INFORMATION TECHNOLOGY TELEHEALTH


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arly indications from government research show that, if used correctly, telehealth can deliver a 15% reduction in A&E visits, a 20% reduction in


emergency admissions, a 14% reduction in elective admissions, a 14% reduction in bed days and an eight per cent reduction in tariff costs. The Government also claims it demonstrates a 45% reduction in mortality rates. These figures were devised from the Whole System Demonstrator Programme, which ran from May 2008 to September 2010. The study monitored 6,191 patients and 238 GP practices for a minimum of a year across Cornwall, Kent and Newham assessing how using telehealth could benefit the NHS. It aimed to provide “a clear evidence base to support important investment decisions” and “show how the technology supports people to live independently, take control and be responsible for their own health and care”. The programme assessed how effective the use of telehealth and telecare were in treating chronic diseases; specifically diabetes, heart failure and COPD.


“Patients need to feel empowered by the process,


not overwhelmed, in order to truly engage and have confidence in its aims”


THE ANSWER TO OUR PRAYERS? The programme was deemed a great success by Prime Minister David Cameron: “This is not just a good healthcare story,” he said, speaking just after the results had been published in December 2011. “It’s going to put us miles ahead of other countries commercially too as part of our plan to make our NHS the driver of innovation in UK life sciences,” he added John Dyson, chief executive of


Telehealth Solutions, believes the savings will be vast. Commenting on the headline findings, he said: “There are enormous savings to be made from the implementation of telehealth that could be reinvested in


patient care. We estimate that these savings could be over £1bn per year which combined with the improvement in clinical outcomes demonstrated in the Whole System Demonstrator results makes the adoption of this approach a real and pressing necessity.” And it’s just as well, because Cameron aims to help three million people with the roll out of telehealth over the next five years, whilst simultaneously saving that infamous £20bn by 2015. But telehealth isn’t a quick fix, and


should be approached strategically if it is to really have a positive impact on outcomes says Mike Evans, commercial director at the company: “Telehealth will only deliver real quality to both patients and clinicians if it is deployed properly to the right patients, with the right clinical protocols and has the right supporting technologies and services.” Knowing your local population and its specific needs from a commissioning point of view is key. When trying to implement a telehealth strategy, usability for patients should be high on the agenda, after all, it is they who will be managing it for the most part. “The technology has to be friendly and value [has to be] gained through its use,” says Evans. Allowing patients to be in touch with their GP and feel ‘in the loop’ with their progress is a good way of achieving this. Evans gives the following examples: “The ability of patients to receive feedback on their health when they have just completed a protocol; or engage with their clinician either through secure video conferencing or a messaging service; the ability to view educational videos; schedule hospital or GP appointments or have motivational/coaching interviews with a specialist triage nurse. All of these activities help the patient engage more strongly, adhere to their care plan, learn how to manage their condition more effectively and so derive the best value and experience from their telehealth system.” Patients need to feel empowered by the process, not overwhelmed, in order to truly engage and have confidence in its aims.


SO, WHAT NOW?


Should commissioners be looking at kick- starting investment in telehealth? The


Government was very eager to release figures revealing how much money the NHS could save through implementation, and around the time the headline figures were released, morale around telehealth in CCGs was high – a GP magazine poll showed that 83.93% of respondents voted ‘yes’ in response to whether or not they thought telehealth would benefit patients. But unfortunately the conversation with the Government around telehealth seemed to end once the headline findings had been released. After an announcement by the care services minister Paul Burstow in April this year that telehealthcare could save the NHS £1.2bn, GP magazine put in a freedom of information request with the Government to find out just exactly how these savings would be made. This request was blocked, with the department stating that it could “inhibit future policy delivery”. Jeremy Nettle from Oracle Healthcare and chair of Intellect Health Group, a forum for companies that supply the NHS, said in his blog on the subject: “The secrecy around this information does little to provide the NHS with the faith that it needs to consider telehealth as a real alternative to the systems that it currently has in place. Evidence for how telehealth can benefit the NHS is limited and the DH has yet to publish full results from its Whole System Demonstrator [WSD] trial of the technology.” He went on to question whether or not the full implications and logistical issues for implementing telehealth had really been considered and suggested that the Government had come to the conclusion that telehealth was a success through looking at evidence that might not be fully transferable: “It’s likely to be based on numbers of consultations or potential hospital savings and some of the small-scale pilots that have been done. Can we really scale up these figures?” It is true that the headline findings of the WSD were a little vague, and without specifics it’s difficult to see how the study will help. If CCGs are to get things moving, they need more than headline findings and empty comments; they need information and evidence.


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