Times are tough for those who believe that technology can help improve the efficiency and effectiveness of healthcare delivery to improve patient outcomes. As pointed out by Richard Vize in the Guardian recently, telehealth has become the weapon of choice in the battle between GPs and the NHS, with publications such as Pulse and, most recently the HSJ, continuing to remind readers of the historic, and wholly-unrepresentative-of-telehealth cost effectiveness comparisons for the Whole System Demonstrator (WSD).
At the same time, the national Telehealth Forum’s survey of potential users indicated a lack of awareness of the technology and Invicta Telecare’s survey, a lack of preparedness to remain independent in old age. There is no single name that is used to describe the technology in a way that, say, people see statins as the answer to high blood pressure – and ask their GP for them – or Skype is short for easy-to-install-&-use videotelephony.
There can be little doubt that the previous incarnation of 3millionlives, or any other national organisation, did not focus adequately on either of the above, so the announcement that the programme is to be relaunched with a different constitution is good news if it is going to happen (or was the apparently outrageously misleading HSJ headline more accurate than the text?).
Ever keen to be supportive and helpful, here are Telehealth & Telecare Aware’s three positive suggestions for the new 3millionlives to improve the take-up of telemonitoring technology:
Firstly, if it’s not possible to bid farewell to the WSD, the most urgent action must be to deprive the opposition of any more ammunition. So academics should only be allowed further access to historic WSD data to produce more headline-grabbing negative press if they overprint each page with the words “Historic enquiry – does not represent current practice & costs”. And we need to see the full story, so if an RCT adversely affected the cost of providing telehealth, reduced the effectiveness of the technology by treating it as a simple intervention when it wasn’t, and used kit ordered seven years ago, the cost/QALY should not be compared unfavourably with the current NICE guidelines. And don’t say for example that there was no evidence of improved self-care when that was not one of the primary end-points of the study and the RCT conditions expressly prevented that from being encouraged.
Secondly we need a charm offensive to the main professional stakeholders opposed to telehealth, to point out that the ‘evidence’ they keep digging up is well past its sell-by date. If for example they look at the Department of Veterans Affairs (VA) in the US there is incontrovertible evidence of huge benefits from telemonitoring when commissioned as outcomes…which will be essential if the UK is simultaneously to cut healthcare costs and improve patient outcomes as average age increases. A further point is that a revised approach to commissioning technology will greatly improve its impact: by commissioning outcomes from providers who may or may not incorporate technology into the delivery of outcomes. That puts technology in its place, as no more than an enabler to improving people’s lives.
That all six CCGs in Surrey have bought into telehealth is a clear indication of how patient diplomacy can work. Perhaps it’s instructive to look at the history of the adoption of the stethoscope invented by the French clinician René Laennec in 1816 but only accepted by the medical profession in 1866 following the endorsement of Austin Flint, an outspoken American clinician of the time. Is Adam Darkins of the VA telehealth’s Austin Flint?
Thirdly we need an innovative public marketing campaign to get patients asking for it. That begins with agreeing a single name that hopefully patients will start demanding. I’m no PR expert, however I have watched with wonder at how strategic placement in a radio or TV soap (eg the Archers) of an issue can raise national awareness very effectively. I’ve also been impressed by the radio and TV ads for bowel cancer awareness – if you can make the first signs of that palatable, you can certainly sell telehealth, whatever it is called. TTA is hugely supportive of the newly-national UK Telehealthcare, which we see as potentially a great partner to 3millionlives in increasing national awareness (however we do suggest they move on from pictures of older people lying semi-conscious clutching pendants, in vacant bus shelter poster slots).
Readers’ comments are always welcomed – especially to this post.