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Viewpoint on Telehealth

Submitted by on 06 Oct 2011 – 12:26


Viewpoint on TelehealthDr Malcolm J. Fisk, Health Design & Technology Institute, Coventry University

Telehealth represents an immense opportunity for European countries to re-shape their service approaches so that more and more people will be able to enjoy better health and well-being. To seize this opportunity, member states will need to get rid of the vestiges of old welfarism and replace them with service frameworks where patients are partners rather than recipients. And, in those partnerships, patients will be able to access and use the services of their choice.

But the immensity of the potential for change through telehealth is being, at least to some extent, overlooked. This is because of the narrow focus, in the main, on vital signs monitoring for people with particular long-term conditions – albeit that this is an appropriate initial focus given the extent of patient needs. But in the arena of vital signs monitoring the agenda is mainly clinical. The scope for greater self-management by the patient is less than might be the case for a wider range of patients with lesser needs – including many readers of this think-piece. Hence, accepting the proven benefits of vital signs monitoring for people such as those with chronic heart or respiratory problems, we must also give attention to telehealth’s other facets.

Those other facets of telehealth include matters such as health training; activity monitoring; medication compliance; responding to falls or seizures; and care and support management. This wider scope for telehealth is discussed in the Foundation Papers of the Commission funded TeleSCoPE project at www.telehealthcode.eu . With such a perspective we begin to see the potential for telehealth for people of all ages – with conditions from diabetes to dementia, and addressing issues from pregnancy to palliative care. By acknowledging the potential of telehealth for these, as well as heart or respiratory problems, we can begin to see the potential for real dividends – not just in terms of service efficiencies but through the empowerment of patients.  The TeleSCoPE project, incidentally, emphasises our need to see ‘telehealth’ as having a broader meaning that includes well-being. It considers, furthermore, that telehealth is the term that the European Commission should now adopt to replace the over-clinical ‘telemedicine’. Telehealth does, after all, fit with the Commission’s policy and strategic agendas concerned with lifestyle change, prevention and public health.

The issues for telehealth are not just for services but also for technologies. The manufacturers and suppliers of the technologies are waking up to a wider consumer market associated with supporting people in maintaining their normal day to day working and social lives. Telehealth is not, therefore, just a matter of technologies for clinicians. Associated with this is the growing realisation that technology applications that gather and automatically transmit information to a third party, usually a healthcare practitioner, can deny the opportunity for patients to make choices. This begs the question, as we widen our vision, of how intrusive or how permissive should telehealth technologies or service configurations be? Clinicians may feel that, in order for them to do their work effectively, they should have maximum information. At the same time there is the paradox that a major component of clinician resistance to telehealth is because it provides too much information!

But if we are, as we should be, increasingly concerned with lifestyles and public health, how far should the technologies go in monitoring and gathering data relating to the well-being of patients at home? To what extent and in what circumstances should we countenance or promote bed and chair occupancy sensors or camera use? To what extent and in what circumstances do clinicians need to know a person’s level of activity or their vital signs within his or her home, or when travelling or at work for that matter? How does this tally with an approach where we must trust people, as part of the public health agenda, to take greater responsibility for their health and well-being?

The answer to these questions lies with patients – and their ability to set the parameters for the gathering of information – where, how often? how it is stored? who has access to it? and when, and in what form, should it be transferred to a third party? Technologies and services must be configured to be able to respond to these questions.

With regard to developments around telehealth we are, in any case, on the cusp of major change. The power of mobile devices means that telehealth can be as much for people ‘on the move’ as at home. At the same time, interactive TV supported by more efficient Broadband networks will support more and more people whose ability to get out and about may be limited. But such technologies will empower even them, not just in relation to better managing their own health conditions, but in their work, family and social networks. Such developments begin to point to the potential for telehealth to offer real improvements in people’s well-being – individually and for their families and communities. And that’s what health is all about, isn’t it?