Telehealth – here to stay?

The digital revolution has had a huge impact on society as a whole, helping to connect people and build relationships, facilitate business transactions and cut costs. Not surprisingly, the benefits of high-tech communications technology are now being felt in the healthcare arena too. Telehealth – which involves the remote exchange of data between a patient and healthcare professionals as part of the patient’s diagnosis and healthcare management – is already helping to change lives for the better.

Over the last decade, telehealth has been used to help patients better understand their health conditions by providing tools for self monitoring, encouraging better management of health problems. It has been used to monitor vital signs like blood pressure and blood glucose from a distance and alert medical teams when there is a problem. Clinicians around the world have been able to debate ideas in real time in video conferencing suites. Surgeons have even been able to carry out operations on patients hundreds of miles away using instruments that feedback sensations of touch. It also involves online self-management support and mobile applications.

Some research suggests that telehealth can reduce emergency hospital admissions and the use of secondary healthcare. It could also bring substantial benefit to patients and clinicians in terms of reducing travel times and time taken off work. “A very significant proportion of health and social care spending is on managing long term conditions,” says Katherine Murphy, Chief Executive of the Patients Association, a registered charity that aims to improve patients’ experience of healthcare in the UK. “If by doing things differently, through using telehealth and other emerging technology, the NHS can provide better care in people’s homes, this would be good news for patients.”

More research needs to be done to explore the patient perspective on telehealth, she says, “but for many patients, avoiding unnecessary trips to the local GP surgery or the hospital would be a positive step forward. Clearly telehealth offers convenience for patients.”

Nowhere has telehealth become more embedded in healthcare than in the US where it was spearheaded by the Department of Veterans Affairs in the 1980s. Today, 72,000 veterans, many of whom are elderly and live in rural locations far away from medical centres, now rely on telehealth to manage conditions like heart disease and diabetes.

The VA has issues in how it delivers care to an elderly population – something that is common to very many health systems,” says Dr Adam Darkins, Chief Consultant for Telehealth Services, Department of Veteran Affairs.

The Veterans Health Administration (VHA), the largest integrated healthcare system in the US, has been sharing information and transferring learning about telehealth technologies with the NHS for the last 12 years.  With a medical care budget of more than US$53 billion, VHA employs over 272,000 staff members at more than 1,700 sites. More than eight million Veterans are enrolled in VA’s health care system. “[Telehealth] is a very good way to provide care. My personal opinion is that this will be the way we deliver healthcare in the future,” says Dr Darkins. “How long it is going to take to get there, who is going to get there at what pace? I think we will have to see.”

In the UK, the role of telehealth is set to expand dramatically.

The growing demand for high-quality affordable healthcare from an ageing population is one of the key factors driving forward telehealth. The average life expectancy in the UK is now 81.3 years in 2013, rising from 75.9 in 1990. If current trends continue, Professor Les Mayhew, Professor of Statistics at Cass Business School, who analysed life expectancy data in England and Wales, predicts both sexes could, on average, be living to the age of 87 in 2030.

As the number of older people grows, so does the number of people living with Long Term Conditions (LTCs). According to the Department of Health in the UK, there are around 15 million people in England with at least one long term condition – a condition that cannot be cured but can be managed through medication and/or therapy. There is no definitive list of long term conditions – diabetes, asthma and coronary heart disease can all be included. Managing LTCs is a huge burden on limited health resources. Patients with LTCs account for around 70 per cent of overall health and care spend. They are disproportionately higher users of health services – representing 50 per cent of GP appointments, 60 per cent of outpatient and A&E attendances and 70 per cent of inpatient bed days.

Telehealth is not just about making savings and bringing benefits to patients. Health professionals are increasingly ‘buying into’ telehealth as they see the advantages of resources like video teleconferencing, secure patients electronic records, instant transfer of information and apps which help them keep up to date with latest developments in their own specialities. Telehealth also allows GPs to consult specialists remotely to avoid unnecessary referrals and enables networks of learning for clinicians and maximisation of skill mix for teams. It has also been shown to significantly reduce travelling time for GP visits and travelling costs.

In December 2011, PM David Cameron said he wanted to roll out telehealth and telecare technologies nationwide in the wake of some early findings of the Whole Systems Demonstrator trial. A study of over 3,000 people showed that telehealth could cut accident and emergency visits by 15 per cent, emergency admissions by 20 per cent and mortality rates by 45 per cent.

The government-backed 3 million lives initiative was launched in January 2012 to achieve a range of objectives including to ‘put the NHS and the UK industry at the forefront of telehealth and telecare globally’ and to ‘promote the benefits that telehealth and telecare services can provide people in managing their health and care.’