Jumping the gun in the telehealth steeplechase?

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If the adoption of telehealth were an Olympic sport, it would probably represent the steeplechase – an endurance event with obstacles that do not fall over when hit and with a 3.5-metre wide pit of water to jump across on almost every lap. Whilst many have been brave enough to try out for the event, most have decided not to enter at all as the barriers to success seem insurmountably steep.

By far the largest hurdle to the acceptance of telehealth has been the lack of robust evidence on outcomes to justify the investment. Earlier in the year, the Department of Health controversially published headline results from the Whole System Demonstrator trial ahead of the peer-reviewed evidence. These results turned heads since they claimed telehealth led to significant reductions in hospital admissions and mortality.

With the evidence barrier seemingly ‘removed’, the government used the results as justification for its Three Million Lives campaign, that established a commitment to work with industry, NHS and social care to roll out telehealth as a mainstream service. Though professionals and academics alike cautioned that full judgment should be withheld until the full evidence became available, the telehealth steeplechase began to look like a more promising prospect.

However, following the first peer-reviewed results of the Whole System Demonstrator trial published in the British Medical Journal in June, the accompanying editorials and commentaries concluded that the government had ‘jumped the gun’. They argued that the trial had not, in fact, provided enough of a convincing case to support a national rollout and that ‘the evidence base is essentially unchanged and uncertainties remain’. So, despite the fact that about 59 lives appeared to have been ‘saved’ in the trial through telehealth (a 3.7 per cent absolute reduction), the impact on utilisation and costs suggested little room for cost savings.

The upshot of the story, as exposed in the recent telehealth debate on Radio 4’s Inside Health, is that the evidence for the appropriateness and effectiveness of telehealth – and hence its rollout as a government priority – polarises opinion. The Whole System Demonstrator trial has not provided the ‘proof of concept’ on cost-effectiveness that it set out to demonstrate. Evidence, therefore, remains a significant hurdle to wider deployment, since even those who truly believe in the potential of new technologies will find it difficult to build the business case.

If telehealth is to be taken forward at all, then it must be part of a wider and long-term commitment to service redesign that seeks to support self-care and to better co-ordinate care and treatment to people with long term conditions in the home environment.

This blog was also featured on the British Medical Journal website.

Comments

Mike Stone

Comment date
30 July 2012
Although not necessarily applicable to telehealth, and a little off-topic, I do have a comment about ‘evidence’ and the NHS. My previous post was cut short by running out of online time.

It strikes me that the NHS likes simple evidence/feedback, of a type that can be easily analysed by statistical methods: things with yes/no or ‘tick a box’ answers.

But for many NHS issues, I think more complex narrative ‘this happened to me, and it is wrong because …’ feedback, is more useful in identifying problems/solutions.

However, politicians in particular, tend to only quote the evidence that supports their pre-existing position/intentions. So simply providing evidence, isn't enough.

And even scientists are not immune – I would be very reluctant to accept any evidence, however apparently well-proven, that homeopathic ‘pure water’ possessed physical properties that were different from other samples of ‘pure water’ !

Mike Stone

Comment date
30 July 2012
Evidence in general, seems 'interesting' for NHS behaviour/beliefs.

After that Panorama programme, the number of whistleblowers/abuse reports to the CQC increased enormously: but I'm sure that the figures previous to that Panorama programme, would have been quoted as 'evidence' - clearly, the earlier figures were unreliable.

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