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Some Issues Regarding the Introduction Telehealth Innovations in Europe

Submitted by on 06 Oct 2011 – 15:35

Telehealth InnovationsProfessor Stanton Newman, City University London

The ageing population and the consequent increase in chronic disease pose great challenges to European health services. One approach to this issue has been the introduction of telehealth (TH) technologies. This involves the remote exchange of data between a patient and health care professional as part of the ongoing management of health care conditions. (e.g. blood pressure and blood glucose monitoring).

It is claimed that TH can support patients develop a better understanding of their health condition, encourage better patient self-management and alert professionals when an intervention is required. As a consequence these technologies promise better quality and more appropriate care for the individual, as well as more efficient use of health care resources by reducing the need for expensive hospital care.

The dominant rationale for introducing TH is to capture potential savings in reduced health-care utilization, fewer face-to-face visits and to intervene so as to capture exacerbations early so as to obviate the need for expensive treatments including hopsitalisation. The assumption that TH will lead to cost reductions needs to be balanced by the recognition of potential obstacles such as the initial cost of the TH equipment, the reconfiguring of services and associated training costs. In addition increased monitoring of patients may lead to increased healthcare intervention and hence greater costs. Finally any reduction in mortality, a potential outcome from the introduction of TH, will lead to increased health care costs.

Structural issues as to where the benefits from potential savings accrue need to be addressed. A financial model that is based on payment by activity (eg. outpatient appointment), creates a disincentive to hospitals as TH is intended to reduce this activity. One potential solution is to not reward activity but to incentivise improved care outcomes. A hospital that introduces TH and reduces urgent admissions should receive appropriate financial rewards based on the quality of the care that is delivered. An alternative is for the health care organisations to be responsible for all aspects of health care from primary care through to hospital care. In this way any savings achieved by reducing hospital visits will accrue to the organisation.

One consequence of the need to demonstrate early savings has been to focus on those patients who are heavy users of the health care system. Whilst there are concerns as to whether this is the group that will most benefit from TH an additional drawback of this approach is that it targets older individuals who are less attuned to using technology. An approach that targets younger individuals with chronic disease early on in their care, would not only focus on those more proficient in the use of technology but will also begin to change the culture of health care in the long term.

It is important to recognize is that TH is not simply a technological solution. Careful attention needs to be paid to the human capital and organizational change required in introducing TH technologies. Issues for health care professionals (HCPs) include concerns regarding clinical responsibility and liability, changing accepted ways of working, the hierarchy and relative power, interest and rewards of HCPs and the perceived ownership of the innovation. It is the case that flexible working is not the hallmark of many healthcare professions making changes in healthcare a challenge.

TH has the potential to significantly alter the HCP/patient relationship. TH is presumed to work by the close monitoring of patients’ states that are in turn often related to patient behaviour. This has the potential to significantly alter the HCP/patient relationship from one of a supporter to one who monitors behaviour and reacts when healthy behaviours are not being followed. This surveillance role also transforms self-care into an obligation rather that a choice for patients. This issue needs to be carefully handled and there is a need to remind patients of the upside in that TH facilitates rapid care.

Careful attention also needs to be directed towards the potential recipients of TH. A not insubstantial number of patients refuse to have TH devices. Reasons include the perception that having TH will remind them that they have a chronic condition and are dependent on healthcare. Other issues include the views that the technology will alter their relationship and contact with HCPs, that it will result in a reduction in service provision and has been initiated to save money. Careful planning needs to applied on how TH is introduced to patients and integrated with healthcare so to provide reassurance to prospective recipients of its potential benefits.

The above highlight some factors that will need careful attention if the potential benefits of TH are to be realised in Europe.