Drop the pilots: is telemedicine going mainstream at last?

The potential of telemedicine has been talked about for years. But a combination of consumer demand, policy imperatives and maturing technology may mean that its time really is about to come. Jon Hoeksma reports. 

Using information technology to remotely monitor and support patients has been on the cusp of entering mainstream healthcare for almost two decades. But for a variety of reasons, the long predicted breakthrough for what are called telehealth or telecare services has yet to happen.

Now, however, there are strong signs that their time may finally have come. Most western countries are seeing a growing demand for more consumer-led health services, including health checks and monitoring and support for health and fitness regimes.

Meanwhile, in the UK, the first women to be born as the NHS was created 60 years ago will retire this year. Because there are fewer people in the generations that followed the so called “baby boomers”, the whole age structure of the population will shift as they age and then grow very old over the next two decades. “Remote devices mean greater independence for patients.”

Inevitably, there will be fewer, younger people to care for them informally (at home) or formally (through health and social services). Using IT to help people monitor and control their own conditions and to provide more remote support may become essential.

Independence, control and choice

In England, the government is also interested in telehealth and telecare as a way of promoting its policies to give patients more choice and control over the services they receive.

Launching three big pilots last May, then health secretary Patricia Hewitt said: “Remote devices mean greater independence for patients. More people will able to monitor and look after their own health. So a person with diabetes can have their blood sugar monitored from home - meaning fewer unexpected or emergency trips to hospital."

At its annual congress in Bournemouth, the Royal College of Nursing voted to support telehealth services for patients with long-term conditions for similar reasons. Seconding the motion, Paul Wainwright said they should give patients more independence and an improved quality of life.

However, speakers warned that nurses and other medical staff providing support would need good information, and that telemedicine can never, in the end, replace face to face nursing.

Pilots, pilots

The potential market for telehealth and telecare has not been lost on a wide range of firms, who see a major opportunity for a range of new, technology-enabled health services focused on everything from well-being to chronic disease management. “The two-year pathfinder programme is the largest trial of telehealth and telecare ever undertaken in England, and it will install more than 7,000 devices in users’ homes.”

Leading ICT suppliers have recently accelerated efforts to forge common industry standards so that low cost, easy to use telemedicine monitors and solutions can be created.

Even so, this tantalising future has not quite arrived yet. A snapshot of the current situation was provided by the Med-e-Tel telemedicine conference in Luxembourg in April, where experts from around the world gathered to debate the future of telehealth and telecare.

Many excellent examples of innovative projects were presented by researchers, academics and vendors. But all too often, the numbers of patients involved were tiny, some requiring only the fingers of one hand to count.

New financial models needed

Unsurprisingly one of the key messages from the event was that new financial and business models are needed to make telemedicine part of mainstream healthcare, rather than many more “unsustainable” projects.

Mark Lange, head of the European Health Telematics Association (EHTEL), set out the challenge: “The question that we are addressing now is what can be done for telemedicine services to become sustainable – to move from pilots to real operational services. It’s started, but it’s not enough yet.”

Another limiting factor identified at the conference is that the benefits of telemedicine are often diffuse, and may not come back to the organisation that actually provides the service.

In the UK, for example, supporting people in their homes may reduce the number and cost of hospital stays, but savings may not work their way back to NHS community services or the local authorities that provide social care.
According to Eric Maurincomme, chair of the European eHealth Industry Stakeholders Group, the widespread take-up of telecare will require a shift away from paying for services in “silos” and a shift towards funding and reimbursement based on health objectives and outcomes.

He said it was no accident that one of the few healthcare providers to be offering telemedicine services at scale was Kaiser Permemante in the US, which is both a payor and provider of health services.

Pioneers push ahead

It is partly to overcome these problems and test new models of delivery that the Department of Health launched the Whole Systems Demonstrator programme for long term conditions in Newham, Cornwall and Kent last May. "...the crucial step [is] still for telehealth and telecare to be integrated into policy and the routine delivery of health and social care services. “We see that happening within 10 years time...”"

The two-year pathfinder programme is the largest trial of telehealth and telecare ever undertaken in England, and it will install more than 7,000 devices in users’ homes. Each of the three sites will recruit approximately 1,000 patients for telehealth and 1,500 patients for telecare.

Using telehealth and telecare to support people with long term conditions is also central to NHS Direct’s plans for the future. The intention is that the nurse-led service will increasingly move from just providing advice to also offering remote healthcare services.

But some NHS trusts aren’t waiting. Nottingham City Primary Care Trust has begun one of the UK’s largest mainstream deployments, aiming to remotely support around 800 people a year with breathing and heart problems. Swindon Primary Care Trust and Wolverhampton Primary Care Trust are adopting similar approaches.

Meanwhile, supported by £50m government Preventative Technology Grants, most local authorities are investing in telecare to help people live safely in their own homes.

The future – still ten years away

So there are plenty of signs for optimism, but how long until telehealth and telecare become truly mainstream? According to Mr Lange, the technology is fast maturing but services are still at the “nice to have but not essential stage.”

He stressed that the essential foundations, including good IT infrastructures, consistent record systems and common industry standards, are now largely in place and: “This provides the ground for the emergence of a new generation of telemedicine services to come into existence.”

On the other hand, he said the crucial step was still for telehealth and telecare to be integrated into policy and the routine delivery of health and social care services. “We see that happening within 10 years time,” he said; perhaps optimistically.