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Submitted by on 09 Mar 2012 – 15:16


A win win win win for telehealthDR MALCOLM J. FISK




The development of telehealth services has been pointed to as carrying the promise of a ‘triple win’ for Europe – through delivering better health and well-being outcomes for people who use or access them; by offering reductions in the cost of service delivery; and in providing worldwide commercial opportunities for EU companies. The potential for this triple win has been recognised by the European Commission and it is indicated in the current strategic and operational plans of the pilot European Innovation Partnership on Active and Healthy Ageing. Meanwhile, a fourth potential ‘win’ is being overlooked.

The fourth ‘win’ lies in telehealth’s ability to help in progress towards the European Commission’s targets for reducing the EU’s carbon footprint – as pointed to in the Europe 2020 Strategy for Smart, Sustainable and Inclusive Growth. The implementation of this environmental strategy must include health services since throughout Europe these are major contributors to emissions. There is a lack of data about this but healthcare, according to LCB Healthcare Consortium calculations, probably contributes 5% of the EU’s total carbon footprint – through emissions of some 250 million tonnes a year, a figure ‘similar to the international aviation and maritime transport activities of the EU27 member states’. Work undertaken by the NHS in the UK points, meanwhile, to patient and visitor travel as contributing 10% to its healthcare carbon footprint.

The potential reductions in healthcare’s carbon footprint arising from telehealth relate at least to patients (because of reduced admissions and a diminished need to attend appointments); and relatives and accompanying persons (because of reduced need for visits). But there are also achievable reductions that arise through lower ambulance use; reduced travel for doctors and community health workers; and the reduced wastage of medicines (because of the greater ease of medication reviews, prompting, etc.).

The context is one where we are faced, at present, with barriers to the development of telehealth because of calls for more evidence regarding its long-term cost effectiveness. But we do have an increasing range of pointers to some kinds of telehealth services delivering significant improvements in people’s health and many European companies are increasingly active within the growing international telehealth market (two of the four ‘wins’).

Only isolated studies suggest that telehealth can lead to cost increases (and then generally for those people with the most complex of health problems). The Whole Systems Demonstrators in England will give us more information during the course of 2012 – but only in respect of a relatively narrow range of telehealth services focused on vital signs monitoring. Regrettably they, and other studies, though noting the extent to which there may be fewer hospital visits or admissions, generally neither hint at what this means for the environment; nor give adequate attention to the health gains that are evident from the point of view of those who use the services.

There is, therefore, an argument for telehealth that is hardly expressed and rarely heard. This relates to the twin ‘wins’ of reducing environmental damage and improving people’s health. Both are hugely important in moral and ethical terms and need to be set alongside the other, more commercially oriented, wins. After all, telehealth services, if nothing else, mean putting into effect a new service paradigm that will empower and give greater choice to those who wish to access and use them (surely a moral and ethical benefit). This change in approach has immense implications for the very essence of our health services and the central requirement that people, where they are able, should take greater responsibility for their own health.

This begs the question as to whether for telehealth we should, in any case, move forward on the basis of the four, rather than the three ‘wins’ – where the foundations for telehealth are as much rooted in ethics and morals as much as being cost or commercially driven?

This may not be quite what Otto von Bismarck or William Beveridge envisaged when they developed the health and welfare systems that have left their mark today in many EU member states. But the approach embodied by telehealth is in keeping with our times. And, albeit paradoxically, it is those same health and welfare systems set up by Bismarck and Beveridge that have helped to give us our legacy of better health and greater longevity – that makes today’s need to embrace telehealth so important.