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Telemedicine is in active use in many parts of the world, but generally restricted to point-to-point applications serving remote geographic locations.
Since the advent of the NHS, it has been possible for medical practitioners to communicate with patients 'over the wire' by telephone. Equally, practitioners have had the ability to consult with specialists on specific issues without physically travelling to meet them. In many respects, the use of 'plain old telephone systems' (or POTS) still remains the bedrock for most practical uses of telemedicine in the UK.
Beyond use of POTS and facsimile, there have been a limited number of specialist projects in telemedicine using more recent developments in technology and usually targeted at remote geographical locations. In many cases, the use of such telemedicine is restricted to specific specialties, such as teleradiology or teledermatology, which are regarded as suitable for this type of communications technology.
Potential revolutionised
As a result, evolution of UK telemedicine has been limited to isolated point to point applications (such as the Isle of Wight to Hammersmith for neonatal scans) or specialist applications like telecardiology or teledermatology (currently used in remote areas of mid Wales). The wider implications of telemedicine and use of Internet technologies and burgeoning communication capabilities have yet to be taken seriously by the NHS in the context of integrated healthcare delivery systems.
In practice, the advent of innovative Internet technologies and intranet infrastructures has effectively revolutionised the potential capabilities of delivering more effective healthcare. Despite anguished protests from the healthcare Establishment over data security, the fact remains that use of smart cards in conjunction with suitable access protocols already enables patient information to be stored safely on the Internet for retrieval by patients themselves or by authorised clinicians.
Data availability key
Add to this the facility for remote consultation (using telephone, Internet or videolink) and the capability for a radical new approach to 'cybermedicine' becomes a real possibility. Practical application of such methods has been helped by the fact that potential costs of data communication have dropped by an order of magnitude where the Internet is used as an alternative to 'normal' broadband communications.
All of this new technology is available today but is not being used to its full potential. The problem lies not with the technology itself, but with the ability (or willingness) of the NHS to actually use it. For example, the availability of patient information on the Internet (or intranet) is as much a problem of putting it there in the first place as of retrieving it safely and securely. The former relies on adequate information systems at the 'host' organisations (Trusts, HAs, GPs etc) and the latter on an agreed corporate policy within the NHS on data access.
Although it is advances in technology that are presenting the opportunities, their importance (and priority given them by the NHS Executive) will ultimately be dictated by political pressure. Expectations of the general public are changing much faster than the NHS Executive appears to appreciate, and the NHS is in serious danger of falling behind the requirements of an information society. The ultimate irony is that we have the NHSnet, but lack the motivation within the NHS to actually use it.
Enable patients to participate
One of the key requirements of the information society is that customers (ie patients) are accorded at least as high a priority as service suppliers (ie clinicians, health professionals and managers) in the provision of relevant information. The latest American thinking is that the patient (or prospective patient) potentially represents the largest (and least used) healthcare resource world-wide. If computer systems can be used to inform and enlighten patients, then the opportunity will be there to improve the quality of care provided and also to reduce the costs.
By enabling patients to participate more effectively in decisions about their own health, information technology can make a significant contribution to improving the process of delivering care. More attention can be given to the important issues of lifestyle and self help, as well as the actual provision of acute or community care (through direct contact or telemedicine). Patients themselves hold the key to more effective deployment of scarce NHS resources, and a more enlightened approach to patient involvement will surely yield big dividends.
Our present healthcare delivery system is dominated by two major premises. Firstly, to gain access to the NHS, patients have to present themselves physically to a 'bricks and mortar' institution. Secondly, the quantity and quality of information provided to patients is in proportion to their sickness (as opposed to wellness). We have the opportunity now to challenge both these premises and we have the necessary technology to transform current outmoded processes of healthcare delivery.
What is missing is a management blueprint for this radical new vision of a truly patient-centred National Health Service, fit to meet the demands of an informed consumer society. This implies moving beyond the purchaser/provider split to a health service with much greater consumer sensitivity, supported by truly service-oriented strategies and enabling technologies.
Mistaken perception
But none of this can happen without the active commitment and participation of healthcare managers at all levels. What is needed is a radical re-think of the way in which healthcare is delivered in the NHS and the creation of new vision for the new millennium.
It is self-evident that new technology (information technology as well as medical technology) will be at the heart of any such vision. Sadly, there is still a mistaken perception in the NHS that information technology is an unnecessary and unwarranted drain on the funds available for patient care. Unless and until this issue is seriously challenged by the NHS Executive, progress towards the new world where technology is used to make a positive contribution to people's health will be limited at best.
First published in BJHC Sep 97
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