Whenever I see the word “telehealthcare” I feel there should be an ® or perhaps a ™ after it as it so often appears in connection with a particular organisation. However no such connection is evident is this paper entitled “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview” (published on the PLOS ONE site), especially as the overall conclusion is far from that often found in articles toting that word:
“Policymakers and planners need to be aware that investment in telehealthcare will not inevitably yield clinical or economic benefits. It is likely that the greatest gains will be achieved for patients at highest risk of serious outcomes. There is a need for longer-term studies in order to determine whether the benefits demonstrated in time limited trials are sustained.”
If you stop there though, you miss some very important points made by the Edinburgh University-based authors of this NHS CfH-funded work, Susannah McLean, Aziz Sheikh, Kathrin Cresswell, Ulugbek Nurmatov, Mome Mukherjee, Akiko Hemmi and Claudia Pagliari.
For example, to whet your appetite, when looking at the ‘classic’ LTCs that telehealth is used to help manage, they say that “there is stronger evidence that telehealthcare can reduce the frequency of hospitalisation in chronic heart failure, chronic respiratory conditions and diabetes. These improvements appear to be greatest in patients at high risk of mortality and hospitalisation…” The section entitled “Implications for Policy, Practice and Future Research” is particularly worth a read.
To me the most important point of all that they make is in support of the mantra oft repeated on this site that telehealth is not a simple intervention:
“The implementation of telehealthcare often requires organisational redesign which may exacerbate or reform existing system inefficiencies and uncover new ones. As such, it becomes hard to disentangle the effects of the technology from the human and organisational processes that surround it. In this setting, telehealthcare should be considered as an example of a complex intervention and, as such, may require a more innovative approach to research.”
It would be wrong to finish without including one further quote: “There was very little in the systematic reviews specifically concerning patient safety and it was not clear whether adverse events did not occur or whether there was a lack of reporting.” There are a growing number of stories of safety-related issues that have emerged to do with telehealth, particularly where the intervention is not integrated fully into the local health & social care delivery structure. I therefore would suggest it is incumbent on us all, as telehealth becomes more embedded into care delivery, to ensure that establishing, reporting, monitoring and responding to telehealth-related patient safety matters are given the highest priority.
Many thanks to Mike Clark for alerting me to this paper.
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