Sustaining Innovation in Telehealth and Telecare

This paper, a Whole System Demonstrator Action Network (WSDAN) briefing paper from the United Kingdom (UK), looks at the need for new care models and technologies - such as telehealth (the delivery of health-related services and information via telecommunications technologies, according to Wikipedia: teleheath) and telecare (offering remote care of elderly and vulnerable people, providing the care and reassurance needed to allow them to remain living in their own homes - according to Wikipedia: telecare) - to support long-term health care. It considers the range of approaches that have been developed, giving some examples. It identifies some of the key challenges to the adoption of technology-based approaches to care, and suggests some strategies to overcome these challenges, so that telehealth and telecare innovations may be sustained.

The paper points out that telehealth and telecare innovations have the potential to improve quality of life for users and to reduce unnecessary hospital and care home admissions. Between 1.6 million and 1.7 million people in England, UK, use telecare services, and user numbers are growing, but telehealth services are comparatively under-developed, with around 5,000 users.

Key barriers to the wider adoption and diffusion of innovation include:

• a lack of robust evidence for the cost-effectiveness of telecare and telehealth associated with the current high cost of deploying some of the technology ‘at scale’;
  
• the implications for professionals and organisations in adjusting to new ways of working when adopting technology-supported care;
  
• the lack of a consumer market; and
  
• the lack of interoperability and minimum standards for the technology.
  

Examples of advantages of telehealth services include: fewer care home and hospital admissions through using telecare alongside personal care, intermediate care, and "re-ablement" programmes; using telecare for short-term assessment and lifestyle monitoring to improve care planning; and replacing overnight support with remote monitoring in consultation with users and their caregivrs and families. Innovations for uptake include: provision of free telecare; demonstration facilities for awareness training - including on an "Older People’s Bus" that travels to familiarise potential users; innovation houses - for example to familiarise conference attendees; partnerships between representatives from the local authority, mental health trust, university, and third-sector organisations; and various sources for financial investment or donation.

Internet news websites provide updates on new products and services, while the UK Department of Health’s Telecare Learning and Improvement Network (LIN) Newsletter gives a monthly update on telehealth and telecare news stories from around the world. Examples include:

1. social networking websites (e.g. Facebook) to support users with long-term conditions
   
2. text prompts, email, and other messaging services (e.g. medication reminders)
   
3. video conferencing and webcam consultations (telemedicine applications)
   
4. mobile and smartphone applications
   
5. implanted cardiac monitoring devices
   
6. telephone-based disease management approaches
   
7. wearable sensors (e.g. embedded in clothing, stick-on plasters).
   

The paper concludes with the following focus on key areas to ensure adoption of innovation in telecare and telehealth services:

• Leaderships and vision
  
• Clarity of goals
  
• Organisational structure and processes
  
• Strong commissioning and decommissioning skills for placing and replacing services
  
• Governance and accountability
  
• Project management
  
• Communication for awareness raising and communication of expertise
  
• Staff and patient empowerment
  
• Information sharing
  
• Evaluation and audit