Telehealth – what’s stopping us?
It’s no new news that health care services are facing their biggest challenge in providing high quality care for all now and for future generations. The NHS needs to provide services that are available when needed, in a way that is both convenient and meets patient needs.
Using technology to support the delivery of health care services is seen as one solution to meet this growing challenge. However, this is not new. Back in 2006 a Government white paper identified that ‘we need to take advantage of the exciting new opportunities opened up by assistive technology’. Fast forward nine years and we still haven’t fully embraced technology that is available.
The NHS Five Year Forward View stated, ‘we do have an arguably larger unexploited opportunity to combine different technologies and changed ways of working to transform care delivery.’ Despite numerous pilots, the use of technology has not spread at scale and successful telehealth pilots fail to become embedded as normal practice.
Why are we not embracing telehealth more?
What is it that prevents clinicians from using technology for delivering health care services? Why is it that we are happy to trust technology when it comes to our banking or booking holidays yet we feel as though a patient must always have a face to face consultation?
In my experience clinicians are generally positive and accepting of technology – in theory. They see telehealth can help them be more efficient, provide good quality care and good outcomes but they’re still reluctant to use it. There is still the belief that it’s better for a patient to attend an outpatient appointment – even if this is inconvenient and inflexible for the patient. I find it difficult to understand why this is the case; outpatient appointments are at a premium and often poorly attended. We might only be able to provide a follow up every 2-3 months which is neither convenient nor practical.
For me, what has become apparent is that many clinicians often do not trust patients or carers to provide accurate information remotely. There is a concern that they will tell us what they think we want to know. There is a reluctance to relinquish control and allow patients to self-manage and take control of their own health. As much as we talk about empowering patients I feel that what is generally meant by this is expecting patients to contact us if there is a concern.
The use of technology and patients providing data is one step to supporting self- care, they are able to monitor their own conditions and see the impact of any treatment or lifestyle choices. Patient’s using the NHS Health Call Undernutrition telehealth service reported they could see what their weight was doing and seeing it change motivated them to follow dietary advice.
There is also a concern that telehealth is going to put clinicians at risk. With our undernutrition service, clinicians were key to the success of it because they provided patients with the reassurance and confidence they needed.
What’s the answer for telehealth?
If technology is going to meet its full potential in supporting health care delivery we need a change in culture. Patients are supportive of telehealth and they see the value in it. So what is it going to take for clinicians to catch up? How can we best support clinicians to be true clinical leaders and support patients through the journey of self-management?