Telemedicine: a healthy adolescence
Eighteen months ago in this column, we observed that the concept
‘telemedicine’ had passed the Humpty Dumpty phase of its life, in which it
could mean anything you wanted it to mean, but most probably meant the
attempt to replicate old systems at a distance.(1)
Perversely, it had come to a point where such a definition was a
straitjacket. A new approach — if necessary, a new word — was needed to
signify a much broader concept, that of furthering care from a distance.
During the intervening months, there have begun to emerge positive and
encouraging signs that ‘telemedicine’ (in its broader definition — alas! no
new word as yet) is slowly moving towards realising some of its potential.
There are perhaps two main reasons why this should be so. The first is the
pressure of events. The growth of the elderly population, with its
associated demand on resources, and the realisation that NHS funding cannot
expand infinitely, have driven clinicians and managers to consider how care
can be provided in the most effective but economical way.
We are entering a period when, as the newly appointed Chief Executive of
the NHS has courageously explained, even sacred cows like A&E departments,
and maternity units, may have to diminish in number.
The second reason comes from a growing maturity, borne of hard-earned
experience, in the ways to which the potential of telemedicine may be most
effectively exploited. There is always a temptation with a new technology to
apply it in a scatter-gun fashion to see what works, and then in the light
of events, to refine its use to those areas where results can be achieved.
Telemedicine in this country has come to a point where there is a growing
understanding that technology alone is insufficient. The way forward lies in
the synergy between technical capacity and human intervention, and the
lessons that can be drawn from that synergy.
The articles in this issue of the Journal show this growing awareness
that the potential for the future lies in exploiting this synergy.
In their article, Susan Procter, Professor of Primary Healthcare
Research, City University, and Angela Single, formerly Project Director,
Long-term Conditions for Newham University and Primary Care Trust, report on
their pilot study to evaluate the introduction of home monitoring of older
people with multiple conditions often leading to multiple hospital
readmissions.
In the study, where physiological telemonitoring was supported by a
dedicated nurse, overall hospital admissions, compared with a similar
previous period, decreased by 38%, and hospital bed days by 56%. In more
than half of the study group, the installation of telemonitoring equipment
enabled early detection and treatment — and thus reduced admission rates. As
the authors point out, the sample size was such that no general conclusions
can yet be drawn, but there are some very important lessons to be gathered.
The capacity of the primary care team to communicate well with the
patient was a major determinant in the successful outcomes reported.
Telemonitoring, coupled with the care team’s understanding of the patients’
experience, gave patients greater confidence and provided more reassurance
for relatives who lived at a distance. Overall, the study showed the
synergistic effect of telemedicine with dedicated staff.
In their article, Dr Simon Brownsell, Hazel Aldred, and Mark Hawley from
Barnsley Hospital NHS Foundation Trust describe their study of
telemonitoring at home for patients with chronic heart failure.
Using a handheld device, patients in the trial were asked to complete a
daily questionnaire on their condition, supplemented by some physiological
data. The responses were reviewed by clinicians at the monitoring centre,
who determined whether or not in the light of the whole picture any
intervention was required. After initial problems were smoothed out, the
undoubted impact was earlier medical intervention and, in consequence,
action in a preventative rather than a reactive way. As with the Newham
study, the synergy of telecare and clinician is apparent.
In our third article, Barbara Archer, Assistive Technology Lead at
Leicester City Council, reflects on some of the beguiling dangers of using
assistive technology in the drive to maintain patients, particularly older
people, at home. She emphasises the importance of a proper individual
assessment of each patient’s need, and from that an informed conclusion as
to the right level of telecare to be employed. Without such an assessment,
telecare might well lead to the cardinal medical sin of treating the
symptom, not the disease.
All three of our articles show that there is growing understanding of the
value that telemedicine can bring when it is allied to sympathetic and
informed clinician participation. Equally encouraging is the desire to
evaluate its impact. Both are signs of growing maturity — adolescence may
hopefully soon be overtaken by adulthood.
Michael Fairey
Reference
1. Fairey M. Neologism needed: apply within. Br J
Healthcare Comput Info Manage 2005; 22(3): 3 . |
