COMMENT: The psychology of change - addressing barriers to telehealth adoption

Claire Medd of Care Innovations on how to overcome barriers to the widespread adoption of telehealth

In this article, CLAIRE MEDD, clinical director at Care Innovations, discusses how to overcome the barriers associated with the widespread rollout of telehealth technologies

Much of the public is fiercely protective of the customary way they interact with doctors, nurses and carers, and many will tirelessly tolerate inefficiencies borne from placing too much pressure on a creaking health service in order to maintain the status quo, no matter how broken the system is

Given the looming realities of an aging population and stubborn deficit, the Government believes telehealth would not only benefit at least three million people with long-term conditions or social care needs, but that it would also help the NHS save precious pots of money. Hence the reason for the widest study ever into the benefits of telehealth, called the Whole Systems Demonstrator (WSD). Its findings are still being released, but it has already discovered that telehealth is associated with lower mortality and emergency admission rates. So why is telehealth not already commonplace?

In part, this may be due to a general disposition that is resistant to change. The adoption of new technology requires a cultural and behavioural shift, particularly in healthcare. Much of the public is fiercely protective of the customary way they interact with doctors, nurses and carers, and many will tirelessly tolerate inefficiencies borne from placing too much pressure on a creaking health service in order to maintain the status quo, no matter how broken the system is. However, if the technology is mature, the conditions are ripe and the benefits are clear, innovation is much more likely.

The key is to achieving the right balance of all three factors described above. The difficulties with integrating telehealth into the fabric of our health system are reflected in the challenges researchers faced finding participants for the WSD trial, and their experience points to a wider perception problem associated with telehealth. To better understand these challenges, the research team released a paper exploring the barriers to participation within the WSD trial.1

Telehealth may very well transform the face of our health service. However, this potential can only be recognised if advances in technology are matched with a more thoughtful and tailored approach to its introduction

The findings of this analysis are quite complex, but a few themes did arise. For one, the WSD researchers found a lack of confidence when it comes to IT literacy in some of the participants. In these cases, the responsibility lies with the providers of telehealth solutions to ensure the technology is intuitive, as well as the care providers, to demonstrate its simplicity and ease of use in the home.

Another identified barrier was a fear of disruption to services. This is particularly a concern among people battling long-term illness, especially for those who have had to wait long periods of time to access the health and social services that they need. In these cases, the onus is on the care providers to reassure their patients that support is still at hand and that by using telehealth, doctors and nurses may improve their clinical decision-making# and patients may experience a better quality of life.

A concern for other patients, at the opposite end of the spectrum, is that telehealth will remind them they are sick and may become a crutch for them that actually reduces their independence. Again, this fear can be easily assuaged with the correct information: the fact that participants in the study were less likely to be moved into a hospital and more likely to stay independent in their own homes for longer is a clear statement on how telehealth enhances independence instead of diminishing it.

The responsibility lies with the providers of telehealth solutions to ensure the technology is intuitive, as well as the care providers, to demonstrate its simplicity and ease of use in the home

Many of the apprehensions listed in the WSD paper are not only based on a common fear of the unknown; they go to the very nub of concerns telehealth is designed to address.

As the WSD trial itself has proven, telehealth actually increases patient autonomy by enabling them to discretely submit biometric data at their convenience and identify the symptoms which indicate their health is deteriorating. Each unit is tailored according to the patient’s personal health profile. Based on this customisation, telehealth not only empowers patients to better discern the points at which they should ask for help, but it also guides them to help themselves by following a specific action as prompted by the system.

The technology has the potential to fundamentally change the way healthcare is delivered in keeping with the NHS reforms' goals. However, to deliver on its full potential much more thinking needs to be done around communicating its benefits to both care recipients and care providers. One way to achieve this is through multimedia, which is particularly apt given the technology in question.

Following a successful trial at NHS Central Lancashire of the Intel-GE Care Innovations Guide, staff suggested that patients would benefit from a DVD clearly outlining the advantages of using the technology. Video is certainly a powerful way of demonstrating how telehealth can be applied, along with testimonials from previous organisations and patients that have used it.

NHS Central Lancashire may well have benefited from sharing the following testimonial from David Ward, a patient at NHS Wakefield District who used the Care Innovations Guide. He said: "The confidence I have in this system means I don’t worry about my health like I used to. I sleep better and don’t have the panic attacks. I’ve started to walk small distances again. I’d go as far as saying it’s given me a new lease of life.”

Telehealth not only empowers patients to better discern the points at which they should ask for help, but it also guides them to help themselves by following a specific action as prompted

In the spirit of supporting future implementations, NHS Central Lancashire is now in a good position to communicate to patients in other districts its experience of using telehealth. These included the opportunity to provide more continuous, less invasive care to detect symptoms early on and intervene before conditions deteriorated, thereby potentially saving patients the trauma of getting sicker and spending days, if not weeks in hospital.

Telehealth may very well transform the face of our health service. However, this potential can only be recognised if advances in technology are matched with a more thoughtful and tailored approach to its introduction. As is the case with all disruptive technology, there is a tipping point after which the technology is adopted on a widespread scale and old practices are soon forgotten and replaced with a new reality.

According to the technology adoption lifecycle paradigm, adoption goes through a number of stages. The fact that the NHS undertook such a massive study on telehealth demonstrates that we’re beyond the innovator-only stage – now it’s time to complete the cycle, make telehealth widespread, and start saving lives.

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