Neologism needed: apply within
The time has perhaps come when it is
necessary to examine with some care what we mean by ‘telemedicine’ and the
varying concepts that the word tries to convey.
The Economic and Social Research Council (ESRC) recently sponsored a
study of telemedicine in the NHS, which concludes that “despite high
expectations, telemedicine and telehealthcare systems ... have had only a
limited impact on the NHS ... the expected revolution in medicine ... has
simply not happened ... the real reason is often the failure to think
through the organisational problems involved in integrating new technology
into everyday NHS activity”. (1)
The last observation is not of course confined to telemedicine: it
applies with equal force to many of the applications that healthcare
computing now makes possible. Partly through the desire to sell a new
project, partly through cautious timidity, many computer applications aim
only to replicate existing systems and not to change an overall process. In
its early stages, telemedicine did exactly that: remote consultations in
specialties such as dermatology replicated the concept of patient attendance
at the consultant clinic, albeit at a distance. Expert interpretations of
diagnostic tests at a distance have proved enormously valuable, but again
replicate existing practice. Times move on however, and horizons expand.
Amongst the HITEA winners in 2004 was a project in teledermatology that had
cut through the concept of the ‘consultant outpatient visit from a distance’
and, by using nurse specialists and carefully defined protocols, radically
improved the entire process of referral.
The great advantages of integrating information and communications
technologies (ICTs) with more conventional healthcare systems are evident in
Norrboten, the most northerly county in Sweden, which occupies a space of
approximately 400 square miles but has a population of only 250,000. The
four hospitals, 30 health centres, and all the pharmacies that serve the
county use the County Social Security base for their patient register. The
diagnostic facilities available in hospitals can be accessed through any of
the health centres; prescriptions are passed directly to the appropriate
pharmacy; and — though this is common sense, not telemedicine — taxi drivers
in the most remote areas are given basic training in delivering babies!
This issue of the Journal shows both how powerful today’s telecommunications
techniques can be and the range to which they may be applied. In his
article, David Kelly, Director of Community and Support Services for West
Lothian Council, describes the package of telecare technology that currently
supports 1,700 older and vulnerable people in their own homes. The average
length of stay in a nursing home has dropped from three years in 2000 to 18
months in 2004, and hospital bed-blocking averages 30 days compared with the
Scottish average of 112.
In their article, Peter Montgomery and Helen McCloughry describe the
positive impact of a specially designed information and communications
system upon the community rehabilitation and intermediate-care services in
Nottingham. It was instrumental in bringing about a significant reduction in
the overall length of all intermediate-care episodes and a markedly reduced
residential length of stay. Need for the new system resulted from an
expansion in both size and complexity of Nottingham City’s rehabilitation
and intermediate-care services, following integration of its domiciliary and
residential services and the melding of healthcare and socialcare teams two
years earlier.
Along the same lines — the beneficial impact through ICT of access to
information — is the article by Martin Old, Manager of the National Clinical
Audit Support Programme (NCASP). He shows how national audit of results in
cardiac care and diabetes not only reveals compliance with national service
frameworks, but also — and of much greater importance — enables clinicians
to compare their practice with that of colleagues across the country, and
thus perceive where their own practice might be improved.
Our final article by Keith Clough and his colleagues of the e-Health
Innovation Professionals Group trails some of the findings of a forthcoming
report on innovative procedures made possible by ICT. Together with the ESRC
survey, the article highlights the frequent failure to seek out or to
achieve the organisational changes that ICTs can make possible; and,
significantly, it highlights the problem with which this editorial began —
in the light of current developments, what exactly is telemedicine?
‘Telemedicine’ now no longer describes the use of ICTs to replicate old
systems at distance. It means far more: the use of rapidly available
information from a distance to deliver care not only more effectively but
also to more people, with greater flexibility and choice, and in new ways
and places. NHS Direct, the NCASP, realtime bed availability, use of
electronic assistive devices and telemonitoring technologies for care in the
home — all these are examples of where innovative thought combined with ICT
can go. The problem with words like ‘telemedicine’ is that they apply a
straitjacket to the concept they are trying to convey.
Furthering care from a distance using ICT is the concept we need to
convey. We need a new word. Answers on a postcard, please — Keith Clough
will provide the beer for the winner!
Michael Fairey
Reference
1. Economic and Social Research Council. Telemedicine
revolution is ‘disappearing’ from the NHS. Press release: 4 March 2005. (Go
to reference point) |
