Healthcare technology - keeping the faith
Technology, it is hoped, has the potential to transform a patient’s experience of care. From consultations via videoconferencing to home telemonitoring of long-term conditions, from wearable technology to enhanced wards, the mainstreaming of telemedicine could mean patients take more control of their care, while physicians have access to more accurate data.
Scotland’s commitment to telecare and telehealth has been significant, driven by demographic challenges and the Scottish Government’s 2020 vision to have everyone able to live longer, healthier lives at home or in a homely setting, with the person at the centre of decisions.
Scotland’s first National Telehealth Strategy was published in 2010, with four national telehealth programmes in Stroke, Paediatrics, Mental Health and Long Term Conditions accompanied by investment in the technology infrastructure, education and training.
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It became apparent the use of technology needed to be normalised, as opposed to just an add-on, so the Scottish Centre for Telehealth and Telecare (SCTT) was taken under the auspices of national advice and information service NHS24 in the same year.
And 2015 saw the third successive three-year delivery plan drawn up to expand ‘technology-enabled’ service redesign at a bigger scale.
Scotland has attracted praise from Europe for its approach to healthcare technology. Participation in the European Innovation Partnership on Active and Healthy Ageing, set up by the European Commission to address societal challenges of an ageing population through innovation, saw two ‘three star’ evaluated reference sites.
The national telecare programme, which ran from 2006 to 2011, was recognised, along with the Joint Improvement Team’s work on anticipatory care planning. This has helped foster Scotland’s reputation on the European stage.
In 2014 the deputy director general for health and consumer protection at the European Commission, Martin Seychell, praised Scotland’s contribution. “We’re very grateful to Scotland, for the very active participation in promoting these actions at a European level,” he said.
Former Scottish Health Secretary Alex Neil said at the time: “I think we’re living on the cusp of a healthcare and social care technology revolution. Telehealth and telemedicine is absolutely at the centre of that revolution.”
However, the 2011 delivery plan recognised change would have to be driven by more than investment. Authors wrote: “Technology itself is not a panacea. As global innovation produces ever smarter and more sophisticated technology, this will only be adopted if our care systems adapt to embed it through service redesign and new ways of working.
“We need to build public and professional awareness and confidence in how technology can make a difference to our lives, and ensure it is reliable and easy for all to use.”
But while investment has continued, securing public and professional confidence has been perhaps more of a challenge.
For example, the £10m online self-management hub ‘Living it Up’ attracted less than a third of the number of users it had targeted. Launched in 2013 with the aim of having 55,000 users across Scotland by May 2015, by then it had attracted just 15,000, at a cost of £690 per patient.
The SCTT conceded: “Recruitment has been challenging against the initial profile established at the outset of the programme,” in a statement in May, but said the project was still “gaining momentum”.
Meanwhile some members of the clinical community have also been less than enthusiastic.
“We need to get the doctors involved in this agenda, and that starts with the undergraduate discipline – medical students of today who will be the doctors of tomorrow,” Professor George Crooks, SCTT director and medical director for NHS24 told a recent Holyrood conference.
Crooks described a recent unsuccessful attempt to persuade deans of medical schools to incorporate technology-enabled care into the undergraduate curricula. “They basically said, ‘what do you want us to take out to put that in?’ which was missing the point completely… It’s part of day-to-day service delivery – it’s not an add-on.”
Another potential stumbling block could be the ambition to have all patients able to securely access their own health information online by 2020. Newspaper stories of data breaches and IT failures have done little to instil confidence in the idea of sharing patient information.
According to the Digital Health and Care Institute (DHI) innovation is not just about technology, but how it drives the capacity of ideas.
Professor Stuart Anderson, of the University of Edinburgh’s School of Informatics, said: “Health and care is kind of an information game. It’s who knows what, and who’s comfortable with who knows what. OK, we have a big and potentially complicated infrastructure but actually, the ideas that’ll make a difference are things that have broad applicability and to some extent, they’re simple. Important things will be things like increasing community capability to deal with care needs, for example.”
However, according to Zahid Deen, eHealth Strategic Lead at the Health and Social Care ALLIANCE Scotland, there have been different interpretations of ‘person centred’ by public bodies. The traditional model of presenting a finished service to users has been discredited, he says. “It doesn’t always go down well because you haven’t involved people in the process.”
Deen has been appointed to get people in the third sector involved in digital health development, which, he says, is linked to the self-management agenda, and shifting to being person-focused.
“People are already going online to get a lot of information, then going to the doctor. Most people who feel they have got something will google it, go to another website, so there is already that space where people are consuming information and using it to help improve their health or find things out about their health. A lot of the drivers for these services is about taking that habit further, and providing access to your health record,” he says.
Ultimately, it should make the person more empowered in the relationship with their health and social care provider. However Deen warns there is a risk, at least initially, health inequalities could be exacerbated.
“People who are elderly and people who live in deprived areas are less likely to be online. But they’re also more likely to have long-term conditions. They’re the ones heavily using the health service. So the whole idea of promoting these services by extension you should be promoting online access, making sure you’re reaching those who most need to access those services.”
Uptake too, could be an issue warns Deen, but will be addressed over time as smartphone penetration increases. Questions will remain however, over who owns the data.
The third sector can play an important role in making lengthy government strategy accessible and relevant for people with long-term conditions, according to Deen. He warns progress could be held up by technicalities.
“My concern around it is, and it’s a third sector concern, a stakeholder concern, is that these things are delivered on time and do what they say they’re going to do: work seamlessly for everyone.”
So far, he points out, a lot of what has been delivered has been for clinicians. To successfully move eHealth into the home setting local IT systems will need to be integrated better, including between health boards.
“If you’re working for an organisation you can always call up the IT department. What’s a person using it at home or on the move going to do? Are they just going to stop using it? Who are they going to call up? It’s got to work and it’s got to work well, and it’s got to reach as many people as possible.”