Telehealth Soapbox: Kiss of death for telehealth adoption in the UK?

Editor Steve grieves for the days when telehealth in the UK had a bright future…

There is a deep irony in the latest move by the UK’s Department of Health (DH) to encourage general practitioners to adopt telehealth (remote care).

Perhaps it is because the health ministers and/or civil servants have realised that the Whole System Demonstrator (WSD) programme results have gone down like the proverbial lead balloon that they have turned to the thing which has ‘traditionally’ motivated GPs to change – money. But, as the GPs see it, the scheme they have come up with involves making them adopt unproven telehealth with inappropriate patients to regain a small part of the money that will be taken taken away from them by one of DH’s other moves involving the Quality and Outcomes Framework (QOF). The following item from GP Online sums up what is happening: Telehealth DES plans are ‘political interference’, warns GPC. UPDATE: Department of Health webpage setting out the contract change proposals.

At any other time in the past 10 years the backing of DH for telehealth adoption would probably have been a ‘Good Thing’. But now, in the context of deeply unpopular changes to the way the NHS is structured and the prospect of a huge funding squeeze for the foreseeable future, anything that DH or Ministers are seen to be promoting will be viewed with deep suspicion. As a result, encouragement in the form of Ministerial support for the 3millionlives initiative was bad enough, but attempting to coerce GPs is surely the kiss of death for telehealth adoption.

Steve Hards

11 December 2012

Categories: Soapbox.

Comments

  1. Steve Hards, Editor

    In the meantime, the rest of the world believes the message being put out that the UK is in the forefront of telehealth adoption…”UK dials up “virtual doctors” in big telehealth push” [url]http://news.yahoo.com/uk-dials-virtual-doctors-big-telehealth-push-123445535[/url]

  2. UpNorthAndToTheRight

    Does anyone know how this would work with the 3ML pathfinder sites? Also has anybody heard anything from, or from within, the pathfinder sites as to how they are going to achieve their share of the 100K ‘users’ in the first year?

    I hope we don’t have rehashed, double counted figures and figures that include planned deployments (continued Telecare installs that would be ongoing anyway for example). I also would like to see an action plan of sorts from the pathfinders defining the technology/services to be deployed that is different from the year before. Asking too much I think.

    Incentivising the GPs is not necessarily the final nail in the coffin but it is very much the misdiagnosis that sends Telehealth to the ICU where it is touch and go.

  3. Alasdair Morrison

    The 100,000 will all be telehealth connections as far as I am aware and as far as the industry is aware. This figures does not include any telecare connections even though 3ML is branded at both but seems more recently to concentrate on telehealth.

  4. Kevin Doughty

    I believe that all these articles (as well as Telecare Aware discussions) are indicators of a healthy industry as they allow an open and frank exchange of views. The natural hype that equipment providers might introduce is properly moderated by so many people who can identify it in a nanosecond. No wonder that other countries think so much of the NHS and see the UK as the source of good practice in digital technologies.

    Incidentally, my view is that telehealth (as currently defined by DH and others) will take off when Joe Public starts asking his GP for better ways to monitor vital signs that don’t require him to travel to a surgery to do so. When every GP practice has the vital signs equipment in the waiting room, and patients see that the data is automatically entered into the record that their GP can see, they will both accept and expect the new technologies. Maybe this is where the investment should be made.

    As Alasdair rightly points out, telecare (again as defined by others) is not to be part of the current rollout perhaps because the WSD found that when tight service eligibility criteria were applied there were few people who would require both telecare and telehealth. As the range of digital healthcare technologies and services increases then we may start to forget the distinctions between alarms and monitoring. This might actually help to integrate social care needs with healthcare needs, resulting in more unified remote care service propositions.

  5. UpNorthAndToTheRight

    If possible can somebody direct me to a document which defines the direction that 3ML will take?

    I would like to thank Alasdair and Kevin for their responses and I do not doubt their words at all but I am unable to find anything ‘written down’ to support this on the 3ML site. Telecare and Telehealth appear to be addressed equally.

    I am easily confused by life in general so a ‘hold my hand’ approach and walk me through it is what works best for me.

    From 3ML – Objectives
    •For DH and industry to work together over the next 5 years to develop the market and remove barriers to delivery.
    •For DH to create the right environment to support the uptake of telehealth and telecare including rewarding organisations for adopting and integrating these technologies in services by developing a tariff.
    •For industry to work with the NHS, social care and other stakeholders to simplify procurement and commissioning processes for telehealth and telecare services at scale.
    •To put the NHS and UK industry at the forefront of telehealth and telecare globally, developing significant opportunities for UK plc.
    •To promote the benefits that telehealth and telecare services can provide people in managing their health and care.

  6. Alasdair Morrison

    UpNorthAndToTheRight,

    I don’t think there is anything ‘written down’ but perhaps the TSA can shed some light on this as they are the ‘self styled’ industry body.

    Would be interested to hear what they have to say. I do not see any providers putting up free Telecare as a starting initiative as part of the initial 100,000 which leads me to believe that the view is one that Telecare is already adopted and delivered but Telehealth isn’t.

  7. UpNorthAndToTheRight

    Thanks Alasdair.

    As someone who works in these fields I really want the take up and adoption of these services to just bloody hurry up (no I don’t own shares or work for any of the providers). I just get worried when I see a lack of clarity. I also fear that the pathfinders will seek out their own paths – some starting from a point of knowledge and others starting from a point of necessity.

    If I was a business I would be sh*tting bricks at the thought of providing 100, 400, 1000 of my units to organisations that might not have the foggiest. Changing the b2b and b2c relationships to p2p is not one I would relish being a part of.

    Also on the part of the PCTs/CCGs – unknown territory for some and taking the lead/working alongside a supplier is not something they are designed for.

    If I were King I would simply just decree that each GP in the country needs to have 20 of their patients monitored or else; and let them get on with it.

  8. Jo

    I share UpNorthAndToTheRight’s frustration regarding the speed of progress – but I also sympathise with suppliers who really do risk going out of business as their products gather dust in the warehouses (and become obsolete as new systems appear), and with DH who really would like to see Digital Healthcare take off as it would justify the push to bring care closer to the home (and avoid the need to build more and bigger hospitals).

    I like the idea of giving GPs (and social workers) some targets to help with the adoption of the new ways of working. 20 users of remote vital signs monitoring might be a start – as long as that’s per month. What about all surgeries having 2 or 3 vital signs kiosks (as Kevin suggests) but with point of care testing too (cholesterol, blood count, blood glucose etc.) along with subjective questions, a screen to provide feedback films, and a video facility direct to a dedicated nurse or professional at a monitoring centre. This could quickly be as much as a routine as patients have got used to with checking in for their appointments.

    Any other ideas from readers?

  9. Alasdair Morrison

    Jo,

    we are already getting GPs to conduct ‘virtual consultations’ from the consulting rooms into residential homes. This will hopefully expand in the very near future as we have managed to reduce the number of home visits made by GPs by 75%. We have also found that ambulance staff are using the system to discuss individual’s cases to determine whether an admission is actually necessary.

    We can also deliver videos / films through the system for therapy such as exercise and speech therapy. These can be accessed from the comfort of your armchair via your TV. The system can also allow any other professional access to the patient / service user virtually rather than making physical visits. Once the network of services build up using the systems, efficiencies will undoubtably come and the patient can remain in their home but with direct access to whichever services they need.

    In terms of Telehealth, we do not necessarily need to purchase boxes, merely provide the peripherals and make regular calls virtually to discuss how things are going. These calls will allows us to provide health advice, see the patient and pick up on any tell tale signs that boxes and question trees can not.

  10. Kevin Doughty

    It’s all about changing the processes of healthcare which we have developed over the past 50 or 60 years, and then making the new ones appear normal (while keeping our heads down when the bricks and hand-grenades start to be thrown at us).

    We must be able to take a leaf or two from the books of supermarkets and banks. When self-service check-outs appeared in the former, there seemed to be more staff around to help people to help themselves than there were check-out operators on the tills. Six months later, people are queuing at the self-service tills because they know how to do it, they are confident that they will do it right, and they know that they’ll be through quicker.

    The same is true in banks, only people with complex requirements queue for a teller, everyone else uses the cash machine, the statement machine or the one that sucks in cheques.

    So what about 2 options at the surgery, one guarded by the old-fashioned receptionist while the other uses an avatar to guide people painlessly through a technological journey in which they are electronically screened and presented to the appropriate healthcare professional who has in front of them both the electronic patient record and any recent vital signs measurements and results of blood or urine tests, answers to questions and ideas for further tests using dedicated decision support tools. People would quickly realise that the process was quicker, safer (less chance of contamination by ill people) and would probably provide improved outcomes. They would also quickly realise that they didn’t need to attend the surgery anyway, as it could all have been done remotely from the comfort of their own front rooms. Maybe a bit like home banking and internet shopping!
    That’s what digital healthcare is all about and it’s a vision that people will, I hope, accept.

  11. Alasdair Morrison

    UpNorth,

    Mr. Hunt’s announcement today would confirm to me that the 100,000 people will receive Telehealth, no mention of Telecare, therefore the questions is whether 3ML is just about Telehealth??!!??

    Discuss :-)

  12. Steve Hards, Editor

    @Alasdair and @UpNorth
    Has he announced it again? The only online reference I can find is this one on 14 November. It definitely looks like 100,000 for health, no mention of telecare.
    [url]http://www.dh.gov.uk/health/2012/11/technologies/[/url]
    Steve

  13. UpNorthAndToTheRight

    I think it may just have been a regurgitation of the 14th Nov’s piece on the Dispensing Doctors’ Association’s site that Alasdair has seen.

    I have no fear of either or both, it would just be nice to have some clarity.

    Falls, epilepsy, nocturnal urinary incontinence, medications mismanagement are all ‘health’ issues.

    I wonder what definition of the term ‘Telehealth’ the Secretary of State is working from. Once I know this, things will be so clear.

    Telehealthcare is such a long word that some people sometimes like to shorten it……

  14. Alasdair Morrison

    Maybe we could ask the TSA board, they have industry members :-)

    I could do with some free epilepsy sensor matts and controllers, they are increasing in demand and also higher in price.

  15. Steve Hards, Editor

    @Alasdair – Ah, it looks like TSA just picked up a local Camden story which includes a reference to the Nov. announcement.

  16. Alasdair Morrison

    Update

    The 100,000 target is for at least 100,000 people to be receiving a Telehealth ‘service’ not just boxes.

    This service will presumably delivered by members of the industry group rather than allowing CCG’s and Trusts to provide their own Telehealth / Technology services.

Leave a Reply

Your email address will not be published. Required fields are marked *