Government warned telehealth plans could fail

The disjointed way the NHS and social care services are funded, and a lack of understanding of the long-term benefits for patients, are the biggest barriers to the widespread adoption of telehealth and telecare services, according to a new report.

Despite the Government’s plan to roll out assistive technology devices to more than three million people across the country, health trusts are continuing to drag their heels, according to a new report by the Digital Policy Alliance.

The adoption of telecare and telehealth to date has been hampered by a number of factors, including a lack of robust evidence of benefit, organisations resistance to change, commissioning practices, lack of skills and technology issues

Living Independently: Shouldering the Burden of Chronic Disease praises Whitehall bosses for embracing telehealth and telecare as a way of improving patients’ self management of long-term conditions and cutting back on spending by reducing hospital admissions.

But it warns that the plan may be scuppered unless key barriers to adoption are overcome.

The document cites seven stumbling blocks, most notably problems with current policy, which mean that the organisation bearing the cost of telecare and telehealth deployment, often GPs, hospitals and adult social services, do not often see any financial benefit from the outcomes. It states: “Arguably the single biggest barrier to the widespread adoption of telecare and telehealth is the difficulty of demonstrating that the organisation bearing the cost is also receiving the benefit.

“Critical to achieving widespread adoption of telecare and telehealth will be the alignment of tariffs and incentives to ensure the financial case for change is compelling to those organisations that need to be at the forefront of adoption.

Policy must either adopt a wait-and-see approach in the hope firm evidence emerges, or stimulate and promote the adoption of telecare and telehealth in the reasonalbe assumption that the benefits are delivered through implementation at scale

“Telecare and telehealth can only lead to a release of cash if the reduction in demand for acute services leads to decommissioning of services and this will only be possible, if at all, when the technology is deployed at scale and for prolonged timescales. This can only be achieved in the context of a strong policy framework which encourages organisations towards adoption.”

Other barriers are said to be:

• Lack of an evidence base: The health profession is particularly influenced by a desire to make evidence-based decisions when adopting new treatment protocols. Currently the evidence for telehealth and telecare is limited, despite positive early feedback from the Government’s Whole System Demonstrator project, the world’s largest independent trial of telecare and telehealth devices. But the report compares the situation to the early reluctance to embrace internet technology, stating: “Telehealth and telecare are both examples of complex systems with many variables affecting the outcomes. As such it is no suprise the evidence base is mixed, but this does not mean that the benefits are small. The early evidence for internet-based businesses was also mixed, but as is now evident, those businesses that correctly exploited technoogy are profiting. Policy must either adopt a wait-and-see approach in the hope firm evidence emerges, or stimulate and promote the adoption of telecare and telehealth in the reasonalbe assumption that the benefits are delivered through implementation at scale. ”
• Current professional practices: In all organisations there is resistance to change and health professionals, in particular, can be resistant to changes in working practices and accepted knowledge. The report states: “Clinicians are often driven by the need for face-to-face contact with patients and there is a long tradition of providing care to individual patients. Adopting telehealth means adopting a pro-active approach to the patient in an attempt to avoid escalations and exacerbations. Concerns workers have include not understanding what it can do, fear it will reduce social contact for users a nd concerns it will lead to replacing staff with computers. The implementation of telecare and telehealth requires significant organisational change and this is not easy to achieve. The resistance of some professionals in both health and ssocial care may have reduced the effectiveness of some pilot studies. ”
• A lack of skills: The application of telehealth and telecare requires the acquision of new skills as well as new working practices. The report calls for a national programme of professional development to provide practitioners with the skills needed to make the most of the opportunities presented by the new technology. It states: “Current approaches to decision making may be characterised by short-term cost saving rather than seeking a more holistic and longer-term benefit.”
• Patient and client reluctance: Findings from the Government’s Whole System Demonstrator project revealed fears among users that they would become ‘tethered’ to their homes if they used assistive technologies, concerns they would receive less care as a result, and a belief special skills would be needed to operate the equipment
• Technology issues: Telehealth and telecare are complex systems that are quickly evolving as underlying technology develops new solutions to problems. Generally, supplier research and development and academic research is directed at developing ways to collect this data unobtrusively and involuntarily to overcome the unreliability of data that depends on user involvement. Development of such technology is expected to advance capability in this area and make technology more appealing. The emergence of smartphones is also having an impact due to significant issues with service availability and reliability, especially for vital equipment such as personal alarms or environmental detectors. In addition, suppliers and researchers are still working on the best ways of capturing and converting data acquired by the equipment, and significant research is still needed to understand the threats and to ensure data privacy to safeguard patients. The report states: “Technology is fast moving and is likely to outpace public sector responses. This requires a different management approach, based on agility, adaptability and flexibility. Other industries have learned to live with, and benefit from, this rapidity and healthcare will also adapt, however there is still some way to go before this is the norm in the NHS.”
• A lack of standards: As the market for telecare and telehealth expands, there is an increasing need for standards to promote the inter-operability of systems. The Continua Health Alliance is currently working on this. Greater clarity is also needed on how telecare and telehealth devices will be certificated and whether they come under existing medical device regulations

The report goes on to suggest solutions to these problems, calling for the Government to implement clear policy and to take the lead on the deployment of telecare and telehealth at scale, which it has announced it plans to do through its 3millionlives campaign.

Other suggestions include the introduction of measurable objectives which will make it easier for suppliers and health trusts to develop capacity to provide the kind of services that will be needed to support telehealth deployment; and the publication of clearly-defined best practice guidance which looks at successful trials and the reasons why deployments may have been unsuccessful. In addition, it highlights the need for a national business case for investment in the technology, which individual clinical commissioning groups can utilise for their own initiatives; and an overhaul of the current tariff system to incentivise adoption of telehealth and telecare. It says investment in staff training and patient awareness will also be vital to ensure buy-in.

Critical to achieving widespread adoption of telecare and telehealth will be the alignment of tariffs and incentives to ensure the financial case for change is compelling to those organisations that need to be at the forefront of adoption

In terms of the technology itself, it recommends:

• Provision of broadband or high bandwidth availability: Broadband increases the options possible and the potential scope of services that could be delivered, while mobile technology enables patients to be monitored outside of their homes
• Supporting the work of organisations developing standards: Organisations such as the Continua Health Alliance have a role to play in enabling the development of a vibrant market in telehealth and telecare by making devices and infrastructure interoperable
• Clarifying the role and scpe of regulation relating to medical devices and data protection: Advice should be developed to clarify how regulations should be applied to telehealth and telecare devices to support suppliers seeking to develop viable products and services
• Working with equipment and service providers to drive down costs by procuring at scale: While telecare has achieved some degree of scale in the UK, currently telehealth implementations are characterised by pilots and trials. Implementation at scale will help to establish a self-standing market, which will drive down unit costs

Failure to achieve these objectives could see the UK lag behind other countries in developing and implementing technology to support the management of chronic conditions

In conclusion, the report states: “The UK, in common with all other countries to a greater or lesser extent, is facing a mounting challenge in managing the increasing incidence of chronic disease in an ageing population. Responses to this are wide ranging, but new models of service delivery, enabled by technology, have a significant role to play.

“The adoption of telecare and telehealth to date has been hampered by a number of factors, including a lack of robust evidence of benefit, organisations resistance to change, commissioning practices, lack of skills and technology issues.

“Government has a role to play in helping remove these barriers. If 3millionlives is successful in delivering at scale new service models underpinned by telecare and telehealth, then the UK will benefit from a reduced dependency on expensive models of care delivery, such as hospital stays and will be able to exploit this advantage at an international scale.

“Failure to achieve these objectives, however, could see the UK lag behind other countries in developing and implementing technology to support the management of chronic conditions. This will make the future challenge even greater as shouldering the burden of chronic disease absorbs ever more resources and money. Deployment of telehealth and telecare at scale, however, as well as reaping financial benefits, will enable the UK’s citizens to enjoy more active an independent lives, particularly into old age, which will benefit individuals and society at large.”

To read the full report, click here.