Getting the bad news out of the way first, the seemingly-eternal researchers have thrown their grappling iron into the ancient store of data from the now-only-historically-relevant Whole System Demonstrator data pool and dragged out yet another unexploded bomb that they have then endeavoured to detonate, in the form of a short research article.
Thankfully the explosive has deteriorated with age so the damage to healthcare technology adoption in the UK is becoming more muted with every addition to their respective CVs. Perhaps therefore it was for old times’ sake that GP ran the story that telehealth does not curb GP workload on Friday. It gave them an opportunity to dust down their well-worn phrases about the WSD one more time, although disappointingly the author seems to be suggesting that the findings are from a recent study.
When will we finally bid farewell to the WSD?
Unlike the previous WSD research target (self-care), the impact on GP attendances was indeed one of the objectives of the study so it is at least worth considering why no impact was seen. Perhaps the most likely explanation is the study design. As explained previously, the WSD was anything but whole system in reality: we were required to establish a separate team to look after patients using telehealth, who were therefore temporarily separated from the usual community healthcare-GP system. With GPs having little involvement with or perhaps even being unaware of patients using telehealth, the huge reductions in GP attendance seen by other telehealth projects in the UK that have been genuine whole system changes (and use much more modern kit & care pathways) just didn’t happen here.
Perhaps more concerning for advocates of remote monitoring is the paper (which reached this author after this post was first published, whence the late addition of this paragraph) in the BMJ entitled “Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial. ” To me the key phrase in the description of the trial is “the only difference between the groups was the use of telemonitoring.” which indicates that telemonitoring is being used as a simple intervention whereas, as TTA has stressed many times already, almost all technology – including telehealth – is a complex intervention requiring a completely different design of the way care is delivered in order to realise benefits. Simply bolting on an expensive addition to an already well-running process is extremely unlikely to generate any benefits, and will just add to costs. The VA, for example, in the US see substantial benefits, through a thorough care pathway redesign.
The good news is that the stream of positive stories on well designed recent projects using modern kit continues. Most recently HSJ ran a great story on how Harrogate & District foundation Trust is using telehealth to help patients return home earlier and free up hospital beds. Cornwall also recently passed 1200 telehealth users, as reported by EHI. The Guardian in September reported on positive patient experiences. Airedale is reported as saving millions using telehealth to manage the health of people in care homes. And the HSJ even has an Efficient Telehealth Solutions award, won this year by SEQOL. In the US, American Well has now made telehealth available on smartphones on demand for significantly less that face:face consultations in order to reduce A&E attendances (although in fairness it reads more like remote video consultation). “I can do almost everything on telehealth that I do in my traditional practice,” says Teresa Myers, a physician from Ohio who conducts telehealth consults in her spare time and was quoted by EHR Intelligence. “The only thing that is available to patients after hours is usually the ER. That is not the most appropriate use of our health-care dollars when it is not an emergency.”
The 3G Doctor among others has been offering the service privately for some time, and some organisations such as the Hurley group in London with 160 GPs can be persuaded to offer remote consultations on the NHS. There is even a recent report that for age-related macular degeneration, remote patient consultation is as, if not more, effective than face:face. You can of course already access a doctor if you answer questions appropriately on the 111 service, although we seem to be a long way from it being recommended as an alternative to throwing loadsamoney at A&E.
And by all accounts, the future prospects for telehealth becoming more ubiquitous are bright. Talk of home telehealth hubs has all but disappeared now as services are increasingly becoming apps downloaded onto smartphones and tablets, resulting in greater focus on peripherals and software. Wired has a nice piece on the Scanadu Scout replacing the thermometer in US households. However it looks as though the race to incorporate vital signs measurement into a smartphone will give the Scout only a very short life as a separate device: plans are for the demonstration of what is expected to become the next generation smartphone that monitors systolic & diastolic blood pressure, pulse, SpO2, respiration and temperature at the Royal Society of Medicine’s Recent Developments in Digital Health on February 27th. It should be in production shortly after.
A mass spectrometer built on a chip offers the opportunity to diagnose a wide range of conditions by analysing molecules in breath that for example can provide early indication of cancer. Cambridge UK-based Owlstone, the developer. is one of 12 finalists in the $2.25 million Nokia Sensing XCHALLENGE and Qualcomm Tricorder XPRIZE.
Pixcell have now developed a blood analyser that can be used at home that will for example enable white blood cell monitoring to improve remote monitoring of patients using chemotherapy. ChipCare seems to be offering another approach to the same topic, claimed to be low cost.
In cardiology Airstrip One, not to be confused with the name George Orwell gave to the England in his novel ‘1984‘, is now accessible by tablets and smartphones running Windows as well.
Elsewhere, Mobihealthnews reports that flexible electronic sensors being developed, worn like temporary tattoos on the skin, could be used to detect everything from blood flow to cognitive function. Having recently attended a fascinating presentation from Duofertility on a worn device that enables precise skin temperature determination as an aid to improving successful human conception, that looks potentially another area of application.
Also, Sotera Wireless have obtained FDA clearance for the first continuous blood pressure measuring device without the use of a catheter or blood pressure cuff and as we reported recently Oxitone have a continuous SpO2 monitor in development.
Turning to the behaviour changing aspects of telehealth, a recent BMJ paper suggested that exercise is as good as drugs for managing certain long term conditions: it rivalled some heart drugs and outperformed stroke medicine. Heartwire reported on a Dutch study showing a positive correlation between exercise and lower mortality for patients with ischaemic heart disease. A great telecoaching opportunity!
If in spite of that you still take the car, it’s looking increasingly likely that telehealth will be with you there too, with the advent of the 4G car.
Of course telehealth only saves money if work can be transferred, typically into primary care. It is therefore worrying to see claims that competition law is preventing the transfer of resources from secondary care.
Finally of course, going against all the drives to reduce the cost of telehealth to the point where it is the cheapest way of treating people, is the telehealth chair recently reviewed by my colleague Toni Bunting.
Thank you to Prof Mike Short, Mike Clark and Dr Nicholas Robinson for pointers to good stories.