As Prof Mike Short pointed out recently, 2016 is the tenth anniversary of the start of the Whole System Demonstrator (WSD) programme that in retrospect, because of poor trial design, probably slowed the uptake of digital health in the UK more than any other single action. It seems appropriate therefore to look at how telehealth* has fared over that period, and perhaps even more importantly, is poised for the next ten years.
The mistakes of the WSD are well documented (eg here, here & here) – suffice it to say that it proved beyond all reasonable doubt, at least to this editor, that unlike medicine-based interventions, which seem less sensitive to their care pathway, digital health delivers most of its benefit through enabling a different, patient-centred care delivery, so every digital health intervention needs to be evaluated holistically, and in its own care pathway. Sadly over the ten years, much of the academic work looking at the benefits of telehealth has continued to evaluate the technology in the time-honoured way that medicines have been evaluated, with predictably largely equivocal results.
Those of us who have delivered telehealth projects though have a sense of disconnect as, time and again, a focused implementation – not a pilot – in which the staff delivering the service understand that it will be a permanent change for which they need radically to change the way they deliver care, yields huge returns on investments through savings typically in the 50-90% region. (more…)