary rehabilitation (where patients took part in exercise classes over a video link) had shown very good results and is now being extended. Participating patients were able to walk further and had better control of their breathing. There were also cost benefits: the telerehabilitation model cost £76, half the £131 of conventional delivery.
Mr Johnson told the conference that telemedicine would become increasingly important as patients are living longer with more long term conditions and multiple comorbidities. But he added: “It’s not just about buying the technology. To be effective you need to redesign the services around the patient, with the technology introduced into that system.”
Adam Darkins, chief consultant in telehealth services at the Department of Veterans Affairs in Washington, DC, agreed. “Telehealth requires a reengineering of the way care is delivered. It can’t just be laid on top of existing care or it will just add costs. We need to spend time getting the basic model right and then spread it out,” he said.
Cite this as: BMJ 2011;343:d7792