When this editor was running a telecare & telehealth programme in Surrey, there was always the dread when meeting professionals that one of the daily internet newssheets would publicise another paper about the Whole System Demonstrator (WSD) that ‘proved’ that one or other form of remote patient monitoring (RPM) cost more per QALY than a voyage on Virgin Galactic. The day was then spent unconstructively, making some or all of the points encapsulated in my original post on 22 July last year entitled “Time to bid farewell to the WSD”.
Thankfully the flow of WSD papers has since dwindled. Doubtless many hoped they had stopped for good, in view of their total irrelevance to the real world in 2014. However, on the offchance that some poor reader has found themselves being challenged about the abstract of a recent paper picked up by Pulse, on the high cost per QALY of telecare by one of the few professionals who still do not accept the value of appropriated technology, here is what you might tell them (more…)
A paper just published in the Journal of Telemedicine & eHealth (Volume: 19 Issue 9) entitled “Telehealth Remote Monitoring for Community-Dwelling Older Adults with Chronic Obstructive Pulmonary Disease” makes refreshing reading for those of us who still believe that a well-designed implementation of telehealth brings immense health benefit to those with chronic long-term conditions.
The authors, Kristen De San Miguel, Joanna Smith, and Gill Lewin, all from Western Australia describe a small RCT using Docobo kit that involved (more…)
I have recently been made aware of an excellent publication jointly by the Royal Academy of Engineering and the Academy of Medical Sciences entitled Establishing high-level evidence for the safety and efficacy of medical devices and systems, so this post is to reach out to those like me who were previously unaware.
It is a major step forward in applying engineering methodology to evaluating the effectiveness of medical devices & systems and, even more important, ensuring their ongoing safety. Those of us who have participated in a substantial randomised control trial such as the Whole System Demonstrator (see earlier post today) will take great interest at what follows the quote: “For pharmaceutical innovation, the randomised controlled trial is the acknowledged gold standard for creating a body of high-quality evidence. But designing clinical trials to establish the evidence for medical devices has proven more problematic.”
(Included in the paper is the observation that the ultimate health improvement device when you leave an aeroplane that is in the air – the parachute – has never been proven by an RCT.)
Finally just to return to an earlier comment, the report makes the point that because medical devices can be changed far more often than the composition of a drug, the importance of appropriate safety monitoring is absolutely critical, an issue that is becoming increasingly relevant as penetration of telehealth (in particular) and telecare increases. Whilst we might choose to ignore the different nature of medical devices when assessing a trial, we cannot ignore the different nature of medical devices when designing and putting in place appropriate safety systems.
TTA Contributing Editor Charles Lowe asks whether it is now time to stop looking back to the UK’s pioneering Whole Systems Demonstrator (WSD) programme.
As the person who led the bid for Whole System Demonstrator status for LB Newham back in 2006/7, this is my case that it’s time now to bid farewell to the programme, as soon as is possible.
Why? This was a great programme that came up with some encouraging results for telehealth, and taught us a huge amount about how best to implement telehealth and telecare. However the echoes from that long gone time are increasingly providing ammunition for the naysayers, when in reality the world is now a totally different place. The technology is unrecognisable from that that we considered when bidding for the WSD in 2006; it is far more efficacious and far cheaper; and it can be deployed much faster & for many more conditions, opening up many possibilities not available to us when we won in 2007. We now know much more about how to implement the technology too: in particular it delivers greatest benefit when a part of an overall programme for improving care and not, as the WSD randomised control trial (RCT) treated it, as a simple intervention, like most drugs. In retrospect therefore there were significant weaknesses in the way the trial was run.
The continuing drip-feed of WSD results is sadly resulting in (more…)