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Wednesday, 2 March 2011

Making the Business case for Telehealth and telecare

Am watching the King's Fund Telehealth and Telecare conference and it is fascinating.
This blog post can be read at

The challenges faced by these projects are oh so similar as those faced in so many other sectors of UK society.

Couple of points: (the videos will be archived and bear watching)

a) The Cornwall project had no broadband to work with so could only play with telehealth and telecare toys that worked over phone lines. (Those behind ActNow should be ashamed at what that says about the huge amount of money thrown at that county to resolve that problem earlier this decade, let alone what is once again being thrown at Cornwall now). Imagine what could have been done with the £31million these pilots have had if the comms infrastructure claimed by the telcos actually existed in this country?

b) There is a difference between telecare kit and telehealth kit. e.g. telecare includes smoke alarms, CO2 monitors, etc, and telehealth kit is much more about vital signs. This is still pretty primitive stuff compared to what telehealth means in many countries abroad, and what was taken for granted by many speakers in Milan just 2 weeks ago. I'm looking forward to the international speakers this afternoon and tomorrow, who I suspect may pop a few bubbles.

c) The users chose the simplest, least glamorous pieces of equipment. Even though there were touch screen, funky 'toys' on offer, the focus groups etc chose the ones they liked to use most. There is a lesson in this for all public procurement - ask the users, first, and secondly, it does not need to be the all-singing, all-dancing, most expensive equipment that hits the buttons for those who must use it.

d) The best story told during the event so far is that of Eddie, who has COPD. The fact that he can now monitor his own situation means that he now sees the correlation between how he feels and what the monitoring shows him - visually, on his TV as I understood it. What this has done it to release him from 5 years of not going out of his house, because he understands his illness far more clearly.

Jamesks on the Tweetstream said: Rather damning evidence on how medical profession have failed to help people take control of their health in the past.

Valid point which many holistic practioners would agree with, but putting a more positive slant on it, when KPMG run their post-lunch session on making the business case for telehealth, it would be interesting to see what GBP pound sterling value they put on Eddie's increased confidence, freedom, improved quality of life etc etc.

Because surely that should be what telehealth is about? Improving patients' lives. Yes, it should not drain the coffers dry to implement it, but surely someone should be seriously taking into account these individual stories, including those from the smoking cessation groups who were also highlighted who have found it much easier to give up because of the increased support available.

This is the SOCIAL CAPITAL side that I have been arguing for years should be shown on the balance sheets for any such project, including deploying FTTH.

BT may not want to be forced to set up so-called non-economically viable projects, but government and local authorities must look at more than just cash projections and profit forecasts, and take on board exactly what benefits and value these type of services have for citizens' well-being, quality of life, and hence the contributions that those people then put back (often many times over) into society.


Somerset said...

Did you find out what bandwidth applications need?

Cybersavvy UK said...

See point 1. Because no bandwidth was available, all three projects were very limited in the solutions that they could actually trial.

A further point was that this has been 7 years in the making, if Hazel's involvement was anything to go by. Just working out how to get all the different stakeholders working together sounds like it has been enough of a trial on its own!

Cybersavvy UK said...

Interesting articles from Jon Linkous, CEO of American Telemedicine Association

Telemedicine in 2011

Wireless telemedicine in 2009

chris said...

I haven't been able to watch it all, due to my connection dropping out, but I have seen a lot of it over the last two days. What gets me is that there are so many things out there which would be of great benefit to the NHS and to the patients, but none of it will work until everyone has a connection. People aren't going to sign up to broadband that they know won't work very well, and dial up is a waste of time with websites full of graphics these days. Until everyone has access to a decent connection the brave new world won't happen. The pipes have to be in first before we can help the people. A fortune could be saved by video conferencing alone, but it has to be on a stable connection. Satellite and BET aint gonna be good enough for consultations and remote monitoring. (At least not at the prices most elderly rurals could afford).
There might be a 10 meg satellite up there but most folk could only afford a tiny bit of it, and BET is just a joke anyway.
All hospitals should provide free wifi for patients and get rid of the ridiculous patientline.
Doctors know that keeping in touch with friends and family lowers stress levels, and if patients can do it online then fewer germs would come into hospital and less carbon would be used.
I know I missed quite a bit, but did anyone hear a mention of getting an actual connection for patients either in the hospital or at home?

Somerset said...

Brave new world can and is happening now.

A few megs is all that is needed for the majority of applications. Which the majority of the UK have.

Video conferencing has been in use for 20 years over 128k.

Cybersavvy UK said...

The point that struck home was that most of what is being piloted in the UK is well-established in other countries, particularly those where high bandwidth is freely available.

Currently, all we are capable of is telecare and telehealth. Telemedicine is not possible in the UK yet. (Confuse these terms at your peril!)

Other countries gave good account of telemedicine in Milan, on my trip to the USA, and in multiple papers, articles, reports, magazines, journals, conferences, websites etc.

The UK simply cannot join the telemedicine game until it has the appropriate infrastructure. Full stop.

Somerset said...

I'll ask again, what bandwidth is required for these applications?

Reluctantly I quote Wikipedia:

Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and videoconferencing equipment to conduct a real-time consultation between medical specialists in two different countries. Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.

Not possible because of infrastructure?

Cybersavvy UK said...

Ah yes, Wikipedia: the fount of all knowledge and known for its accuracy ;o) Is that all you found googling telehealth, telemedicine and telecare - I know the Farmer update has taken some good sites down the SERPs, but didn't realise it was that severe?!!!

Somerset - yesterday, there was an international conference about the subject, which included speakers from across the world. The videos are archived for all to spend their own 2 days watching them. And that was only the UK Pilot. Other countries have this stuff and MUCH MUCH more if you fall ill in their countries.

Discussing a case over the telephone is NOT telecare, telehealth or telemedicine. It's called a consultation and we have been able to do that since AGB did his thang.

Telecare and telehealth examples were given in the original article. They are far more about prevention and monitoring than the practising of medicine. Telemedicine goes up into remote surgery, radiology etc. There are literally thousands of links on all of the above on t'interweb - please go and look for them before asking the same questions over and over again.

As was clearly stated by the health professional at the conference, (which I lay zero claim to be) BECAUSE THERE WAS NO BROADBAND, (a subject I do know) they were limited in what they could actually pilot. What limited them? Lack of bandwidth. Full stop.

This is a ground-breaking (for the UK) pilot. It is not ground-breaking for many areas of the world. However, there are aspects of it which *are* ground-breaking and that has absolutely zero to do with the technology - it is about the systemic changes that needed to be trialled to get health care professional and social care professional working in tandem for the patient's well-being. As I said in my first comment, that in itself sounded like a major trial for Hazel and the other professionals, who needed to see if there was any way they could make this work across the National Health Service pilots. For which we paid £31M tax payer's money. (See original article on my thoughts on that)

Running a remotely monitored smoke alarm over a phone/mobile is yes, a great boon for people, who were shown in the videos by the speakers, but it is the very simplest of things that should be available.

However, due to the atrocious infrastructure in this country, that is about our limit. Go to Holland, go to Denmark, go the USA (as we have all had to) and see for yourself what the realities are.

I would love to see you permit an operation or life-saving decision to be made about you over a 128k video link. Shall I arrange it?!

Somerset said...

So what bandwidth do we need for these sort of decisions?

Please explain the detail for everyone. Will the infrastructure of VM and BT FTTC be sufficient?

Remote surgery would use dedicated links, well away from the public internet. Agree?

Cybersavvy UK said...


Perhaps I should list 1001 different applications across the medical spectrum and find you the individual bandwidth requirements for each?

Or you could ask a telemedicine expert who is using these apps every day....this is how we do it normally. JFGI and ask an expert, nicely....

I put the links up to Jon, start there. He is one of many thousands of JFDI medical people! But you will need to go outside the UK to get hard evidence because we cannot do it here.

No, I don't agree to that last. You may not get to choose to be in a surgical unit when you require an expert to guide someone else's hand through a life and death operation.
Millions of people do not have that luxury around the world. The Golden Hour starts where it starts......

I'm not sure Facetime will be up to it but Chris has an iPhone we can test it out on if you want...we have a brain surgeon in the family in London, I'll ring him. When do you want to give it a go?

chris said... is the link if anyone would like to view the archives.

Somerset said...

Some UK examples:

So wrong to say nothing is happening. Look at what the NHS N3 network provides as well.

'Telemedicine, hosted voice services, video-enabled virtual teams for specialisms such as oncology, transmission and storage of digital scans and radiographs, electronic patient records, paperless prescriptions, and self-service appointment scheduling are just some of the broadband-enabled innovations made possible by N3.'

A 128k video over ISDN is probably more stable than a shared internet conection.

To repeat, faster connections enable more, but saying 'Until everyone has access to a decent connection the brave new world won't happen.' It can and is happening for many people in the UK now. Does not need 'everyone' to run now.

Somerset said...

I'm intrigued why you query the reliability of an ISDN2 link. Please explain.

Dial Doctors said...

Somerset you can have telehealth through a phone. Ideally doctors would use teleconferencing but that isn't always possible. For example, many towns in the US which don't have access to broadband. It's not expensive but simply impossible to get it.

That's why we use telehealth to provide health care over the phone or email. Most matters can be dealt over the phone and patients can email pictures if necessary. Skin conditions usually use email too.

Somerset said...

Interesting that those that claim to understand all this are reluctant to find out more and do not reply to my points...