The concept of telehealth, healthcare delivered remotely, has often promised to make big changes to the NHS – and has so far failed to deliver. But in one sense, it is already here, with millions of calls to NHS 111 advice lines and 86% of GPs seeing telephone consultations as an effective way of communicating with patients, according to the British Medical Association’s national survey of 15,560 GPs. Telephone consultations cannot replace a physical examination and are no way to deliver bad news, but when appropriate they save time for both patients and professionals.
There are other telehealth techniques ready to join the telephone appointment. “We think there are some really interesting opportunities, and it can be really effective, as long as it is part of care package,” says Jules Acton, director of engagement at healthcare charity coalition National Voices. “The danger is that people see it as a quick fix, something cheap. Like any tool, it’s how you use it that counts.”
Video appointments from patients’ homes
Video appointments are an obvious development of telephone consultations. GPs who use them mention the benefits of seeing as well as hearing their patients and the prime minister says patients should be able to receive medical advice online or via email.
However, 50% of those in the BMA survey say they are worried about the clinical limitations of video or web appointments. A sizable minority, 29%, would not use such consultations for reasons of security and confidentiality.
Dr Richard Vautrey, deputy chair of the BMA’s GP committee, believes these concerns could subside if the technology is shown to work well. There are problems with telephone consultations in getting to talk to the patient without hitting voicemail or poor reception: “GPs fear that would be worse with video consultations, as the bandwidth to support it isn’t that great in many GP surgeries,” he says. “It’s more to do with getting the technology to a level that is as reliable as a telephone call.”
Some hospital trusts use video appointments, with Barts health NHS trust allowing patients with diabetes to use video calls, leading to fewer missed appointments and shorter and better focused consultations. The trust says patients who don’t have to travel or wait in clinical environments are showing better blood sugar levels.
Dr Shanti Vijayaraghavan, a consultant diabetologist at Barts, says staff can pick up visual clues that are not available over the phone. He adds that while not everyone wants to use video conferencing, many young people use the service routinely.
Video and data appointments between NHS sites
One way to improve the reliability of video consultations is for patients to use GP surgeries or other professionally-equipped NHS premises for appointments with healthcare professionals such as hospital consultants. This allows the health service to manage the video link, and also for professionals to undertake physical tests.
Remote analysis of data gathered by patients
While many medical practitioners are wary of using data gathered automatically by commercially available devices, some are asking patients to provide readings from medical equipment electronically. Florence, or Flo, is an NHS-developed system that has been used by more than 27,000 patients across 31 clinical commissioning groups to send in readings by text message.
It was initially developed to let patients suffering from hypertension submit blood pressure measurements, but has extended to medication reminders and smoking cessation. “The benefits are improved convenience for patients,” says ProfRuth Chambers, who helped to develop the system as a GP in Stoke-on-Trent.
“They do not have to make unnecessary trips to their GP practice for monitoring of their condition that can be done remotely; the reminders from Flo can help them adhere to their regular medication and the interactive messaging help patients detect early signs of deterioration triggering the initiation of standby medication or other interventions, thus improving the control of their long term condition(s).
“The benefits for clinicians include increasing accessibility for patients with avoided consultations for others liberating consultation slots, and slicker clinical management for patients with long term conditions, acceptable challenge to patients to reverse their poor lifestyle habits – with Flo underpinning pre-agreed shared care management plans.”
Distribution of results directly to patients
Some patients with chronic conditions understand their results as well as medical professionals. PatientView is a UK-wide service through which regular kidney patients can see their own data, including the results of tests as soon as they are logged. It first opened in 2005 after development by Scottish NHS staff and is now run by the Renal Association. Almost all UK adult renal units offer patients access to their results through the system. Patients in Salford are able to use the system for data on inflammatory bowel disease and diabetes, and the Scottish government is piloting its use for those with heart failure.
Mental health treatment
Providing mental health support remotely has a long pedigree: London vicar Chad Varah set up the Samaritans as a telephone helpline in 1953. It now provides crisis support through email and text messaging as well as phone calls, while Childline has set up extensive help services online.
Away from emergency work, some mental health patients now receive therapy online such as through Big White Wall’s services, which are purchased by several NHS trusts. Chief executive Jen Hyatt has said online provision of therapy sessions can work for those who feel culturally isolated and for those whose phobias mean they find it hard to leave home. But she adds: “Digitisation is not for everybody. People with some disorders may find digitisation damaging, rather than enabling.”
Brother’s video and data web conferencing service
Brother UK’s Omnijoin video and data web conferencing service includes clinical commissioning groups, GP surgeries and NHS trusts among its customers, according to Andy Ostler, head of its Omnijoin business unit. Many use it for internal video conferencing such as for training. Clinical uses include letting patients in mental health rehabilitation see and talk to their families. One customer is looking at allowing patients who find it difficult to visit GP surgeries, such as those suffering from obesity, to have video appointments. “Virtual consultations are a very hot topic, and there are a lot of projects running at the moment,” he says.
Ostler says the service uses very high levels of encryption for data protection, and that contacts with new users are set up by emailed invitations that only work once. It also automatically adjusts itself to the bandwidth available; if a connection slows down it may lower the video resolution or switch to audio only, rather than drop the call.
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