Telehealth or remote monitoring of patients is strategically important to the health sector globally due to the increasing chronic disease burden and the pressing need to shift emphasis to self-care and lower cost healthcare interventions. There are a number of important barriers, such as reimbursement models and incentive alignment to overcome to enable telehealth for the mass market, few of which are technical.
The UK has been recognised as being well placed for early success in the mass telehealth market, perhaps top in Europe, with early national scale initiatives expected within a 2-3 year timeframe[1],[2]. To achieve this BT and others believe that a fundamental shift is required from high cost, disconnected, small patient number pilots to large scale, low cost, integrated solutions that overlay routine care provided for patients with long-term conditions. Existing data indicate that out of a possible treatable 450,000 patients only about 0.05% are being served today by a telehealth solution[1].
The UK is in this enviable position because healthcare informatics is a stated Government priority and sizeable infrastructure investments are taking place, which indirectly support telehealth. Scalable and affordable telehealth solutions will require the leverage of existing health service resource, telephone triage services, Spine health IT services for summary care record, demographics management, and electronic bookings, as well as electronic patient record solutions and integration environments such as the EMIS Medical Interoperability Gateway. It will also need to make use of the widespread use of modern consumer communications equipment such as mobile phones, broadband, set top boxes, personal computers, and gaming consoles.
BT has broad experience in telecare, telehealth, telemedicine, electronic patient and health record services, broadband and digital media retail services, and managed service provision and is working with other thought leaders to help catalyse scalable mass telehealth solutions.
BT’s vision is that people will be able to buy affordable connected telehealth solutions for self care that suit their individual needs and the recommendations of their caregivers. In the future the public sector may enable purchases to be made by roll out of Personal Health and Social Budgets. Such services could range from lower cost web behaviour change programmes, social network and SMS services to more expensive and intensive home health hubs. People should be able to use these solutions to self-care with the option that the information be accessible to NHS Direct, their General Practitioner or Community Matrons for supportive care – out of the box.
Over time, BT believes there will be convergence of services and technologies in the telehealth, telecare, and telemedicine areas. The future is patient-centric managed services that deliver evidence-based and predictable support for self-management of a patient’s needs and condition(s) through channels that best fits with their environment and cognitive ability.
Such a vision must be supported by an underlying flexible technology platform that conforms to open health informatics and technical standards, but importantly must also integrate with existing electronic patient and health record services and clinical triage services. This is a step change in the current approach as it breaks the proprietary way in which this market has evolved to date and provides a suitable basis for scalable and affordable telehealth solutions. BT is seeking NHS partners to take this vision forward and is already offering this approach within the UK.
Most investment to date in telehealth has been targeted at higher cost patients requiring case management. To address this need and to provide a solution for NHS organisations, BT is providing a managed service for the Intel Health Guide personal health system.
Dr Justin Whatling
Chief Clinical Officer
BT Health