What it takes to make telehealth really work

In line with my fellow editor, forgive this editor engaging in a little nostalgia – going back to 2006, when the Whole System Demonstrator was a still a wonderful idea, before the competing forces of academia and management consultancy put short-term financial gain before long term patient outcome improvement. Those were the days when we genuinely believed that recording vital signs was what it was all about.

Move on nine years and it’s clear from the American Heart Association review referred to in this column recently, and subsequent articles, that one key success factor is drip-fed education. To quote:

“The amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets,” the researchers say. “Mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.”

This is underlined by a recent study of attempting to control hypertension using just text messaging, which was far from an unqualified success.

Another major driver of course is cost saving, as demonstrated by the move by US companies to encourage the use of teleheath by employees as recently highlighted by a National Business Group Survey.

In the UK, as we reported in May, BUPA is working hard on mHealth solutions, and Aviva has tied up with Babylon. However as employers typically only provide ‘private’ healthcare for a small subset of their employers, the incentives sadly are not so great, and indeed elsewhere in the UK health system they are positively perverse – for example hospital administrators continue to discourage telemedical consultations because the NHS tariff for these does not recover hospital overheads, whereas face:face out-patient consultations do.

There are also perverse barriers to development of lower cost treatments in general, as a recent article in the Journal of the American Medical Association explained.

Another problem with telehealth can be getting patients to records vital signs data. The myEarlySense sensor gets round this by being placed under a patient’s mattress, collecting information on heartbeat, respiratory rate, sleep stages and movement and then wirelessly transmitting the data to a smartphone app.

In this editor’s mind, two factors are likely to improve telehealth usage in the near future. The first is the arrival of smartphones with in-built blood pressure sensing, using the Leman Micro chip, or one of the other competing technologies. The second is the use of self-learning algorithms such as that being trialed in the US by WANDA (for whom this editor has previously done some work) to automate and vastly improve vital signs monitoring, leading to much lower cost longer lead-time identification of patients with long term conditions at high risk of exacerbation.

Clearly though the issue of drip feeding behaviour change material remains of paramount importance – combining this with vital signs capture, initially just to keep on the mobile device to inform the correct information to drip feed, enables very cost-effective self-care treatment at the bottom of the Kaiser-Permanente tranlge to prevent conditions worsening. Further, such apps can then gradually be scaled up if conditions worsen by connection to a monitoring centre, followed by increasing intensive remote care, as conditions dictate.

Hat tip to Prof Mike Short for pointers to material used.


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