Cross Talk on the coming revolution in telemedicine
A revolution in telemedicine has been talked about for decades. But Mike Cross argues that policy and technology are now combining to make that revolution a certainty and the NHS will benefit - as long as it can overcome its pilot mentality.
Telemedicine was born to meet the medical needs of two very distinct sectors of US society - prisoners and astronauts. Back in the 1960s, doctors couldn't go into space and wouldn't go into Texas prisons (at least not for the payments on offer).
The twin needs spurred the development of a range of medical consultation techniques based on closed-circuit TV and remote physiological monitoring. Over the past four decades, we've moved far beyond these niche markets.
On the cusp of a revolution
Numerous trials and live deployments have created a vast library of experience with different technologies and techniques - and nearly everyone agrees that remote diagnosis and treatment will play a significant role in 21st Century healthcare.
What has not come together, though, is the combination of technology and health policy drivers needed to make telemedicine a universal default option in the NHS. We're now on the cusp of that revolution.
The health policy imperative is the need to find new ways of catering for people suffering from chronic disease - they account for 80 per cent of GP consultations and, as a new pamphlet from the think-tank Demos warns, the workload is set to grow. “We need to move to the assumption that wireless electronic communication is as much the norm in healthcare as it is in other walks of life.”
"From diabetes to depression, from chronic heart conditions to longer life expectancy, we are on the cusp of an epidemic in chronic conditions that will force the question: how can such exponential rises in demand be met by a system designed to deal with acute health issues and not much more?"
Forward with the mobile phone
The technology breakthrough is probably in your handbag, or even in your hand - the mobile phone. The near universal acceptability of the mobile phone interface, and the near ubiquitous (and relatively secure) GPRS infrastructure, make it the ideal tool for connecting the mass population to medical care.
As usual with mobile technologies, the Nordic countries are in the forefront. On a visit to Sweden earlier this year I saw a demonstration of a commercial system called BodyKom which continuously monitors an individual’s ECG via sensors connected across the mobile phone network.
The uses are both diagnostic and for emergency response - if an individual’s heartbeat becomes critical, the system automatically calls an ambulance and sends a text message to designated relatives.
Drop the pilot mentality
The extent to which such technology is applicable to, and affordable by, the NHS remains to be seen. However, there is evidence that remote ECG monitoring of people suffering from serious cardiac conditions can reduce the number of unnecessary hospital admissions and greatly reduce patients' anxiety, a health condition in itself. I know of at least one hospital in England planning to pilot similar technology later this year.
Heart disease is only one example of the sort of chronic condition that may lend itself to monitoring by mobile technology. With 85 per cent of Britons owning a mobile phone, it is time to put the infrastructure to use. However, this will mean moving beyond the "pilot" mentality that has beset telemedicine since the days of prisoners and astronauts.
Although there is still plenty of room for clinical trials and evaluations of the benefit of individual applications, we need to move to the assumption that wireless electronic communication is as much the norm in healthcare as it is in other walks of life.
We also need to find ways of paying for technological investments made by one part of the NHS out of consequent savings realised by another (or by councils and other agencies). And that takes us on to the debate about stimulating innovation that goes far beyond telemedicine, or even healthcare.
Related links:
Read the full Demos report, Unlocking innovation
Review more information about the Swedish pilot