'Digital divide' threatens future of telehealth and telecare

Assistive technologies need to be more user-friendly, conference told

Telecare and telehealth technologies are being heralded as the way forward for health and social care

A ‘digital divide’ is scuppering the rollout of assistive technologies, a recent conference heard.

Speakers at the King’s Fund’s third Annual International Congress on Telehealth and Telecare also revealed that unless suppliers improve the interoperability of their equipment, the Government’s dream of rolling out supportive technologies to more than three million people will fail.

Helen Herklots, chief executive of Carers UK, said more needed to be done by industry to ensure solutions were easy to operate, particularly as many of those with long-term conditions or additional health and social care needs are elderly.

As part of a panel debate, chaired by health commentator, Roy Lilley, exploring the pros and cons of telehealth and telecare, she said: “There is a digital divide. Some technology does not require a mobile phone, such as simple alarms, and this is technology most people can deal with. But we need to understand that there are people who are not connected and manufacturers need to be very careful about that.”

Lilley said he used Skype video technology to communicate with his elderly mother, but slammed the fact she could not get in touch with medical staff in the same way.

“We all use technology in our daily lives and it is bizarre that we still have to call our doctors on the telephone,” he added. “Should we not be demanding more use of technology?

“There is no silver bullet, but there is silver buckshot if we can use technology to relieve the pressure on doctors. Technology does not suit everybody, but that is not a reason to trash it all.”

But Alison Mlot, assisted living innovation platform leader at the Technology Strategy Board, warned: “Technology will not work for everyone and it will only work if we have got products that are interoperable.”

What is also needed to make the rollout a success, is the backing of GPs and hospital consultants.

However, the conference heard from a number of medics who are yet to be convinced of the impact of telehealth and telecare.

It is widely considered that the next step for telehealth is its integration into mobile devices, enabling patients to conveniently contact their doctor using video streaming as new and emerging technology becomes more reliable and affordable

Dr Jonathon Tomlinson, a GP at The Lawson Practice in north London, said: “Some people might want to email or Skype their family or doctor, but most of my patients frequently change their phones, have them stolen, or are on pay-as-you-go tariffs. One of my patients, who has dementia, recently ran up a £400 phone bill and had her phone cut off for 10 days. I use a smartphone for some things, but the battery runs out regularly and I wouldn’t trust it if I was relying on it for my health and wellbeing.

“Under certain conditions it is fine, but what people perhaps forgo is the relationship between the doctor and the patient and that is my concern.”

A GP in the audience added: “I am not against technology as a whole and my practice uses systems to enable patients to order prescriptions and get results, but if you want to use technology you need to be aware of issues such as privacy.”

It is these fears that are stopping many GPs from welcoming deployment in their areas.

One member of the audience said: “We would love to do live video consultations, but Skype, for example, records all interactions and I have not found anything that allows me to it that safely and securely. If there was a failsafe solution, then that would be great.”

Professor Lionel Tarassenko, professor of electrical engineering at the University of Oxford, said manufacturers and service operators needed to make products more user-friendly.

“The evidence of telehealth on the whole is not good,” he added: “Three years ago in the South West we started to work with patients and we asked them what they wanted in terms of telehealth and telecare technology. For starters, they did not want a box, so we gave them android tablets, and they wanted us to get rid of keyboards as people with tremors, for example, can’t use them. “In terms of getting used to the technology, they wanted time to practice with the equipment before officially going live with it, and they wanted flexibility over when they could input the information. A lot of services ask for the information between 9-10am and people want to be able to do it in their own time.

Telehealth is coming of age as an effective measure that can harness new, affordable technology with the potential to deliver convenient, effective care to patients willing to embrace it

“Not everyone needs the same level of management, so we have to learn about the patients as individuals and then set up the technology around their needs.”

Shirley Ayres, a digital strategy and communications consultant, added: “I don’t think there is a box for everything, but I do believe that used correctly and relevantly, technology is an enabler.”

Hilary Thompson, a specialist stroke nurse at Southern Health and Social Care Trust, has led a telehealth campaign aimed at supporting stroke and TIA patients.

She said: “High blood pressure is the single most significant and reversible risk factor for stroke. In 2008, I adopted remote telehealth into practices to monitor blood pressure following a stroke. We took basic blood pressure before giving people telehealth monitoring systems, and then at the end. Over the period 32% of patients did not need additional inappropriate pharmaceutical intervention.”

Another example of where technology has worked is at the Cumbria and Lancashire Telestroke Network, developed by Imerja and Virgin Media Business and operational in eight hospital sites across the North West.

The network provides an out-of-hours, remote video stroke diagnosis service, allowing the correct drugs to be prescribed quickly, irrespective of the doctor’s location.

With 4,000 people across the Cumbria and Lancashire becoming victims of strokes each year, this innovative technology has significantly reduced the level of morbidity and mortality in the region, particularly in rural areas where healthcare is relatively inaccessible.

Ian Jackson, managing director of Imerja, said technology was constantly evolving and suppliers were listening to feedback on the future design of systems.

There is no silver bullet, but there is silver buckshot if we can use technology to relieve the pressure on doctors

He said: “Telehealth is continually evolving and can be adapted to many different situations. “It is widely considered that the next step for telehealth is its integration into mobile devices, enabling patients to conveniently contact their doctor using video streaming as new and emerging technology becomes more reliable and affordable. Such mobile telehealth methods would also reach thousands of nurses, support staff and GPs, widening access to convenient, timely care.”

He added that telehealth would also become integrated into more specialised areas of healthcare, such as rehabilitation processes for mental health patients or prisoners.

“Telehealth is coming of age as an effective measure that can harness new, affordable technology with the potential to deliver convenient, effective care to patients willing to embrace it, and provide an alternative way for an overburdened NHS to deliver outstanding health outcomes.

And David Cockayne, managed services director at Tunstall, added: “Over the last 12 months, we have continued to work with NHS trusts and local authorities to help them support those with long-term health and care needs. We have seen the value of telehealth and telecare as a means of reducing hospital admissions, cutting costs for the NHS, and improving independence for those who want to live at home for as long as possible.”

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