Telehealth Soapbox: The questions (and answers) are out there

Kishore Sankla, CEO of UK-based Solutions4Health, puts out a plea for proof of effectiveness through innovation and looks ahead to an era of consumer-driven services.

We in the industry are already fully convinced that telehealth works, and we have the satisfied customers to prove it.

The Whole System Demonstrator outcomes to date suggest that we have to focus in the right areas, aim for the right goals, and shout loud about our achievements in order to convince the payers of the enormous potential. Some really strong positive points have already emerged…

  1. 43% of intervention patients admitted to hospital compared with 48% of control patients. In a trial involving people with chronic illnesses, this is almost certainly due to patients being able to manage themselves better, avoiding the need for hospital visits. This is exactly what we would expect from using wireless monitoring devices, with online behavioural and motivational support. Scaled up to whole patient populations, and taken over a much longer period, the potential savings are enormous.
  2. Even more striking was that significantly lower number of intervention patient deaths (4.6%) compared with 8.3% of controls. I challenge anyone to see a negative in a 45% reduction in the mortality rate!

Should those advantages be lost if the WSD cannot show convincing cost savings for the NHS? Certainly not!

In addition to user benefits, cost savings must clearly cover or exceed the cost of investment in the technology and infrastructure.

Producing evidence

But we cannot just wait for the WSD to say something good about that. We need to produce our own evidence of success.

Let’s understand where the WSD comes up short, and make sure our own trials do not fall into the same traps. And let’s be clear on the outcomes we want – proof of effectiveness through innovation.

Chronic illnesses are an obvious target, and a good proving ground. But after that, we can target behavioural support, device-augmented patient data management and patient empowerment for sexual health, HIV, alcohol and drug abuse. This is where innovation really counts if the telehealth industry is to have broad-based and long-lasting success.

We have the tools, the technology and the vision to achieve that. But having the right relationship with the customer is vital and that includes not only the payers but the whole community of healthcare professionals involved in the chain.

A atmosphere of confidence is needed, involving users, physicians, business partners and service delivery people implementing the services.

The NHS needs a new model, as the Health and Social Care Bill pointed out. The well-established Chronic Disease Self-Management Programme (CDSM) is good, but it is a generic model that is rigid and dated. We have to move on, and the way forward is telehealth – a transactional model which, we know, consumers increasingly like.

Healthcare requires clinical input and physical examination, which have been difficult to do remotely until now. Platforms such as my company’s iTeleHealth not only enable tele-consultation, counselling and support but also, with the help of wireless devices, monitoring services that have the confidence of clinicians and which work in the community.

Nobody needs to convince us that telehealth works. Solutions4Health’s years of experience with smoking cessation programmes and other projects, and talking with experts and customers, are evidence enough.

NHS-approved third party consumer-driven services

I expect to see a sharp rise in consumer-driven services supplied by third parties, approved by the NHS. These will enable chronic illnesses and other care areas to be managed at the ‘front end’ where prevention (of a worsening condition, resulting in doctor visits, hospital admissions, or death) can be reduced or avoided. The result will be more available resources to help people with chronic illnesses when they really need them, and more resources to help other healthcare consumers too.

‘Consumer’ is a key word here, and one we should all accept. There is doubtless a rise in demand for new delivery models. But web-based healthcare tools have lagged behind other consumer-facing industries.

We have some outstanding health information sources online but, compared with other consumer sectors, they can hardly be called innovative. If people can do their banking, grocery shopping and travel arrangements online, then why not ‘shop’ for healthcare?

This country can no longer afford the kind of NHS it has previously had. If we carry on as we are, we will not have the money to manage chronic illnesses. People need to take more responsibility for their healthcare, and telehealth helps them to do that.

Are ‘consumers’ going to be interested? Of course they are. Just look at the analysis of online use by age group. Older people are pretty evenly matched with young adults, which points to increasing willingness to receive services online, including healthcare.

Ten years from now I expect telehealth to be as familiar to consumers as online banking is today.

In the industry we need to ask sensible questions about where and how quickly we develop the services:

  • What early wins can we encourage?
  • What are the points of resistance, and which of them should we tackle or avoid?

Kishore Sankla

30 August 2012

Categories: Soapbox.