The NHS in Scotland should do more to consider telehealth when introducing or redesigning services. It provides an opportunity to treat patients in new ways, and to help manage rising costs and demand.
An Audit Scotland report published today, A review of telehealth in Scotland, looks at how the health service is providing care to patients at a distance, using a range of technologies such as mobile phones, the internet, digital televisions, video-conferencing and self-monitoring equipment. This could include a consultation between a patient and a doctor being carried out at different locations using video-conferencing.
The report says NHS boards must look at new ways of delivering care, particularly as the NHS is facing growing demand. Telehealth has the potential to help deliver a range of clinical services more efficiently and effectively, and boards should be considering it when introducing or redesigning services.
Telehealth is popular with patients, doctors and nurses who have used it. Its benefits include less travel, faster diagnoses and fewer hospital admissions. However there have been limited opportunities for clinical staff to gain experience of using it, and more education and training is needed.
Auditor General for Scotland, Robert Black, said:
“The NHS in Scotland is facing serious pressures, from the ageing population and increasing numbers of people with long-term health conditions such as diabetes and respiratory illnesses. Telehealth could help to provide a range of services efficiently and effectively. Where it has been used, patients, doctors and nurses generally like it.”
Audit Scotland looked at the use of telehealth to monitor patients with chronic obstructive pulmonary disorder (COPD) at home. The report concluded that telehealth management of COPD patients at home might help NHS boards avoid costs of around £1,000 per patient per year, mostly through reducing admissions to hospital.
There are about 70 small initiatives across Scotland which have identified the benefits of telehealth. Three large-scale UK projects, involving at least 37,000 people should improve the evidence. The first of these is due to report later in the year.
The Scottish Centre for Telehealth has recently been merged into NHS 24 and the Scottish Government has put in place a new e-Health strategy. These changes should help the development of telehealth services across the country.
A £5 MILLION telehealth system with the potential to save around £1,000 per patient per year has been largely ignored by NHS boards, the public spending watchdog has warned.
Telehealth is designed to provide remote electronic healthcare, particularly for hard-to-reach areas. But Audit Scotland’s review found that the system is generally not considered an option when NHS boards are planning or redesigning services.
An estimated £4.7m has been allocated to telehealth initiatives since 2006. Economic modelling work suggests the home monitoring of patients with chronic obstructive pulmonary disease could save NHS boards around £1,000 a year for each patient.
However, Audit Scotland found limited coverage in local delivery plans and only half refer to telehealth specifically.
Over a third of the medical directors interviewed did not know if the Scottish Centre for Telehealth (SCT), established in 2006 to support NHS boards to develop telehealth, was performing its core functions well.
Half of medical directors felt that the integration of SCT and NHS24 had no impact on the delivery of telehealth within the board.
Auditor General for Scotland, Robert Black said: “The NHS in Scotland is facing serious pressures from the ageing population and increasing numbers of people with long-term health conditions such as diabetes and respiratory illnesses.
“Telehealth could help to provide a range of services efficiently and effectively.”
Health secretary Nicola Sturgeon said: “Telehealth has a pivotal role to play in delivering efficient and effective care to people of all ages across our country.”
The Royal College of Nursing Scotland backed the auditor’s call. Director Theresa Fyffe said: “Investment has been inconsistent and a survey of our members last year, found that less than 20 per cent use telehealth.”
After the success of the P4 Digital Healthcare convention in 2010, Highlands and Islands Enterprise offers the opportunity to further explore the rapidly evolving field of P4 digital healthcare.
The term ‘P4’ is being adopted in the life sciences and digital healthcare sectors to describe the changing healthcare landscape as it becomes more Predictive, Preventative, Personalised and Participatory.
P4 Digital: The future of healthcare conference, taking place at the Centre for Health Science in Inverness, will be held on 10 and 11 May 2011. The theme of the event will be ‘exploring and connecting’.
Day 1, 10th May 2011
12.00pm – 1.00pm registration and lunch
1.00pm – 1.10pm introduction and welcome
1.10pm – 1.30pm scene setting – Dr Steven Dodsworth, Highlands and Islands Enterprise
1.30pm – 2.10pm P4 Digital and m-health – Sarah Sanders, Vodafone
2.10pm – 2.50pm P4 Digital, sensors and devices – Steve Setford, LifeScan
2.50pm – 3.50pm coffee and exhibition
3.50pm – 4.30pm P4 Digital and the web – Dame Wendy Hall, Web Science Trust*
4.30pm – 5.00pm Moray, a living laboratory – Moray Community Health and Social Care Partnership
5.00pm – 5.10pm closing remarks
* Remote connection
Day 2, 11th May 2011
8.45am – 9.15am registration and coffee
9.15am – 9.30am opening remarks
9.30am – 10.10am P4 Digital and the NHS – George Crooks, NHS 24
10.10am – 10.50am P4 and consumer health psychology – Vivien Swanson, University of Stirling
10.50am – 11.30am coffee and exhibition
11.30am – 12.20pm P4 and design innovation – Irene McAra-McWilliam, Glasgow School of Art
Ten million pounds is to be invested over four years to improve care by growing the Scottish telehealthcare sector.
The project – jointly announced today by the Scottish Government and the Technology Strategy Board – will show how new technologies and innovative services can help improve the quality of life of, and support independent living for, older people and people living with long-term conditions.
The demonstration programme will involve at least 10,000 older people and people with disabilities.
In the first joint project between the Technology Strategy Board and the Scottish Government, the Scottish Assisted Living Demonstrator agreement was signed today by Health Secretary Nicola Sturgeon and Iain Gray, Chief Executive of the Technology Strategy Board.
Ms Sturgeon said:
“Supporting people to live independently at home is a key priority for the Scottish Government. It is what older people have consistently said they want and we know it is generally better for people’s health to remain at home wherever that’s possible.
“Over the last four years, Scotland has made significant progress on developing and expanding new technologies to help people do just that – providing effective care and reassurance to many older people.
“Today’s announcement demonstrates our commitment to build on this progress and to expand even further the role technology plays in supporting twenty-first century healthcare.
“The experiences from the Scottish Assisted Living Demonstrator will also be used to inform and provide invaluable opportunities for Scottish businesses in support of economic growth.”
Iain Gray said:
“I am delighted that the Technology Strategy Board and the Scottish Government are to work together to establish an Assisted Living Demonstrator in Scotland. Scotland is a leader in the introduction of innovative technologies and services to enable independent living for older adults and people living with long-term conditions.
“This demonstrator programme, which will involve at least 10,000 users in Scotland, will be the first step towards the aspiration of providing assisted living services for millions of people across the UK.”
The key objective behind the demonstrator is to help break the barrier between new healthcare technology and the implementation and use of the technology in the public sector, such as NHSScotland, the private sector, for example in housing and in the insurance sector and the third sector, including by charities and social enterprises. Other key agencies involved in the development of the demonstrator are NHS 24, Highlands & Island Enterprise and Scottish Enterprise.
The demonstrator will also show how cost savings could be made alongside the provision of improved health benefits for both public and private provision, while opening new markets in social innovation, service innovation and wellness.
The Scottish Assisted Living Demonstrator is likely to be the first of a number that will be established across the UK by the Technology Strategy Board under a programme named DALLAS – Demonstrators of Assisted Living Lifestyles at Scale.
Further details of the Scottish Assisted Living Demonstrator programme, including the geographic focus, will be agreed in discussions between the Scottish Government, its agencies and the Technology Strategy Board.
The Technology Strategy Board is a business-led government body which works to create economic growth by ensuring that the UK is a global leader in innovation. Sponsored by the Department for Business, Innovation and Skills (BIS), the Technology Strategy Board brings together business, research and the public sector, supporting and accelerating the development of innovative products and services to meet market needs, tackle major societal challenges and help build the future economy.
The demonstrator programme sponsors, and anticipated funding contributions, are: Technology Strategy Board (£5m), Scottish Government (£3.9m), Highlands & Islands Enterprise (£0.8m) and Scottish Enterprise (£0.3m). NHS 24 will be the delivery arm for Scottish Ministers and the Scottish Government’s Health & Social Care Directorate.
Further details of the programme will be developed and established by the Scottish Government, its agencies and the Technology Strategy Board over the next year, as preparations are advanced for implementation of the Scottish Assisted Living Demonstrator from April 2012.
This programme is being run through the Technology Strategy Board’s Assisted Living Innovation Platform (ALIP), which is responding to the challenge of the demographic shift – in essence promoting independence by making technology better, cheaper and more desirable. The ALIP aims to significantly advance the technology to meet the demand for independent living from the expected increase in the numbers of people suffering from long term conditions and age-related disability. By 2021 half of the UK’s adult population will be over 50 and by 2025 almost 1.5 million people will be living with an age-related disability.
At the Healthcare Innovation Expo in London I met with Dr Richard Pope, Consultant Diabetologist, who is reporting some great success with the use of Video Conferencing with home based patients:
Key take aways of the talk:
There are currently 150 home based patients being telemonitored. Set against registry data service is saving ~0.1 all cause admissions, per patient, per month
Between July 2009 and December 2010 it has saved 202 all-cause admissions
Based on these reduced admissions alone it’s saved >£93k in 18 months
5 year programme is running across 20 prisons delivering A&E urgent care service + 21 outpatient specialities offering elective services via telemedicine
“…There is no expensive journey to and from hospital. No re-organising of work commitments to then spend time sitting around in waiting rooms… simply a live link up where I can talk freely and we can swap ideas as to how to improve my life…“
Consultants opinion on the value of video connectivity:
“…First of all it allows you to deal with comorbidities much more straightforwardly, we’re doing what we’re doing in clinic but we just happen to be remote from the patient. And the visual dimension gives you a lot more confidence in your decision making. So you’ve got a data stream coming in oxygen saturations are low and you’re going to admit somebody because thye’ve dipped but you can actually see them in their own house and they’re not breathless and you just make decisions that you make day in day out and I also think there is an ability to engage in a different way with the family so i’ll give you an example, I was doing a call to a guy with diabetes at home and he’s telling me how he’s sticking rigidly to his diet and then i hear a shout from the kitchen “oh no you’re not you lying bugger!” and his wife comes around the corner joins in the call and we have a much more engaging conversation. So obviously he’s given permission to have his wife in the room so confidentiality isn’t an issue in this case but there are lots of examples like that were another patient who was hospital phobic and wouldn’t come to clinic, and her (blood sugar) control was awful and she felt really bad about herself. But she engaged through this modality in a way that allowed her to have really quite complex clinical discussions, six or seven sessions later and her HbA1c levels are back down and have stayed down. so i think it allows you to do what you do day in day out but actually do it in a much more efficient way“
Remote capture of health information from the home can save NHS millions and improve quality of life for people with long-term chronic conditions, says new report “Healthcare without walls – a framework for delivering telehealth at scale.”
Urgent government action needed to put in place a national strategy.
The explosive growth in the number of people with long term conditions (LTCs), such as diabetes, heart disease and lung disease, could overwhelm NHS resources, according to a new report to be published on 24th November. The report by the think tank 2020health.org warns that the current NHS approach to delivering care to people with LTCs is unsustainable both in terms of cost and quality, and in no one’s best interests – least of all the patients and their carers.
The report will be launched by former Health Secretary Rt Hon Stephen Dorrell MP, chairman of the Commons health select committee, at 6 pm on Wednesday November 24 at St Stephen’s Club, Westminster, London.
The scale of the problem is immense, according to the report:
A rise of 23 percent in LTC patients will occur over the next 25 years
LTC patients account for 31 percent of the population, 52 percent of all GP appointments and 65 percent of all outpatient appointments
Three out of every five people aged over 60 in England have a LTC and it is not just the elderly who are suffering from chronic disease. Many of the young obese could develop diabetes, heart disease and arthritis among other things in their 30’s.
The report demands urgent Ministerial support to facilitate the use of the remote capture and relay of health information from the home for clinical review and early intervention. Julia Manning, Director of 2020health.org, says:
“Properly implemented this is a prescription for the next generation and would easily save the NHS up to £1 billion.
“If things are left as they are now, however, the pressure that the LTCs put on the NHS and social care could overwhelm it. Doing nothing is not an option. Government needs to grasp this nettle and make enabling telehealth a national priority now.
“If we get this right now, we can improve the quality and affordability of patient care for the next generation.
“Implemented effectively, the remote capture of information from patient in the home, distance learning and consultations can all improve the patient’s care and quality of life by reducing the need for appointments and emergency admissions to hospital. It also means nurses’ and GPs’ time can be focused on genuine needs instead of taking routine measurements.”
With no complex technology, the telehealth care devices are installed in the patient’s home and typically connect to their telephone line or broadband service so that the data collected can be sent to a central monitoring centre.
The patient uses the system and accompanying device (e.g. digital thermometer, weighing scales, blood pressure cuff, pulse reader) to take readings such as blood pressure or oxygen levels which are sent automatically. If the readings show any signs of the patient’s condition deteriorating, a doctor or nurse is alerted to contact the patient.
Based on a thorough analysis of the relevant evidence, John Cruickshank, the report’s author and independent health IT expert, calls on the Government to recognise the key specific recommendations so the NHS can best exploit the transformational potential of telehealth:
The key recommendations are:
Amend tariffs/incentive schemes to recognise and reward telehealth- and teleconsultation-enabled services on a consistent basis across the NHS
Create improved public awareness around telehealth and its ability to enable better self-care – leading to systemic improvements across health and social care.
Establish a national framework of support and expertise in telehealth to share best practice
2020health calls on the Government to act on the recognition that face-to-face services are under significant pressure – even before taking into account the financial challenges of the years ahead –and is reason enough to promote less resource intensive ways of delivering high quality evidence-based chronic disease management.
This follows a Department of Health acknowledgement in 2009 that “Transforming the care and lives of those with long term conditions and delivering truly integrated, efficient and people-centred community services has the potential to improve the quality of millions of people’s lives.”
The last government sponsored three large “whole system demonstrators” with a view to gathering robust evidence and learning lessons for implementing telehealth at scale.
And in many ways the latest health White Paper creates the environment in which the demand for telehealth-enabled services can be fostered. Yet there is a prevailing view that initiatives such as this can be left to the market to sort out and action is limited, according to the 2020Health.org report.
“While there are over 100 telehealth projects around the NHS, there are estimated to be less than 10,000 patient units deployed. The majority of these projects are small-scale, many are known not to be well integrated into healthcare systems. The need to build on successful pilots to create scaled up projects is crucial,” Mr Cruickshank says.
“To enable these ‘tele’ technologies to make a dramatic impact in terms of patients’ quality of life, and the NHS’s capacity to cope with the ever-increasing numbers of cases and in the associated economic costs, the government must adopt a firm strategic leadership for telehealth at scale,” he adds.
“With our national finances now severely constrained and for the foreseeable future, the current, largely reactive approach to chronic condition management is unsustainable. Telehealth should sit as a part of a nationally recommended suite of enablers that if integrated through local business change and service delivery, will underpin the transformation outlined in the NHS White Paper.”
From over-the-phone patient consultations and coaching to:
real-time audiovisual conferencing system that allows specialists in stroke care to remotely assess patients and to view their CT brain scan images
simple video conferencing between at home patient and case manager
through-the-TV technology to send messages and reminders or have a consultation
text messaging: medication reminders; appointment reminders; blood monitoring reminders; physical health monitoring; behavioural change; social inclusion; ‘feel good’ messages
in-home vital signs data collection of blood pressure, blood glucose, oxygen levels, weight or body images and transfer to professional for evaluation or automatic assessment
in-bed sensors that detect changes in pulse and breathing
implants such as pacemakers and insulin pumps from which readings can be collected remotely
Reduced service utilisation costs including primary care attendance, A&E attendances, outpatient attendances and acute admissions, improved quality of life for patients and carers.
The report was supported by the following eight organisations – Accenture, BT, isoft, Medtronic, Pfizer Health Solutions, Tunstall, TPP and Vodafone.
Many caregivers who use health IT tools to help care for family members or friends believe emerging technologies such as mobile health devices and personal health records will significantly benefit them and their care recipients, according to a recent study by the National Alliance for Caregiving and UnitedHealthcare, InformationWeek reports.
The study was based on a November online survey of 1,000 caregivers who provide at least five hours per week of unpaid care to an adult relative or friend. All of the caregivers in the survey use the Internet or some other technology to help provide care.
In response to questions about the expected benefits of using health IT tools, the researchers found that:
77% of survey respondents believed the tools would save time;
76% believed the tools would make care easier logistically;
75% believed the tools would make care recipients feel safer;
74% believed the tools would increase feelings of effectiveness; and
74% believed the tools would reduce stress (Lewis, InformationWeek, 1/11).
Top Three Tools
The survey also identified three health IT tools that appeared to have the greatest potential to improve care because they appealed to a large number of caregivers and had minimal barriers to adoption. The top three tools identified were:
Personal health records, with 77% of respondents saying they would find it helpful to have a Web- or software-based PHR to track medications, test results and other data;
Caregiving coordination systems, with 70% of respondents saying they would find it helpful to have a system that logged a care recipient’s medical appointments and helped coordinate care; and
Medication support systems, with 70% of respondents saying they would find it helpful to have a device that reminded patients to take their medication and provided data on side effects (Hobson, “Health Blog,” Wall Street Journal, 1/10).
Scotland has the potential to become a world leader in mainstreaming telehealth, but progress, despite concerns about a rapidly ageing population, has been slow. James Ferguson, lead clinician for the Scottish Centre for Telehealth, explains why, and what the NHS needs to do to move things forward and avoid being swept away
Whilst speaking at a recent conference on care of the elderly at the Royal College of Physicians of Edinburgh, one of my co-speakers referred to the ‘silver tsunami’. This refers to the increasing number of patients with long term medical conditions, approaching or already in retirement. This cross section of the British public is fast becoming a major issue for government, who must address the health and social care needs of a rapidly expanding elderly population.
Issues such as demographic and social changes in the general population, as well as the impact of the largest global recession in over 80 years, means the NHS is currently facing its most challenging period of development since its inception. Financial and resource constraints are making it increasingly difficult to treat the elderly and long-term ill within the traditionally secondary care based model.
The reality of this oncoming tidal wave of an increasingly aged population, combined with the very real threat of NHS funding cuts, mandates a change in the way healthcare services are delivered across the UK. Current traditional pathways of care are likely to be overwhelmed. Redesign to improve efficiency and implement innovative, effective pathways of care is urgently required to maintain care and support for the elderly, many of which suffer from chronic conditions.
The upshot is the NHS must focus on achieving healthcare delivery and value for money by shifting the emphasis on care from hospitals to community-based care. Patients with chronic conditions require increased support to help them manage their conditions at home or close to home. If more efficient ways of managing long-term conditions are not put into practice, the NHS is in danger of being engulfed by the wave.
It is widely acknowledged that advances in modern technology have had, and continue to have, an enormous impact on the quality, delivery and efficiency of public healthcare services. Telehealth home monitoring systems, supplied across Scotland by a variety of providers including Tunstall Healthcare, offer a potential solution.
Telehealth enables patients to stay at home, helps prevent avoidable admissions, supports early discharge and improves quality of life for patients. This benefits patients from a clinical point of view and helps alleviate the organisational burden on the NHS.
One of the key advantages of telehealth is the potential to deliver high quality healthcare to patients in, or close to, their own homes, reducing the need for travel to hospitals to receive care and treatment. This is relevant for all elderly patients and particularly for those living in rural and remote areas of Scotland.
Telehealth in Scotland
In 2006, the Scottish Centre for Telehealth (SCT) was established to support and guide the development of telehealth for clinical, managerial and educational purposes across Scotland. This involves working across boundaries, with industry, academia, local authorities, NHS Boards etc, to develop models for redesigning care.
The Centre’s role is to provide support and advice to NHS Boards and help evaluate and implement the benefits of new technologies, with the aim of making Scotland a recognised global leader in telehealth.
The geographical spread of Scotland with its widely distributed population has always made the delivery of healthcare challenging, but telehealth technology has made this task easier. Its value in assisting clinicians to manage patient’s long-term conditions, as well as saving on secondary care costs to the NHS, has long been recognised and has been demonstrated through numerous pilots and projects carried out across the country.
The SCT identified the potential use of telehealth in the management of Chronic Obstructive Pulmonary Disease (COPD) in Scotland as a priority area of work and commissioned a report to: 1) review key reported studies, 2) detail the COPD telehealth projects known to be ongoing both in Scotland and elsewhere, 3) introduce, examine and propose options for the use of telehealth nationally to manage people with COPD in Scotland.
In 2009, an evidence session held by the Scottish Parliament’s Health and Sports Committee with the SCT reported that excellent work was being undertaken across Scotland on telehealth development. Telehealth systems had been widely used in Aberdeenshire and The Highlands, with one project leading to a 100% reduction in emergency admissions for patients with chronic cardiac conditions.
However, concerns were raised that progress with widespread implementation was not occurring at a rapid enough rate. Nearly all the applications reported had been on a small scale and a lack of large-scale evidence meant reliable measurement of the potential benefits was unavailable.
There was varying feedback on the benefits of telehealth and, whilst some pilots may say that telehealth has been 100% successful, others have indicated that workload was increased by its use.
However, despite the lack of widespread usage and quantifiable results, the majority of applications report discernable benefits in various areas, including patient and carer satisfaction and secondary care admission reduction. To truly observe, derive and measure mass scale benefits from telehealth requires its usage to transform from pilot studies to mainstream usage.
A national agenda
To drive this agenda, the SCT is planning to establish a national home telemonitoring service for COPD patients to monitor and record the effects of telehealth on a wider scale.
Initially, existing telehealth users from a number of different areas across Scotland will be recruited to pool together data to give a better picture of its current effectiveness.
Parallel to this, the first phase of a national telemonitoring service will be constructed consisting of four health boards reflecting urban, rural, semi-rural and island areas of Scotland.
Once established, if this platform proves to be effective, the remaining health boards will have the opportunity to join the service, creating a truly nationalised service.
Obstacles and vision
It is not enough just to plan the widespread uptake of telehealth. An important element of progressing the telehealth agenda in Scotland centres around overcoming obstacles to telehealth implementation, which currently exist within the NHS.
Examples of barriers to implementation include cultural resistance and fear of change, lack of training amongst clinicians and health professionals in telehealth technology, protection of vested interests amongst certain health professionals and a narrow focus on traditional ways of delivering healthcare.
Many clinicians are unaware of the non-clinical benefits of telehealth, such as cost savings, and so are not incentivised to change the way they work. Awareness of the tangible benefits to patients, healthcare professionals and the organisation in general must be raised to encourage integration of telehealth into their working practice. Clinicians must be convinced and confident that telehealth is best practice in their sphere of influence.
A major factor slowing progress is the lack of clinical confidence in telehealth. Many clinicians raise concerns that patients may feel that the level and quality of care they receive via telehealth will be inferior to the care they receive face-to-face.
In fact, the vast majority of patients, who have participated in telehealth, have proven to be enthusiastic and satisfaction is very high. One tactic to drive the agenda forward will be to recruit patient groups to present their positive feedback to clinicians.
It is not solely clinicians who need to be convinced. Organisational confidence to buy in to telehealth is required for telehealth to go mainstream. A significant driver here is the economic climate.
To engage health boards and other bodies, business planning must be undertaken clearly demonstrating the potential long-term, clinical, organisational and cost benefits resulting from mainstreaming telehealth across Scotland.
Driving the agenda
What drivers may push the telehealth agenda forward? Two factors highlighted by the SCT are:
• Incentivising health boards and clinicians to adopt telehealth
• Ensuring telehealth is mainstreamed into the education and training of all health care professionals.
The approach adopted by the Government to encourage health boards to use telehealth systems has, to date, been largely unsuccessful. There is ongoing frustration at the continued failure of telehealth projects to achieve the critical mass required to become mainstream options for the delivery of care by health boards.
Whilst, many boards have undertaken effective pilot projects, there has been no real incentive to ensure telehealth development overcomes the cultural resistance which has prevented its widespread use.
In light of this, a two-year strategy has been developed by the Joint Improvement Team, in association with the SCT, which outlines the first phase of an approach to develop and deliver telehealthcare education and training opportunities in Scotland.
Stakeholders, who have been identified as potentially benefitting from telehealthcare training include; senior strategic and operational managers, GPs, nursing professionals, social workers, allied health professionals, equipment installers, home carers and service users.
The strategy will involve a two-pronged approach:
• The inclusion of training in telehealthcare in the core curriculum of the emerging telehealthcare workforce
• The development of accessible, Scottish Qualifications Authority (SQA) accredited training and CPD opportunities for staff already working within telehealthcare services
As telehealthcare education and training is new ground, robust review and feedback mechanisms will be employed during this two-year strategy to enable the approach to be adjusted and refined as necessary.
The power to make a difference
Scotland has the potential to be a world leader in telehealth. A major problem for the SCT in driving forward the telehealth agenda has been the advisory nature of its original remit. A review by the Scottish Government of the SCT undertaken in 2009 identified it being hosted by a regional health board, rather than being part of a nationwide NHS body, as possibly creating a perception that telehealth is only relevant to remote and rural health services. This may have limited the SCT’s credibility in encouraging clinicians and health boards to take up telehealth as a mainstream delivery tool.
A recommendation from the review was that the SCT integrate with Scotland’s answer to NHS Direct, NHS 24. This integration occurred in April 2010 and will provide the national platform required to ensure telehealth is given the focus it deserves within health board planning, and should lead to more innovative solutions to redesign healthcare in Scotland.
During the 20th century, the biggest challenge facing the healthcare industry was whatto use to diagnose, treat and cure ill health; this resulted in the discovery of medicines such as Penicillin and imaging techniques such as MRI.
The challenge we face in the 21st century is not what we use to deliver healthcare, but how we deliver it equitably, and advances in communications technology have presented us with a solution.
Telehealth technology has a vital role to play in revolutionising healthcare in Scotland, and it is this point that needs to be driven home. The question is how will the NHS in Scotland harness this technology to deliver efficient and sustainable services for patients?
The healthcare environment is ripe for Scotland to move forward and become world leaders in mainstream telehealth deployment. The continued failure of the NHS in Scotland to capitalise on successful telehealth pilot projects has been very disappointing. However, if the measures outlined here are successful, then Scotland could become the first country to establish national-scale telehealth services.
Scotland has the opportunity to lead the way and we need to grasp this opportunity as the silver tsunami is coming, and healthcare, like it or not, is changing. In the words of the great singer song-writer Bob Dylan, “You better start swimming or you’ll sink like a stone. Because the times they are changing.”
Early results from a pilot study suggest that telemedicine-based care could help improve treatment for geriatric depression, according to a presentation at the annual meeting of the National Association of Home Care and Hospice, Healthcare IT News reports.
Thomas Sheeran, a clinical psychiatrist at Rhode Island Hospital, led the study and presented its findings.
The project integrated evidence-based depression care with existing telehealth programs in Florida, New York and Vermont.
Researchers started the study at the Cornell Homecare Research Project at Weill Cornell Medical College and completed the project at Rhode Island Hospital in collaboration with the University of Vermont’s Telemedicine Program.
When the study began, 19 patients met the full criteria for major depression with a mean depression severity score in the “markedly severe” range, Sheeran said. He added that during the follow-up to the study, mean depression severity scores were in the “mild” range.
Sheeran said that most of the elderly patients involved in the study reported that they:
Believed the telemedicine program had improved their care;
Encountered few technical difficulties with the technology;
Felt comfortable using the telemedicine equipment;
Were satisfied or very satisfied with the overall program; and
Would be willing to participate in the telehealth program again (Merrill, Healthcare IT News, 10/4).
The health and social care partnership, Orkney Health and Care has launched a telehealth service using advanced solutions from Tunstall Healthcare to enhance healthcare delivery for patients with long-term conditions, such as chronic heart disease and chronic lung disease.
Telehealth enables patients with long-term conditions to measure their vital signs in their own homes, helping to reduce the need for them to travel to health centres for routine check-ups. This is also aimed to benefit healthcare providers in NHS Orkney, where the rural geography means that GPs and nurses often need to visit patients by ferry.
By remotely monitoring patients’ vital signs on a daily basis, it is hoped that telehealth will reduce avoidable travel and help ensure the best use of health resources.
Telehealth deployments across the UK have shown that daily health monitoring helps patients to understand their condition, reduce anxiety, and ultimately prevent unnecessary hospital admissions. In addition, increased communication with patients via the phone helps to promote a more preventative approach to the management of long-term conditions.
Keith Farrer, NHS Orkney consultant nurse and clinical lead for long-term conditions, said: “We are already using video consultations for patients that have a number of different long term conditions, and telehealth is the next step for helping other patients with long-term conditions. Due to our rural locality I expect to see telehealth reduce the need for patients to travel to their health centres for regular checkups therefore reducing the burden of travel. It will also help some patients to better understand how to manage their illness.”
Orkney Health and Care is using Tunstall’s icp integrated care platform, including mymedic and icp triagemanager, which are designed to support integrated, fully managed and patient-centred care. The patient simply uses the solution to measure their pulse, blood oxygen rate, weight, temperature and are asked a series of health related questions.
This information is automatically transferred either by traditional landline connections or over GPRS mobile networks. Voice and visual prompts help guide the patient through their health session making it easy for any user.
The data is then automatically collected by NHS Orkney’s clinical staff in real time. This makes the process easier for patients to manage, and also ensures that healthcare staff get instant access to the results, enabling them to monitor the patient’s condition daily to provide timely, preventative care when needed.