Telehealth has a key role to play in meeting the challenge of delivering better preventative care for an aging population. But for maximum impact, telehealth initiatives need to focus on high-intensity users of acute services, establish a flexible operational platform for other patient groups, and develop the right capability and capacity to have an impact on the entire system.
Providing healthcare for the ageing population is driving a far-reaching debate about how best to meet older people's need for medical care, nursing and social support.
One solution is to look at re-orienting healthcare away from treatment and towards prevention. Telehealth technology has a key part to play in enabling this change by identifying and managing illnesses earlier, providing more effective care to those with chronic conditions, and managing risk for vulnerable people to enable them to live independently for longer.
The large-scale implementation of telehealth is not, however, happening rapidly enough to have a significant impact on the overall costs of care or to develop new capability and capacity. This is being exacerbated by the uncertain economic climate.
Healthcare systems need to get three things right to maximise the impact of telehealth and use it to drive the shift towards preventative care:
focus on patients who are, or are about to be, high intensity users of acute services
achieve the right scale to drive the development of capability and capacity
establish an operational platform that has the flexibility to expand to reach out to other patient groups.
Focusing telehealth initiatives on the right patient group
Healthcare systems need to focus telehealth initiatives on patients who are, or are about to be, high intensity users of acute services.
The results achieved in the US Veterans’ Health Administrations Care Coordination Home Telehealth programme show what can be achieved: 25% reduction in numbers of bed days of care; 19% reduction in numbers of hospital admissions; significant savings in total cost of care; and high levels of patient satisfaction.
Telehealth trials in the UK are beginning to show similar results. These are quick wins’ for patients, clinicians and payers. However, only addressing the most complex ‘downstream’ cases will not provide a sustainable solution: there is a need to consider how telehealth services can be developed and extended.
Achieving the right scale with telehealth implementations
Achieving the right scale means ensuring that early implementations of telehealth can drive the development of capability and capacity. A risk-averse culture in healthcare means innovations, such as telehealth, often end up as interesting topics for the research community yet have limited impact on mainstream services. Careful risk assessment is clearly necessary to manage any impact on the health economy, but that should not prevent innovative services becoming part of mainstream care pathways or contributing to the professional development curriculum.
In England, this is beginning to happen, with the NHS looking to establish telehealth services that care for patients by the thousand rather than the handful. Progress has already been made in NHS North Yorkshire, West Midlands and with the mainstreaming of the Whole System Demonstrators in Kent and Cornwall.
Developing the right operational platform for telehealth
To develop the right operational platform for telehealth, you need to build in the flexibility to support what you want to be doing in five years' time. A key reason why early adopters of innovation in connected health have failed to exploit their initial successes is that, all too often, they have not asked ‘where next?’ They find that, as they expand into new patient groups and new groups of professionals, they have to meet very different expectations. Standards, both professional and technical, have a big part to play in providing the flexibility needed to adapt and early investments in standards will pay dividends when it comes to reaching mainstream adoption.
If telehealth is to fulfil its potential, healthcare systems must focus initially on acute services, be flexible enough to adapt to different patient groups, and be sufficiently scalable to have an impact across the entire healthcare system.
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