Brief report on the European Telemedicine Conference, Edinburgh 29-30 October 2013

The European Telemedicine Conference held in Edinburgh’s historic Assembly Rooms this week exceeded my expectations in many ways.

A vital requirement of all such events is good networking, which Edinburgh promoted most effectively. There was plenty of break time and lots of opportunity to see and meet people. There was a goodly number of stands too, where like-minded people could coalesce. For some there were personalised itineraries that helped as well. Then on the second day, a very deliberate effort was made with three different types of interaction to encourage people to meet up. Perhaps most important though was that the conference attracted a very high quality of delegate – these were people in the main with interesting things to say…and they came from as far away as Hong Kong.

Perhaps the principal draw was the Scottish telemedicine scene which is clearly very vibrant. Among the presentations I selected to attend (the choice was invidious as outside the plenaries all three stream featured excellent speakers), there was for example an excellent presentation by Dr. Jeremy Keen  on the ‘Virtual Hospice’ (covering the challenges of providing palliative care to 0.5% of the UK’s population spread over 20% of the UK’s land mass). There was an equally good one on the ‘eMental-Health’ by Stella Clark from NHS Fife; this demonstrated how well Soctland is using technology to help improve mental health, which Prof. Dr. Heleen Riper in the previous presentation had pointed out is now the underlying cause of four of the top five health burdens in the developed world.

Clearly that’s got a lot to do with the sheer quality of those involved in developing the telemonitoring services to meet real needs. Some at least will have been attracted by the excellent leadership displayed by Prof. George Crooks and his supporting team including, “James Bond’s doctor” (Prof. James Ferguson, whose idea the cardiac arrest scene in Casino Royale was). The political backing too is something that those of us working south of the border can only dream about. Two very senior Scottish politicians gave excellent presentations that demonstrated real passion for using technology to improve the health of the nation…and these policymakers are clearly directly accessible by even middle-level management. Whilst not wanting to undervalue the excellent combination of supportive politicians, good leadership and staff quality, there’s also surely something about the population (c5m, about 10% of the UK population), just small enough to cover single instances of appropriate technologies, and size of the place (c 30% of the UK landmass) which benefits so much from any technology that shrinks distance and avoids long & expensive patient transport.

A surprise was just how far advanced others were in their use of telemedicine. A series of presentations from John P. Williams and Lawrence Wechsler of the University of Pittsburgh Medical Centre (UPMC) and Dr. Don Kosiak of Avera eCare, both organisations being from the Midwest of the US, for example, demonstrated astonishing improvements in patient outcomes and cost reductions from using telemonitoring to reduce hospitalisations (47%) and rehospitalisations (significantly more), and to provide electronic expert emergency care assistance to up to 84 small-medium sized hospitals. I was particularly taken by the way that Avera had now developed a substantial expertise in regularly dealing with rare and unusual conditions, as that was all they do.

There was no hint here of legions of academics doing rigorous RCTs to ‘prove’, or otherwise, the effectiveness of their offering, no adding of telemedicine to an already-optimised system (to find that when they did it just added cost), no mining of ancient data collected using care pathways and equipment now found only in museums to ‘prove’ no benefit. No, these people looked at the sparse population that could only justify small (often 50-bed) hospitals and worked out how best to provide a service electronically that would for example enable each to provide thrombolysis for stroke victims when no single hospital of that size could individually justify retaining an expert in the intervention. Interestingly it typically took three events before the teams in each hospital became comfortable with experts providing a telemedical service; at the third and thereafter, it was accepted as the only way to provide the service…and the improvements in patient outcomes, coupled with reductions in costs were so outstanding as to blow away any concerns about the minutiae of the benefit analysis.

There was an intangible energy at the meeting – as John Crawford of IBM, the principal sponsors of the event, put it in his introduction, the time is now ripe for telemedicine to become the accepted way of delivering 21st century healthcare – the combination of the mobile revolution, the social media explosion, the growing power of analytics (aka ‘big data’), and ‘hyper digitalisation’ that resulted in so much more analysable data, created the perfect preconditions to promote telemedicine. It is surpising how long you can spend justifying what you fervently believe to be the future of healthcare provision only to realise that what people are really aguing about is essentially the same thing: it’s just that telemonitoring enables far more efficient delivery especially in a rural setting, and catalyses a massive improvement in the way care can be delivered effectively.

If we don’t grasp this nettle, according to Phil Smith, CEO of Cisco in UK & Ireland, quoted in an article in Forbes, every school leaver in the UK will need to be employed by the NHS to deliver care full time by 2025.

I’ll finish with what is an obvious statement for many and a profound thought for those of us who have perhaps been focused too much on making business cases for technology. It was made by Martin Seychell, deputy  Director General, DG Sanco, European Commission, in his introduction to the conference. He said: “Health is both an economic & social opportunity.  We need to change the perception from it being regarded just as a cost.” What I understood from this was a call to recognise the benefits of prolonging a life, such as continuing beneficial economic activity, and societal engagement, and see those, as well as the cost of prolongation. spending more on healthcare can therefore be an economic & societal net benefit.

Next year’s conference is in Italy – I’ll be watching out for the date and ensuring it’s in my diary just as soon as the event is announced.

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