Making a reality of telehealth: lessons from the Whole System Demonstrator programme

Later this month, the long-awaited results of the Whole System Demonstrator pilots will be published. This ambitious field trial – which cost more than £30 million and involved almost 6,000 patients across three health communities – tested the capability of new technologies to support the remote management of people with long-term conditions.

If the results are positive in terms of patient experience, care outcomes and costs, then the trial will have proved that telehealth has a significant role to play in the way we care for patients, and the way they care for themselves. But would this evidence be enough to stimulate the wider adoption of new technologies and the service redesign innovations that are needed to support them?

A new report from The King's Fund's recently completed WSD Action Network project reflects on three years of experience from 12 innovator sites. We conclude that even though a positive evidence base would provide helpful context, a significant number of cultural and organisational barriers remain. The technology itself is only a small part of making telehealth a success; some wider service redesign is needed.

We identify a number of factors that support widespread adoption and sustainability of telehealth. These are collaboration within and across organisations; a shared vision; strong leadership and engagement at every level; capacity and skills to do system redesign; quality standards, and investment in professional development and staff training. In other words, one cannot hope to make a success of telehealth without acknowledging that a fundamental shift is needed in the way in which care is delivered.

One key lesson was that data and evidence must be constantly reviewed to ensure that telehealth projects are delivering their intended benefits. A cultural shift is required away from 'evidence-based practice' towards accepting the value of 'practice-based evidence', enabling organisations to implement technologies on a larger scale. The report argues that producing evidence on the clinical benefits and cost-effectiveness of telehealth is never going to be enough to formulate a strong business case for change. Rather, what is needed is a clearer understanding of the operational processes that are required at an organisational, clinical and service level that will ensure commissioners and providers make the right decisions.

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Comments

#589 Julian Simcox
Patient participation Group member
Three Wins Academy

I’d like to underline the need for cultural shift towards ‘practice-based evidence’ and improved understanding of operational processes – especially at service level. However evidence needs to be jointly interpreted in real time by both clinician and patient. A new discussion on how to make this possible is available on the Three Wins Academy site, a paper that also shows how standard data and information tools are urgently required – tools that can be as easily used by the patient as by clinicians.

#595 Jenny Tarver
Community Respiratory Specialsit Nurse

I totally agree with your statement Julian. I am currently undertaking my dissertation for my Masters qualification and are exploring the literature to determine how telehealth can improve the patient experience. I would really like to look at the paper you have identified but can’t find the website can you provide the web address please.

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