Telehealth and telecare

In a social context, information and communication technology increasingly pervades our lives. We communicate through telephone, text, email, and video and we collaborate through lists, discussion boards, blogs and wikis. In just a few short years, these technologies have become commonplace, not only because they are available, but also because people find them useful.

Just as information and communication technology has become integral to our social lives, it also offers great potential in a health care context, and an increasing number of patients and health and social care organisations are reaping the benefits.

This introduction to telehealth and telecare provides definitions and examples, discusses potential benefits, introduces ethical and policy issues and training needs, considers some of the issues around telehealth or the telecare programme and reflects on the potential impact.

Definitions

As telehealth and telecare are relatively new eHealth services, the language used to describe them is still evolving - you may find that the terms are used interchangeably.

Telehealth (also referred to as telemedicine) covers the remote monitoring of physiological data e.g. temperature and blood pressure that can be used by health professionals for diagnosis or disease management. Examples of telehealth devices include blood pressure monitors, pulse oximeters, spirometers, weighing scales and blood glucometers. Telehealth also covers the use of information and communication technology for remote consultation between health professionals or between a health professional and a patient e.g. providing health advice by telephone, videoconferencing to discuss a diagnosis or capturing and sending images for diagnosis.

Telecare uses a combination of alarms, sensors and other equipment, usually in the home environment, to help people live more independently by monitoring for changes and warning the people themselves or raising an alert at a control centre. Examples of telecare devices include personal alarms, fall detectors, temperature extremes sensors, carbon monoxide detectors, flood detectors and gas detectors.

There are many different varieties of telehealth and telecare:

• Remote consultation between nurses e.g. a district nurse seeks advice on a leg ulcer via video from a tissue viability nurse
• Remote interaction between nurses and patients e.g. a patient  seeks advice from NHS 24 , an online and telephone health information and advice service for Scotland, about an episode of breathlessness
• Remote environmental monitoring e.g. a falls sensor in a patient's home triggers an alert in a control centre
• Remote physiological monitoring e.g.  blood pressure data is send to a cardiology unit for interpretation
• Store-and-forward  e.g. an ultrasound scan is captured and sent for remote  interpretation

As telehealth and telecare encompass preventive aspects of health and social care, they are particularly relevant to nursing. Many nurses now encounter telehealth and telecare applications in their daily work. An increasing number of nurses take a lead role in telehealth and telecare programmes. More information is available from Setting up a programme.

RCN conference

The RCN is hosting a conference on 30 March 2012 called "Bringing clinical benefits to your patients through technology" It will explore the use of telehealth to support patients living with long-term conditions from the viewpoint of nurses and service users. More information can be found at the RCN events web page.

Potential benefits and impact

By expanding access to specialist services, providing real-time health advice, and remotely monitoring both care environments and health status, telehealth and telecare programmes have the potential to reduce visits by patients to care providers (and vice versa), facilitate more localised care, provide more timely diagnosis and intervention, and even reduce costs. An increasing number of studies are beginning to identify both the benefits and the challenges associated with telehealth and telecare. 

A Cochrane review of published research evidence found telehealth and telecare technologies to be reliable, non-detrimental and well-accepted by patients [1]. However, the review found little firm evidence of benefits, safety or cost-effectiveness.

The results of more recent studies are more encouraging. In a study carried out in the USA, patients with diabetes answered questions daily using a messaging device [2]. Care coordinators (registered nurses and nurse practitioners) monitored the answers daily in order to determine if an intervention (e.g. a telephone call or a referral) was necessary. When compared to a control group there were fewer deaths and longer survival among those using the device. The authors of the study concluded that the "results suggest that daily management of patients with diabetes through home monitoring by a registered nurse reduces mortality".

England's NHS Direct is a nurse-led service and provides information and advice via telephone (handling around five million calls per year), a website and digital TV. There are similar services also in Scotland (NHS 24) and Wales (NHS Direct Wales). A recent study reported a high level of satisfaction among users of NHS Direct [3]. Many people contact NHS Direct out-of-hours because they do not know who else to turn to and many people return due to a positive previous experience. Nearly three quarters of those who visit would have gone to their GP or A&E department instead while home treatments are recommended for nearly half of visitors, suggesting a positive impact on resources.

A number of case studies are available via the web. For example, an appendix to the Wanless Social Care Review published by the King's Fund [4]. "Telecare and older people" includes a series of case studies that provide some initial evidence on the benefits of telecare for older people. The paper also models the potential impact and acceptance of telecare.

External links to relevant organisations and further guidance are available from the Links to resources page.

References

1. Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098
2. Chumbler NR, Chuang H-C, Wu SS, Wang X, Kobb R, Haggstrom D, Jia H. Mortality risk for diabetes patients in a care coordination, home-telehealth programme. Journal of Telemedicine and Telecare 2009; 15: 98-101
3. Clinical Solutions (2009). Access all areas: Making better use of primary care services. Basingstoke: Clinical Solutions.
4. Poole T (2006). Telecare and older people. London: Kings Fund.