Primary Care: Working Differently- Telecare And Telehealth - A Game Changer For Health And Social Care

Part 1. Introduction

Technology has the potential to enable more people to be cared for in their own homes by supporting them in managing their own care needs more effectively. It also provides health and social care professionals with information that can help them understand changes in the patient's condition and when intervention might be needed. Telecare and telehealth were highlighted as technology-based solutions in the Deloitte report "Primary Care: Today and tomorrow: Improving general practice by working differently".1 In this report, we explore in more depth the potential for this technology to help the NHS change the way it responds to the growing demand for care.

What are telecare and telehealth?

There is no universal definition of telecare or telehealth, nor is there a single uniform type of technology. Rather, they comprise a wide range of assistive technologies targeted to individual needs. For the purposes of this report, we have adopted the following definitions.

Telecare:

Uses alarms, sensors and other equipment to help people live independently for longer, particularly those who require a combination of social care or health services. Telecare comprises assistive technologies and services tailored to individual needs. It monitors activity changes over time and can call for help in emergencies. For instance, a bed occupancy sensor can monitor when a person gets out of bed at night and raise an alarm if they do not return within a certain period.

Telehealth:

Is aimed at supporting people, typically with long-term health issues, to monitor and manage their own condition. It uses a combination of devices to monitor people in their home and involves the exchange of data between the patient and healthcare professional. The equipment monitors vital signs, such as blood pressure, blood oxygen levels and weight, supporting diagnosis, healthcare management and patient education. The clinician monitors periodic readings to look for trends that could indicate deterioration in the patient's condition. Telehealth solutions can help deliver care tailored to a patient's specific needs that can improve quality of life, prevent avoidable hospital admissions and reduce surgery visits.

The use of telecare has evolved over decades, predominantly as a social care support tool; telehealth is a more recent development, used largely to monitor the vital signs of people with chronic diseases such as heart failure, chronic obstructive pulmonary disease (COPD) and diabetes (Figure 1). The use of telehealth in the UK is accelerating, putting the country at the forefront in Europe. In England, the expansion has been driven by initiatives such as the Department of Health's (Department's) Whole System Demonstrator Programme;2 the 3MillionLives campaign3 and the Concordat between the Department and the telecare and telehealth industry4. There have also been national initiatives in Scotland5, Northern Ireland6 and Wales.7

This report is based on a detailed literature review and discussions with key stakeholders, including primary and secondary healthcare providers, GPs, suppliers, and representative organisations such as the Telecare Services Association. Building on the research conducted for "Primary Care: Today and tomorrow: Improving general practice by working differently",8 the report explores the evidence base for the wider adoption and implementation of telecare and telehealth. It presents a number of examples of evidence-based good practice, illustrating the way such technology is starting to make a difference in supporting more people to have better health outcomes while remaining longer in their own homes.

A brief history of telecare and telehealth

The evolution of telecare started over half a century ago with the development of alarms that initiated a rapid response in an emergency. Such alarm systems traditionally supported people who lived in sheltered housing and dispersed housing situations. Over the past 20 years, the development of new telecare technology has advanced at a pace commensurate with the development of electronic, computing and telecommunication innovations. Today, technology systems support individuals with mobility, sensory or cognitive problems and help improve quality of life for people with long-term conditions, enabling many to maintain a degree of independence for longer.9

The UK Preventative Technology Grant, launched in July 2004, was aimed at encouraging the adoption of telecare and telehealth, and creating an environment in which industry could flourish.10 While the grant helped address some of the social care needs of frail and elderly people, the use of technology to tackle health needs advanced at a much slower pace. Many healthcare providers remain sceptical about the benefits of telehealth and have tended to use it only for specific conditions, such as chronic heart failure.11

Recent developments in mobile technology, particularly the smart phone and the development of mobile applications (apps), have the potential to transform telecare and telehealth. Deloitte predicts that, globally, by the end of 2012, there are likely to be over 500 million smart phones with a retail price of $100 or less, supporting email, instant messaging and a selection of pre-loaded apps. Some 200 million of these phones are likely to have near-field communications capabilities, with potential to transmit patient vital signs and other physiological measurements to healthcare workers at a central site.12 The UK has the biggest app market in Europe13 and by the end of 2012 there will be over 88 mobile subscriptions per 100 individuals and an explosion in tablet computer users.14

Apps are changing fundamentally the way that the public interacts with technology. Across Europe, there are over 40,000 medical, health and fitness apps alone, a volume which can make product choice and navigation difficult.15 These provide information about diseases, medicines and medical devices and can track symptoms and send alerts (known as mHealth). Many apps are aimed at healthcare professionals but increasing numbers are designed for patients. Healthcare providers are watching this development closely, aware that while patient-oriented health apps have the potential to help patients understand and manage their medical conditions better, they can also mislead. Ultimately, they will change the doctor/patient relationship.16 This report focuses on the traditional approach to telecare and telehealth; developments in "mHealth" will be covered in a future report.

Telecare and telehealth can help tackle a number of the challenges facing care providers

The most significant influences on health and social care in the past ten years include:

more people living longer, accompanied by increasing and complex long-term health problems; acceleration of innovative technology; and recognition that budgetary pressures across health and social care services require...