The first day focused on problems with designing and implementing studies that evaluate telehealth interventions. In our own overview of the impact of telehealth we found that the majority of studies have shown a positive impact across a range of criteria (including cost-effectiveness). However, the quality of the evidence varies and its sheer diversity in terms of technology used, patient group supported, and outcome measures assessed makes comparison highly problematic. The result of these difficulties means there is a lack of understanding of the impact of telehealth and how to successfully apply and adopt new technologies in practice
The second day started with direct messages of government support for telehealth from Paul Burstow and Stephen Johnson. Drawing on the headline findings from the Whole System Demonstrators and the subsequent 3 Million Lives initiative speakers argued that not only was it 'morally right' to offer such care, but that it was also the smart thing to do in terms of reducing the cost-burden on the care system in the long-term. This vision was supported by the experience of three evaluation sites – Cornwall, Kent and Newham – who were all keen to roll out the use of telehealth. The apparent coming together of evidence with belief was music to the ears of the converted.
We heard many stories about the issues, problems and successes experienced with new technologies. From these, a number of key 'laws' for successful telehealth adoption began to emerge of which my top five (in no particular order) are:
- keep it simple for patients and carers to use, and for professionals to adopt
- tailor the service to the specific needs of the user; consider how they might best use and accept new technology
- enhance human contact by better connecting patients to family, friends and care professionals; users must feel safe, secure and empowered
- embed an IT infrastructure to act as the bedrock of better care through integrated information systems
- build relationships and networks to influence behaviours, build alliances, and overcome the significant mismatch of motives that exist between patients, carers, professionals, commissioners and industry.
The last of these is arguably the most important. There is an acute need in all care systems to work across a diversity of competing interests towards more mutually beneficial relationships that improve people's lives.
The third day of the congress will be remembered for the carefully crafted presentation on the cost-effectiveness of telehealth in the Whole System Demonstrator trial by Catherine Henderson from the London School of Economics. In five crucial minutes the world of telehealth was seemingly turned upside down as Catherine explained how the undoubted benefits to patients in the trial came at a significant financial cost. Knee-jerk reaction to the findings must be put on hold, however, until the full peer-reviewed studies are published in the British Medical Journal and the time is taken to fully digest and understand these cost implications.
What was clear from the innovations presented at the congress is that the capabilities of new technologies – especially smart phones, tablet computers and the internet – make those deployed in the trial look old hat. The research evidence lags well behind technological innovation and care systems are very slow to adopt new ways of working. What is needed is 'simultaneous innovation' where the system changes to keep pace with technology. Unlikely, of course, but this shines a light on the fact that 90 per cent of the problem in adopting new ways of working is cultural, behavioural and systemic.
Learning the right lessons from the Whole System Demonstrator pilots is important. In terms of the substantial wider evidence on cost-effectiveness, the evidence presented at the congress bucks the trend by providing what appear at this point to be negative results. A thorough look at the findings is required, as the keynote speech by Adam Darkins shows, huge benefits at both a patient and system level can be achieved. We should not attempt, said Adam, to 'build a pyramid from the top-down' by focusing solely on the complex, high-cost, patients where interventions are expensive and difficult to deploy; instead we should move forward by building alliances and networks and focusing on high-volume and low-cost solutions.
- Catch up with the highlights from our International Congress on Telehealth and Telecare
- See our prezi presentation on the impact telehealth has on long-term conditions management
- Find out more about our work on telehealth and telecare