Matthew Billingsley: Telehealthcare, integration and innovation

Matthew BillingsleyLast week I attended the International Congress on Telehealth and Telecare at the King’s Fund, which was an opportunity to discuss the current opportunities in telehealthcare. The focal point for the conference was the presentation of the Department of Health’s Whole System Demonstrator (WSD) pilot project, which invested £31m in a trial of 6,000 users of telehealth services. The results showed that there is a growing evidence base for the effectiveness of telehealthcare and a recent BMJ Clinical Review has also shown that there is a growing interest in this area.

The arguments for introducing telehealthcare are gaining stature. With ageing populations telehealthcare offers the ability to assist in self care and improve integrated health and social care in the community, which is a conscious attempt to move the monitoring of certain services such as COPD, diabetes, and heart disease away from the hospital or GP surgery and into the home.

In an environment where GPs could be responsible for commissioning services, telehealthcare offers the opportunity for GPs to encourage patients to manage their health remotely and at cost effective prices. At the conference, exhibitors were showing off their latest products, which are mainly “responsive” devices that prompt patients to send the latest blood pressure reading via text or a smartbook, to a centralised system where it is analysed and alerts the medical professional or patient if any immediate action needs to be taken.

Reading between the wires at the conference, these technologies seem to point towards the contentious issue of electronic health care records, but it is really hard to know if this is part of natural progression or a case of technological determinism. It is extremely difficult to separate the demand, hype and necessity. The presence of many private companies is necessary in part in providing tangible solutions but is also a great opportunity to take a slice of a GP’s commissioning fund. Is this a convenient convergence point -part of logical trajectory? Or is it an excuse for generating hot air and profit?

To ensure that products on the market are designed for the end users, the innovation springboard should surely come from within the NHS. However, as Richard Smith highlighted in a recent blog,  there are a lot of obstacles in the way of this and many unanswered questions about the NHS and innovation, which need to be addressed first.

The benefits of embedding a spirit of innovation were highlighted by Hal Wolf from Kaiser Permanente, who talked about its approach to innovation which openly encourages an innovative culture and has been recognised as one of the world’s most advanced non profit health organisations in terms of providing telehealthcare solutions. Currently, it employs eight regional innovation hunters (out of 165,000 employees) whose primary role is to seek health based innovations that will improve healthcare management. He claimed that $5m is spent per year on coming up with ideas, which come from a range of people including: doctors, carers, engineers, scientists, and patients, who contribute suggestions for tools needed to assist in direct and remote healthcare. In one year, the average number of ideas which are considered is about 45, but in reality the number of ideas taken forward is about eight. This is an ethos which encourages innovation and a culture where it is “OK to fail” (a successful mantra of many of history’s greatest inventors). Also, an impressive quality of this approach is that there are no financial incentives attached to the generation of these designs, rather the desire to innovate and to get ideas adopted by fellow regions.

Marshall McLuhan once said: “[it is] the electric implosion that compels commitment and participation.” It is true that digital technologies insist upon our interaction and this could encourage patients to become more directly involved with the management of their healthcare. However, it is also important to not be subservient in how the technology is conceived in the first place. We should utilise the qualities of innovation and technology to encourage participation as a basis to create tools that the end users want and human participation could be a sustainable route towards this. 

Overall, the conference posed far more questions than answers. The presentation of WSD project showed that substantial strides are being made in backing up the claims of telehealthcare. The talk and discussion on International Perspectives was inspiring, however, with two US speakers and one Scottish speaker, the full global angle -especially how this works in low income countries- was sorely missing. But the lesson I learnt was that it is really important not to be seduced by the technology as an end in itself, but to shape it to address current needs and problems. However, setting up a credible evidence base for every invention, conflicting interests of providers, GP’s commissioning budgets, and an initial reluctance to give new ideas a chance might smother any genuine innovation or change.

Matthew Billingsley is the editorial intern, BMJ