Telehealth Soapbox: Standing firm on the argument for telehealth is vital

<em>Keith Nurcombe, Telefonica’s global director of healthcare, and managing director of O2 Health UK, makes a rallying call to all telehealth supporters.</em>

Telehealth significantly reduces mortality rates, emergency admissions, A&amp;E visits, elective admissions, bed days and costs. Yet despite the overwhelming evidence, there is growing worry about its implementation. We’re far from crisis point, but unless we continue to argue the case for telehealth and promote the evidence available we will allow detractors to win.

That’s why I read with worry last week that the Nuffield Trust’s Adam Steventon – one of the lead investigators behind the WSD – had claimed he doubted the safety of telehealth. As the <a target=”_blank” href=”http://www.telegraph.co.uk/health/healthnews/9509181/Doubts-raised-over-safety-of-doctor-by-broadband”>Telegraph reported</a>, he said…

“A study done very recently which looked at patients with multiple chronic conditions found that more deaths were associated with telehealth than the control group.”

This is worrying, but as I read it, he is just stating that not all the evidence agrees – and there is a wealth of evidence showing the exact opposite. Yet once out in the open, his comments have spurred on those who oppose the technology. In contrast, I would argue that a seemingly negative trial outcome is not a reason to slam down the shutters on the use of remote and mobile patient monitoring. Far from it – if anything it’s a reason to understand what the challenges are and then address them.

It is absolutely right to be cautious when it comes to patient safety. Nothing is more important when introducing new technologies and innovations. As a vendor, more than any other organisation, we need to be 100 per cent sure that the products and services being offered to the health and social care sector meet the very high standards demanded of them.

But to let the outcome of one trial derail the overall objective of better patient care is irresponsible – just as ignoring negative outcomes would also be irresponsible. The key is to keep a calm head, take into account all the evidence and ensure patients and their needs and safety are at the heart of how telehealth is rolled out.

What we cannot do is allow alarmist views and opportunist use of evidence to derail the aims of the 3 Million Lives (3ML) initiative and its supporters. If that happens, we will have failed patients, failed practitioners and done nothing to help address the financial black hole facing the NHS. I look forward to the fight-back, and I for one will be in the vanguard.

Keith Nurcombe
O2 Health

Categories: Soapbox.

Comments

  1. UpNorthAndToTheRight

    The study that adam Steventon refers to has various conclusions as to why the mortality rate was greater in the Telehealth group.
    There was an expected average mortality rate of 13% for both groups. Telehealth showed only a small increase on that at 14.7% yet the ‘usual care’ group was 3.9%. What you must realise is that the average was worked out with the current usual care model in mind so whilst the Telehealth group were actually not too far off the mark the usual care group was significantly less.
    The usual care group mortality, although great for the patients that lived, is actually more worrying with regards to the study and how it was conducted.
    I think Adam Steventon should probably ‘study the study’ and not regurgitate the headline results; and of all the joints in all the world he had to walk into mine. Or of all the studies across the world, he chose the one that has the least amount to contribute.

  2. The crucial point arising from this (and other studies) is that a variety of outcomes for telehealth interventions are indicated. What is being continually missed, however, is the fact that even if there are no benefits (as measured in terms of clinical outcomes), there can frequently be other benefits in terms of people’s ability (and willingness) to manage their conditions and an improvement in overall well-being / quality of life.

    What is also being overlooked is that telehealth has a much wider repertoire than just vital signs monitoring. We should also (though I’m not sure that the 3 Million Lives is poised to do this) look to the impact that is beginning to be apparent through those aspects of telehealth that enable people to use a widening range of technologies – from devices associated with vital signs monitoring through smart mobile devices to the ordinary telephone. One study with an ambivalent outcome should not, therefore (as indicated by Keith Nurcombe), distract us from the immense benefits that telehealth can (and will) deliver. Not least of those benefits is a shifting of service paradigms away from those which are concerned to deliver services ‘to or for’ people; and towards services that are provided in ways that people can access and use in accordance with their needs and choices.

    The newly emerging European Code of Practice for Telehealth Services (to be launched at Medetel next April – see http://www.telehealthcode.eu) is pitched very firmly in the camp that is concerned with providing a shape for such telehealth services. The Code (an advanced draft of which is now being validated in six EU countries) does not deny the fact that some people need care and support in traditional ways. It, however, guides telehealth service development and underpins the moral imperative that justifies further telehealth service development. The evidence for its benefits for health (in both its clinical and well-being senses) is increasingly clear.

  3. Mike Clark

    This small Mayo Clinic telehealth RCT (n=205) does tend to get referred to by a number of telehealth critics and commentators (eg http://bit.ly/HZqXgp and the recent BBC Radio 4 discussion). I am surprised that it appears again in the recent Telegraph/Nuffield article.

    As already discussed, the mortality rate for the telemonitoring group (14.7%) in a small study was about what they expected from their knowledge about that group with complex comorbidities (13%) and the usual care mortality was lower than expected (3.9%) in this particular case for the 12 months covered.

    It is important that anybody interested in telehealth looks at the paper in more detail to read what the researchers found. Articles referring to this paper seem to conveniently leave out the detailed discussion.

    Here is the link for the full paper. The discussion on mortality starts on Page 777 of the Journal – ‘A Randomized Controlled Trial of Telemonitoring in Older Adults With Multiple Health Issues to Prevent Hospitalizations and Emergency
    Department Visits’ (http://bit.ly/Om87Em)

    If there had been any significant safety risks from the telehealth devices and service follow up then the trial organisers and researchers would have stopped the programme. Indeed on Page 775 of the Journal, the researchers say ‘No direct harms or unanticipated problems involving risk to participants or others were reported’.

    It is about time we moved on from the dramatic headlines derived from this one paper and looked at the important lessons in service design that need to be made to support the growing number of people with long term conditions (70% NHS budget). This means looking at better case-finding, integration of services, early intervention and prevention approaches, community services including re-ablement and rehabilitation, medication review, self-management – with the support of cost-effective telehealth remote monitoring as appropriate. Remember, it was a ‘whole system demonstrator’ trial that had five broad evaluation themes that will give us a number of important pointers to how services are designed in future.

    The 3 Million Lives Initiative (http://www.3millionlives.co.uk/) as well as the QIPP Programme and the NHS Mandate will provide us with a fresh opportunity and momentum to ensure that people with long term conditions can benefit from more individually tailored support services based on improved clinical and financial models that are being developed.

    Mike Clark (Twitter: @clarkmike)

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