In many countries the use of telecommunications technology to improve healthcare is becoming a hot topic. ‘Telehealth’ as it is increasingly termed is seen by some as a panacea for the demands placed on over-worked health services and a convenient channel for patients to keep abreast of the status of their treatment.
The UK’s National Health Service Operating Framework requires the health service to make efficiency savings of £15 billion to £20 billion in the next four years. At the same time, it expects the NHS to enhance and improve the quality and productivity of its patient care. To achieve these targets, the NHS must learn to deliver services in innovative new ways. In particular, it must concentrate on providing more accessible and integrated services to those with long-term conditions.
The UK has an increasingly ageing population, with many people suffering from long-term conditions. These patients make up 31 per cent of the population and consume approximately 69 per cent of all primary and acute care budgets in England. They account for more than half of all GP appointments and nearly two-thirds of all outpatient appointments. One of these conditions on its own – chronic obstructive pulmonary disease – represents the second most common cause of emergency admission, the largest cause of hospital readmission and is one of the most costly diseases in terms of hospital care.
At present, for many patients with long-term conditions, healthcare involves unnecessary hospital admissions, fragmentation of care and high levels of anxiety about their condition and symptoms.
From self-help to self-health. One way for the NHS to improve the care it provides to these patients is through telehealth – the delivery of health services and information to patients via telecommunications technologies. This provides a mechanism for patients to develop an understanding of their condition and encourages self-management, whilst also providing clinical teams with improved information for case management. In the UK, telehealth has been shown to deliver significant benefits to patients with long-term conditions while giving the NHS and social care organisations the opportunity to deliver care more efficiently and cost-effectively, leading to reduced hospital admissions, improved clinical outcomes, improved patient self-management and a significant shift in the settings through which care is provided. More importantly, it promotes a shift to the delivery of care to either within or closer to the patient’s home.
The recent Department of Health Whole System Demonstrator results show that the use of telehealth has led to a 20 per cent reduction in hospital admissions, a 14 per cent reduction in elective hospital admission and a 45 per cent reduction in mortality.
But reaping the benefits of this approach in the future will involve more than simply buying telehealth equipment. There will have to be changes in behaviour and approach. While a significant number of patients suffer from long-term conditions, not all will benefit from using telehealth. Some patients may, for example, be too frail or elderly or may suffer from cognitive impairment and therefore continue to require traditional care. Others may need fewer hospital admissions or may self-manage. It is therefore essential that health and social care bodies invest time prior to commissioning telehealth services in developing a thorough understanding of their patients, their service use and the benefits that could be derived from giving them access to telehealth.
Healthcare systems are also currently highly fragmented, leaving patients often confused about how to access the services they need. Using telehealth, healthcare commissioners and providers should be able to design and implement more integrated care pathways across specialist secondary care and community boundaries. This integration could improve the quality of care offered to patients and increase the quality of the information that is available to support case management, ultimately resulting in an improved patient experience.
Yet the successful implementation of telehealth requires patients, carers and clinical teams to behave in new ways. For example, patients need to take more responsibility for managing their own care. Clinical teams need to invest time in developing new pathways and mechanisms for engaging with their patients, often remotely. This means that the implementation of telehealth systems will need to be supported by comprehensive education and training programmes for patients and clinicians alike. These will need to promote the use of telehealth as well as train people how to use the equipment, deepen understanding of what readings mean and how they can better manage their own care.
Scaling investment to meet demand. To date, telehealth procurement has tended to involve small-scale capital purchases. This has meant that the NHS has invested up-front in equipment, taken ownership of it and incurred the costs of maintenance and system redundancy. To move to a larger scale, however, will require commissioners, providers and suppliers to work collaboratively to procure and implement an integrated telehealth solution. Ultimately, this will mean both suppliers and purchasers behaving in a more mature manner. They will need to invest jointly in the development of a benefits case prior to procurement as well as develop revenue-based service delivery models.
Such a model would enable the NHS to pay a monthly per-patient charge including the costs of system design and implementation, project management , installation, remote monitoring and technology updates as appropriate. This would mean that equipment is maintained and installed by dedicated technical specialists and implementation planned and delivered rigorously and effectively. The revenue model would take account of risk and reward, reflecting who has responsibility for delivery of each element of the service offering, incentivising both commissioners and providers to deliver telehealth at scale.
Many commentators feel that the time for small-scale telehealth pilots is now over. If the NHS is to embrace the challenges of the 21st century it must now embrace the opportunities that telehealth provides and implement at scale. In progressing to scale the NHS will need to recognise that telehealth will only be successful where it is seen as an integral part of integrated care or admissions avoidance projects and where it is embedded as an enabler of change. It will need to be supported by wide-ranging patient and staff engagement , process redesign and rigorous benefits tracking and monitoring.
Ultimately whilst telehealth is not a one-size-fits-all solution or suitable for everyone it does provide a solution that can be tailored to individual patient needs and improve the quality of patient and staff experience – and clinical outcomes.
Ivan McConnell is a telehealth expert at PA Consulting Group.
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