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Blogs > Quocirca

The opportunities and risks of telehealth in the NHS
Simon Perry By: Simon Perry, Principal Associate Analyst - Sustainability, Quocirca (Moved)
Published: 18th June 2009
Copyright Quocirca © 2009
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Though their lineage dates back to before World War II, ATMs in their modern form appeared widely on the high street in 1973. Since then they have bred like rabbits and spawned numerous cousins in the form of automated ticket dispensing machines and point-of-sale devices. They have also arguably created the payment services backbone that has enabled the "cardholder not present" transaction capability that is internet payment services.

Along the way ATMs have also fundamentally altered the relationship customers have with their banks. Gone are the days of queuing at inconvenient times in actual banks and dealing with real tellers, bank managers and advisors. All replaced with anytime, anywhere banking, in whatever currency of whichever country you're standing in. Meanwhile branches have closed, and while almost everyone appreciates the convenience, there are many who rue the dehumanising of the bank/customer relationship.

All of this is worth keeping in mind as the NHS, and its international health care counterparts, dabbles increasingly in technology-enabled remote diagnosis and treatment of patients. The efforts of the NHS' Aberdeen TeleHealth initiative, based in no small part on Cisco's telepresence technology, have yielded some impressive results.

The NHS trials used high-definition telepresence communications, enhanced with customised cameras, scanners and a wide variety of other electronic diagnostic tools. The patient, normally assisted by a relatively unskilled helper (who may have no more than rudimentary first-aid skills), can be subject to an array of tests as well as being interviewed by the remotely located GP or specialist.

The healthcare service has field tested such diagnostic services in the remote wilds of Northern Scotland, out to the remote North Sea oil drilling platforms and with the communities on the Orkney and Shetland islands. Such communities are remote, sparsely populated, and suffer from a lack of dedicated and local health professionals. If enough trained personnel were to be supplied, they would be underworked - but horrendously expensive to maintain and manage.

The NHS trials have delivered impressive results, with the service reporting that diagnostic accuracy is on a par with in-person capability. While the telepresence approach requires availability of relatively high network bandwidth between the patient location and the remote healthcare professional, as well as a not-insignificant capital cost in technology, it is cost effective compared to providing comparable healthcare to remote communities via traditional means. Telepresence-based medicine makes it possible to more accurately and more rapidly diagnose a patient compared to the service that could be provided by way of the irregular in-person approach that such remote communities have historically suffered.

Such benefits are substantial, and it is clear that remote diagnostics provide important potential benefits in terms of service and cost. That said, it is also critical to remember that effective healthcare ought to be more than just treating patients as "units" to be pumped through an increasingly automated health service factory. Arguably, telepresence-based health services are another step down the path of dehumanising healthcare and turning it into an assembly line for the dispensing of treatments that address mainly the symptoms, and rarely proactively address the causes. The provision of telemedicine to a remote community that previously had no service is better than nothing, but is it the best we can do as a society?

The old bedside manner has to become the new telepresence-side manner. If some of the more mundane reviews and check-ups can be automated out of the health system—such as repeat prescriptions, blood pressure tests and anything else that can be made self service through web interface or remote monitoring—then more time should be freed up for the medical professional to spend in real consultation with the patient. This can then help with preventative treatment, so minimising reactive treatments, and again freeing up more time.

Therefore, technology used correctly can create a virtuous circle—whereas used wrongly can be counterproductive. Let's ensure that the healthcare beancounters don't ruin it—and that healthcare professionals can get back to caring more about their patients, and focusing less on the profitability of the service.

Many people would complain already that they are treated as walking wallets rather than individuals by GPs, as they are herded through community clinics in 10-minute appointment increments. We need to be careful as we take this path that we do not end with unintended consequences whereby there is some added convenience to some, at the expense of degraded and dehumanised services to everyone.

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