Been there. Done that. Waiting for the zealots’ t-shirt.
For the past few years the Telecare Services Association’s conference has flirted with telehealth – its core ‘home’ audience being social services telecare providers. But during the past year the seduction has been complete and throughout today the speakers’ focus on telehealth’s nuptial preparations has been positively upbeat – complete with ‘topical’ reference to Dylan’s The Times They Are A-Changin‘ (1964).
With all the attention on telehealth, telecare has been largely relegated to the workshops and exhibition hall where, I’m happy to say she seems to be getting along quite nicely, thank you.
As if telehealth were already wearing her bridal veil, none of today’s speakers defined what they meant by the term and with each new speaker it will take time for the audience to work out that they are not talking about the same thing as the previous one. Furthermore, if the term ‘telecare’ in the final day session entitled What can the UK teach the USA about Telecare delivery and what opportunities does this offer to the UK market? by Jonathan D Linkous, Chief Executive of the American Telemedicine Association does not also turn out to be a variation of ‘telehealth’ I’ll wear my conference bag home on my head!
So what was revealed today?
Nothing of the Whole System Demonstrator (WSD) randomised control trial results, of course, but we knew that would be the case, anyway, didn’t we? I suppose so because no one took Conference Chair Roy Lilley’s challenge to ask for their money back. Professor Stanton Newman’s re-titled session turned out to be WSD Trial – Evaluation of Telehealth and Telecare: Who accepts and rejects the equipment and why which was an interesting complement to the Telecare Aware Soapbox item on the topic. However, it is really just a byway in the WSD countryside.
Between Professor Newman, Paul Burstow, the Minister for Care Services and Stephen Johnson, Head of Long Term Conditions at the Department of Health (DH) we were variously told that the WSD results were:
- in the last stages of the peer review process
- that they are only a couple of weeks away from publication
- that DH was considering how to follow up publication to get the best bang for the buck (I paraphrase)
- that DH is working on a LTC-based ‘year of care’ tariff which, one assumes, will include an element for telehealth
Hey ho! Telecare in England had its chance to become the belle of the ball with the Preventative Technology Grant back in 2006-08 and councils frittered that chance away like nervous adolescents. Let’s hope the NHS can do better when its turn comes! (Hmm…have I just mixed metaphors? Sorry!)
A couple of snippets from Professor Newman’s presentation (you can wait for the full results, can’t you?): 5831 participants to the WDS were recruited [out of 27,000 invitations, we learned from later speaker Gwyn Weatherburn] but only a very small percentage of people who had the equipment installed asked for it to be removed. People who were less likely to ask for it to be removed were female, younger and from minority ethnic backgrounds.
Roy Lilley, who, at some point had been branded a zealot neatly turned that around and had the majority of the audience proclaiming that they too were telehealth zealots! We are now waiting for the t-shirt.
Dave Tyas, telehealth co-ordinator from the Cornwall WSD brought the issues to life with the example of patient ‘Eddie’. Main points I picked up from his presentation were:
- Most people DO get on with the technology regardless of age
- Resistance initially came from the GPs who had workload concerns, but referrals are now increasing
- A service needs to set up in a way that can scale across conditions and numbers
- Patient satisfaction with delivery/installation is critical
- Lack of information is the main barrier for patients
- What patients DO is more important than what they SAY
Stephen Johnson followed Paul Burstow’s speech. Three points from Stephen for me were:
- If we cannot be clear about telehealth amongst ourselves (the zealots!) how can we expect the public to be clear?
- After the WSD results are published it will be hard for people to argue for more pilot projects. (Hooray!)
- Unlike MRI scanners we do not have the luxury of having 30 years to get it mainstreamed.
To the last point I’d add that neither do current potential users.
Gwyn Weatherburn’s presentation was a round-up of the wide-ranging interest of the Royal Society of Medicine in the topic. It was more interesting than I’ve probably made it sound.
The afternoon was drawn to a close by Adam Darkins, a British ex-brain surgeon who is Chief Consultant, Care Coordination Services for the Department of Veterans Affairs (VA) in the US. As he oversees one of the largest telahealth projects in the world (he has picked up the American way of pronouncing it despite not losing his English accent) his credentials are second-to-none. His presentation was also the most visually interesting with old photos drawing analogies with current technological concerns. Two significant points I noted were:
- Using home telehealth does not unlock money from hospital-based healthcare
- Developing counties do not have to disinvest from old healthcare systems before investing in the new ones that are emerging. So, if they can invest, they could leapfrog the developed counties.