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Be wary of signing deals for telehealth technologies, conference hears

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1750 (Published 08 March 2012) Cite this as: BMJ 2012;344:e1750
  1. Matthew Limb
  1. 1London

NHS organisations should be wary of bulk buying telehealth technologies and getting locked into unsuitable and costly deals, says a leading campaigner for patients’ interests.

Jeremy Taylor, chief executive of the National Voices coalition of health and social care charities, said there were risks associated with the spread of telehealth and telecare initiatives and patients’ needs must come first.

Although some technologies could help people with long term conditions live independently, they must not be a substitute for effective services and must be “wired in” to well coordinated support, he said.

Mr Taylor, who is a member of the NHS Future Forum, said health technologies were “usually designed by young, fitter people for use by older, sicker” ones.

He said the NHS had spent lots of money in recent years on “kit” that had failed to live up to expectations.

“We have to avoid the trap of having technology driven solutions in search of problems,” he said. “It leads to expense and not delivering the improvements people need.”

Mr Taylor spoke at an event to launch an O2 Health telecare service, held on 7 March at the King’s Fund Second International Congress on Telehealth and Telecare.

Available from April, the service, called “Help at Hand,” uses mobile technology. Potential users, such as elderly people who are at risk of falling, would wear a “mobile enabled” pendant or wristwatch connecting them to a secure website and a support centre.

The centre would detect where they go, trigger alerts, and give them access to “appropriate support,” such as visits from neighbours or carers, if they get into difficulty, provided they stay within range of O2 network coverage.

Keith Nurcombe, O2 Health managing director, said the device met an “identified need” and would give users the “freedom and reassurance to get out and about.”

O2 Health is charging £100 (€120; $158) for the equipment and £20 per month for the service, and is targeting health organisations and local authorities initially, although it could be available to individual users within a year.

Mr Nurcombe said the company was in discussions with a “large number of organisations” but would not say if contracts had been signed or discuss the potential volume of business.

He said the service would help healthcare organisations to manage highly pressured resources for long term care more effectively.

Devon Partnership NHS Trust, which trialled “Help at Hand” in 2011 with mental health patients, says it allowed healthcare professionals to “interact with patients at risk from suicide as they entered into high risk areas.”

Tobit Emmens, managing partner for research and development at the trust, said, “Allowing patients to be more in control, particularly in a mental health setting, is extremely important.”

Mr Nurcombe said the service was not designed to help people with long term illnesses, like diabetes, to manage these conditions. But he said in future there might be scope to integrate such technologies, describing this possibility as “on the radar.”

Mr Taylor told the BMJ use of health technologies depended not only on the quality of the equipment but on the quality of the people “at the end of the line” purporting to offer support.

He said mobile technologies offered exciting opportunities but raised issues around equity and access if devices were both NHS or locally authority funded and on sale to individuals.

Stan Newman, of City University, told the conference on 8 March, that extending the use of telehealth in the NHS needs very careful thought because it is “disruptive technology” that will radically change the way professionals work and interact with patients.

He said adding telehealth technologies into “a complicated environment” would require substantial changes in behaviour from organisations and individuals.

He said telemonitoring of patients by professionals raised issues around surveillance and policymakers should be aware that adopting telehealth technologies could lead to increased costs.

Professor Newman is the lead investigator on the Whole Systems Demonstrator project funded by the Department of Health to evaluate the role of assistive technologies in health and social care.

The project studies, which have yet to be published in full, constitute the largest randomised controlled trials on the role and impact of telehealth and telecare devices.

He said “scaling up” telehealth devices to be more widely used in the health service ought to happen but it posed major challenges, particularly to health professionals who would need new training.

Professor Newman said, “If you start surveilling [surveying] an environment that has high needs and a relatively poor service it is likely you will improve care but at a cost.”

In addition, he said telemonitoring “changes the healthcare professional’s relationship fundamentally if they are involved in surveillance about patient behaviour and prompting them to change their behaviour”.

Notes

Cite this as: BMJ 2012;344:e1750

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