Where is telemedicine going?
One thing is absolutely clear about telemedicine today: despite the
huge promise that the field appears to offer — at least at first
glance — there is still uncertainty about which, or how many, avenues
to explore, and how best to do so. Take, for example, the views
expressed by Keith Clough and Ian Jardine — both of them well
experienced in the field — in their article in the Journal in
July 2003:1 “There has been a reluctance in top management
to take ownership of telemedicine, or any desire to see telemedicine
techniques introduced quickly into the English Health Service. The
potential of these technologies . . . has been ignored by the
Modernisation Agencies until very recently . . .” Compare this view
with one expressed by the same authors in October 2001:2
“In our view . . . instead of asking the question ‘Should we use
telemedicine?’ we should be asking ‘Is there any valid reason for not
using telemedicine?’” What is it that can transmute the optimism of
the latter statement to the pessimism of the former?
The answer is far from simple. There have obviously been some
tremendous successes. NHS Direct now covers the entire country, and
although the jury may still be out as to whether it decreases the load
on other parts of the service, it is quite obviously meeting the
public’s need for healthcare information.3 Since 1998, the
Armed Forces Medical Services have used satellite links from remote
theatres of operation to provide expert medical opinion for those in
the front line.4 In Northern Ireland, telemedicine
techniques are helping patients with chronic obstructive pulmonary
disease (COPD) to monitor their own condition and stay at home longer.5
In a remote island in the Dodecanese, it is possible to obtain expert
interpretations of ECGs from a cardiac specialist in Athens.6
The range of applications described above illustrates one part of
the answer to our question. The field is still young, people are still
experimenting and — apart from the fact that there is definitely a
role ahead — established, and widely applied, roles have yet to
emerge. It is self-evident that telemedicine has a role where great
distances are involved — expert assistance for obstetrics in the
Highlands7 for example, or long-distance monitoring of
intensive-care beds in Oklahoma. What is far less clear is the role of
telemedicine in the geographically compact urban situation. Is it,
perhaps, possible to formulate a rule of thumb that the value of
telemedicine increases by the square of the distance to be covered?
Another strand in this complex matter is one that affects all of
medical informatics: the march of technical progress. Not only is the
capacity to transfer all types of data infinitely faster than 10 years
ago, but the range and capacity of peripheral equipment is far
superior. In consequence, the range of possibilities that the
techniques of telemedicine might address increases, and with that
increase a greater potential for an impact on healthcare practice.
That increasing potential highlights a final strand in the
argument. Although in some ways, telemedicine only makes current
techniques available, in many other ways it offers the ability to
change current methods of working. Early ventures in teledermatology,
for example, offered a remote, but traditional, consultant episode:
the GP or the nurse operated the video camera, and from afar the
consultant announced the diagnosis, and further action to be taken. In
one sense, the only advance was that the patient did not have to
travel. By contrast, and in an urban situation, a current project uses
nurse specialists in a range of surgeries to screen, prescribe
treatment in minor cases, and to record with a digital camera cases of
difficulty. Those images are then downloaded overnight for a
consultant opinion, and to determine further action. In this case,
telemedicine is positively changing practice. Sadly there are many
instances where this is not the case, and telemedicine remains an
engaging gimmick.
Articles in this issue illustrate a number of aspects of the field.
In his contribution, Benedict Stanberry explains the work of the
European Health Telematics Association, and the problems ahead in
healthcare that face it. Dr Kevin Doughty and Tony Rice describe the
impact of telemonitoring techniques in caring for COPD patients. And
Dr Paul Johnson, Directorof Oxford University’s Centre for e-Health
Research, shows the potential, both for research and prevention, that
self-telemonitoring techniques offer.
Telemedicine has already demonstrated many possibilities for the
future. Those delivering healthcare have in many cases yet to
understand those possibilities, and to take advantage of them.
Michael Fairey
References
1. Clough K, Jardine I. Telemedicine: five years on — what
progress? Br J Healthcare Comput Info Manage 2003; 20(6): 21–3.
2. Clough K, Jardine I. Telemedicine — the agent for change.
Br J Healthcare Comput Info Manage 2001; 18(8): 22–4.
3. Jenkins P, Gann R. Developing NHS Direct as a multichannel
information service. Br J Healthcare Comput Info Manage 2002;
19(4): 20–1.
4. Barnes D, Capon K. MOSS and the first operational
telemedicine link via satellite for the Defence Medical Service. Br
J Healthcare Comput Info Manage 1998; 15(4): 34–5.
5. Doughty K, Rice A. Assisting the COPD burden with
technology. Br J Healthcare Comput Info Manage 2004; 21(1):
27–8.
6. Fairey M. Tilean medicine. Br J Healthcare Comput Info
Manage 2000; 17(5): 3.
7. Lamb A, Eydmann M, Boddy K. Remote maternity clinics.
Br J Healthcare Comput Info Manage 1997; 14(7): 22–4.
