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.
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 nursing staff, for example a district nurse seeks advice on a leg ulcer via video from a tissue viability nurse
remote interaction between nurses and patients for example 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, for example a falls sensor in a patient's home triggers an alert in a control centre
remote physiological monitoring, for example blood pressure data is send to a cardiology unit for interpretation
store-and-forward, for example 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 nursing staff now encounter telehealth and telecare applications in their daily work. An increasing number of nursing staff take a lead role in telehealth and telecare programmes. More information is available from Setting up a programme.
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 . 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 . Care coordinators (registered nurses and nurse practitioners) monitored the answers daily in order to determine if an intervention (for example, 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 . 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 . "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.
Dallas (Delivering Assisted Living Lifestyles at Scale) investment of up to £23million is being made to establish up to five communities across the UK. These will show how assisted living technologies and services can be used to promote wellbeing, and provide top quality health and care, enabling people to live independently. Assisted living is another term which includes telecare and telehealth.
The Whole System Demonstrator (WSD) was the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites in England. Findings showed a reduction in A&E visits, hospital admissions and mortality rates for diabetes, heart failure or COPD. More information is available from the Department of Health and King's Fund websites.
The focus has now moved on to the 3 million lives campaign which aims to have three million people in England benefit from telehealth and telecare over the next 5 years. Further information is available at 3millionlives.co.uk
The Scottish Centre for Telehealth and Telecare works with Scottish health boards to implement telehealth solutions in their local area.
'A review of telehealth in Scotland' carried out by Audit Scotland looks at how the health service is providing care to patients at a distance. The report says that telehealth has the potential to help deliver a range of clinical services more efficiently and effectively, and health boards should be considering it when introducing or redesigning services. Audit Scotland found that telehealth is popular with patients, doctors and nursing staff who have used it. Its benefits include less travel, faster diagnoses and fewer hospital admissions. The report can be downloaded from the Audit Scotland website.
A remote telemonitoring service for patients/clients living with complex long-term conditions such as heart failure, chronic obstructive pulmonary disorder (COPD), diabetes and stroke. Further information can be found on the Centre for Connected Health and Social Care website.
The All-Wales Telemedicine Development Programme three demonstrator projects aim to: "Provide and test a sustainable, affordable generic Chronic Conditions Management service model, that supports people's needs locally and promotes independent living within the community, including telecare and telehealth."
A Learning Zone resource, Telehealth Explained, is available for members interested in gaining deeper understanding of telehealth.
Links to relevant organisations and further guidance are available from the Links to resources page.
- 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
- 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
- Clinical Solutions (2009). Access all areas: Making better use of primary care services. Basingstoke: Clinical Solutions.
- Poole T (2006). Telecare and older people. London: Kings Fund.