Telehealth for long term conditions

Almost 50 years of innovation in telehealth have seen great progress in tackling a wide range of conditions using a variety of technologies and covering a wide range of outcomes. Although this work shows great promise, it also creates challenges for interpretation. The uncertainties in defining terms like “telehealth” reflect broader difficulties in interpreting the complex interplay of technology, service designs, clinical input, and patient involvement. New studies can challenge existing findings as much as they corroborate them. For example, two recent large scale trials of telehealth for heart failure found no benefit,1 2 whereas previous meta-analyses suggested reductions in mortality.3 4 5 To this we can now add the initial findings of one of the largest telehealth and telecare studies ever conducted: the UK Whole System Demonstrator trial (doi:10.1136/bmj.e3874).6

Telehealth does not just “work” or “not work.” Particular interventions may be successful, but this depends on many factors, including the specific contributions of the type of technology and of the context, such as the willingness and ability of clinical staff to change their care processes; the disease stage and severity of disease in the patients involved, their social backgrounds, and their needs and expectations; the predictive power of any monitoring data that are collected; and, indeed, the endpoints that are used to specify success.4 7 The research agenda established by systematic reviews of telehealth consistently argues for study designs that …