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Telehealth

Submitted by on 09 Mar 2012 – 15:19

Telehealth

Michael Wilks, Vice President, British Medical Association

Telehealth“Telehealth” is a term that embraces all information technology (IT) used in medical care; in the EU this is commonly referred to as “eHealth”, which covers electronic medical records, prescribing, remote monitoring and telemedicine.

In different parts of the EU, the main eHealth developments have much the same ideals in all Member States: to provide easier access to medical information, whether this is for acute medical care, or the “cross-sectoral” access needed for chronic care that involves improved co-ordination across primary, secondary and social care.  Such linkages improve patient care and outcomes, and reduce risk.  Specifically, the two main objectives of telemedicine, where patients and services are linked in spite of geographical separation, are to increase the availability of specialist services to “hard to reach” communities.  By doing this, a second objective, that of reducing inequalities in the access of care, can be achieved.

The most common applications are in prescribing, in which cross-border writing and dispensing of prescriptions is now being piloted, and the remote reading of X-Rays.  Most notably in Scandinavian countries, access is provided for remote communities to city-based services.  Of major importance, especially in the care of long-term diseases, such as diabetes and heart failure, is the use of tele-monitoring, allowing an oversight by clinicians of a patient’s vital signs, tested in the home environment, and fed into the active medical record.

We can already see how telemedicine has changed, not just the practice of medicine, but also the relationship between patients and doctors.  These are worth noting and considering in some detail, as they represent changes whose momentum will increase.

First is the way in which medical care is delivered, and by whom.  In very many areas of care, the traditional relationship between a doctor and a patient has been replaced by one that involves care given by a team.  Some may find this a less personal approach, but IT should at the very least allow linkages within the team that inform all members who is doing what, and how the best use of the team can be utilised.  The introduction of the specialist nurse is just the start of this change.  One example is how the monitoring of a patient remotely, say for diabetes, will trigger responses from the team that do not necessarily involve the doctor.  Monitoring the signs of heart failure in one project has produced a different type of healthcare professional whose roles include specialist IT oversight, advice to patients remotely or directly, and the ability to recognise when vital signs are sufficiently unbalanced to require hospital admission.  As a result, acute admissions can be reduced significantly, saving patient distress and reducing acute costs.

Secondly, the involvement in patients in self-monitoring has a number of consequences.  Among these are an increased understanding by a patient of their condition and the ability to self-manage some aspects of it.  In order to do this well, a patient will need access to information.  This will include background data on their own measurements, such a blood sugar, but also the ability – within previously set parameters – to alter medication in order to keep their condition stable.  A two-way process of information exchange can be realistically established, using e-mail, telephone, or the web.  The vehicle for a lot of information flows can be the electronic record itself, as long as patients are given more access to their own data – which after all, is their property.  Such a move tends to be resisted by doctors, but desired by patients.

These changes need to carry a health warning.  The risk is that we may, in our enthusiasm create a group of patients – through inability or unwillingness – who cannot take advantage of more innovative pathways of care or information.  We must take care that what are exciting possibilities to join up chronic healthcare pathways, improve “health literacy”, and create effective partnerships between doctors and patients are not in themselves discriminatory. As we develop eHealth services, we must ensure that they are designed, configured and delivered for the benefit of all.

Dr Michael Wilks

Chair, eHealth working group, CPME