COMMENT: Has telemedicine reached its tipping point?

EVEN its most ardent advocates would acknowledge that telemedicine still makes up a tiny proportion of overall healthcare activity worldwide.

Clunky technology, cultural and organisational issues and a lack of enthusiasm, even antipathy, from clinicians have been some of the barriers to wider uptake of telemedicine solutions.

Clunky technology, cultural and organisational issues and a lack of enthusiasm, even antipathy, from clinicians have been some of the barriers to wider uptake of telemedicine solutions

Some of these are understandable. If reimbursement systems don’t allow payment for telemedicine consultations, then why do them? If video-conferencing facilities constantly cut out, who is surprised that the frustration factor for patients and clinicians is high? Both of these issues have contributed to the fact that telemedicine, although recognised as having great potential, has yet to take off.

Yet, I believe, that now, in 2011, it is time for telemedicine to spread its wings.

That is because the conditions to make this happen are coming together like never before. Convergence of a number of elements is conspiring to ensure that, in the very near future, telemedicine will shift from bit player to star of the field.

Demand and resource pressures

First there is demand. There’s little need to reiterate the state which nations and their health care systems are in, with ageing populations with growing health needs, particularly in the realm of long-term conditions.

Set this against a background of shrinking labour markets and tightening purse strings, and the challenge becomes even more acute.

Convergence of a number of elements is conspiring to ensure that, in the very near future, telemedicine will shift from bit player to star of the field

Telemedicine doesn’t hold all the answers, of course, but it can help. Pilot after pilot has shown that telemedicine has major benefits in terms of cost, resource use and, importantly, in patient satisfaction and that it can be adapted to a wide range of medical conditions, including the chronic diseases which afflict us as we age.

Technological advances

The technology environment, and technology itself, is another significant factor. The advances made in the last decade have been immense and, if current trends are anything to go by, will continue exponentially. Who would have thought, when first trying out video-conferencing from a remote Scottish island to the mainland, for example, that just a few years later we’d be enjoying the benefits of wireless broadband enabled (virtual) face-to-face consultations which are as clear and flowing as a telephone conversation?

Likewise, who could have anticipated when beholding the earliest mobile phones that in a few short years they would have transformed into today’s Smartphones, which means growing numbers of the population are carrying highly-advanced computers in their pockets?

The infrastructure is also increasingly there, with high broadband penetration even in developing countries, and it’s improving all the time.

Population demands

The third element in this ‘perfect storm’ is the population itself. For today’s teenager, current healthcare systems, still based on buildings and face-to-face transactions, may seem quaintly old-fashioned.

Why should they journey across town and wait in a hospital clinic to have a battery of tests and then, how archaic, telephone a few days later for the results? Such behaviour is completely out of step with the way they lead the rest of their lives with shopping, socialising, and even education, increasingly being done online from their own homes.

This is the generation for whom telemedicine will seem the norm. More than that, cumbersome, time-consuming, traditional alternatives could seem unthinkable.

But it’s not only the young who are leading their lives in this way. Today’s baby-boomers, born in the years after the Second World War, are keen users of technology, too. What’s more, this is a generation of people accustomed to making decisions about their own lives. They will insist on being partners in their own care.

Pilot after pilot has shown that telemedicine has major benefits in terms of cost, resource use and, importantly, in patient satisfaction and that it can be adapted to a wide range of medical conditions, including the chronic diseases which afflict us as we age

So the wider environment is right, the technology is there, and the population is waiting – what does telemedicine have to offer?

Virtual consultations

Obviously telemedicine solutions vary. Perhaps the simplest form is a telephone consultation, while more sophisticated technologies involve virtual testing kits which allow patients to send their measurements from home to their healthcare providers, leading to an informed communication via video link with relevant clinicians. There are also technologies available which allow virtual ward rounds where the clinicians ‘visit’ the patients, but rather than going from bed to bed in hospital, the patients are at home and the consultation is, again, via video.

In our experience, such technologies are popular with clinicians and patients alike, particularly patients. For example, we tested the CSC eMEDlink solution, which allows patients with long-term conditions to be treated at home via remote audio-video consultations, as if they were in hospital or in the GP surgery. The patients use a modified wireless netbook which connects with different devices to monitor vital signs, such as a pulse oximeter to measure oxygen saturation of a patient’s blood and a spirometer to measure the lung capacity.

Almost to our surprise, the patients, who were mostly older people, really took to it, needed less training than we’d anticipated, and, when the pilot was finished, clamoured to be allowed to keep the devices. They liked the sense of control it gave them and, of course, the benefits in terms of clinician time and hospital resources were also evident. Indeed, rather than having a ‘distancing’ effect, patients actually had more access to healthcare professionals, being able to get advice at the press of a button.

Barriers coming down

So if telemedicine is so good, how come its use isn’t more widespread? Well, as with everything, it takes time to effect change, and effort to overcome obstacles to progress. I’d say the barriers to general dissemination of telemedicine fall into six categories: payment, organisational, legal, cultural and attitude, clinical evidence and technical barriers.

Payment is obviously a major issue for health systems worldwide. Getting paid for what you do is essential to run any business or organisation. Healthcare providers can have a problem with how to get reimbursement for patient care delivered via telemedicine. In comparison, it’s easy to work out payment when a patient is on a hospital ward. If the patient is occupying a hospital bed, then the provider gets paid. But what do you charge when the patient is at home?

I think the time has come when we should just be getting on with it. We’ve had enough trials, we know it works. We should be doing it at local level, or at regional level or even on a larger scale, but we should do it now

But there are solutions. It might be reasonable to charge the same rate as an ordinary face-to-face consultation, for example. In Denmark, there is a charge for consultations via telephone or email. Perhaps a similar charging structure could be implemented for a telemedicine consultation.

Similarly, simple steps could be taken to overcome legal hurdles, for example changing data protection laws to allow a wider range of clinicians to view patient data.

Organisational barriers could also be broken down by changing the way we look at healthcare, encouraging different teams to work together, and introducing solutions across groups of hospitals, or even regionally.

Cultural and clinical evidence barriers are breached, in my experience, when patients and staff actually get their hands on these solutions and see how much it streamlines the healthcare process. And the technical barriers, as discussed earlier, are becoming more flimsy by the day as advance succeeds advance.

In any case, I think that the time has come when we should just be getting on with it. We’ve had enough trials, we know it works. We should be doing it at local level, or at regional level or even on a larger scale, but we should do it now.