What is the future of technology in healthcare?
If Professor James Ferguson’s tone should fail to convey his frustration, his use of figurative language does not. “It’s like going up to a guy hacking his way through a log with a hacksaw and saying, ‘look, I’ve got this chainsaw but you’re going to have to learn how to use it and you’re going to have to work a bit differently’, and he says, ‘no, I’m too busy to do that, I’ll just keep going with what I’ve got’.”
Perhaps it is not the most reassuring analogy from a medical professional but it’s a measure of his exasperation with the clinicians he considers to be causing harm by unnecessarily filling up hospitals. A consultant surgeon in emergency medicine at NHS Grampian and clinical lead at the Scottish Centre for Telehealth and Telecare, Ferguson has spent the last 15 years calling for greater use of technology as an alternative means to deliver care.
“This isn’t something for the far future; we have been talking about this since the last century, literally, and now we have to do something about it,” he tells Holyrood. “There is no choice, there is no more money – we can’t do it any other way. [Either that] or it (the system) just falls over, people just fall over and we don’t get good quality care.”
Observers do not need to look far for evidence to back up Ferguson’s assertion that the system is “creaking at the edges”. Audit Scotland last month underlined the need for fundamental change if the NHS in Scotland is to cope. Government progress on achieving its 2020 vision of changing the balance of care to more homely and community-based settings has been too slow, the financial watchdog warned.
What’s changed? The Digital Health and Care Institute (DHI) – one of eight innovation centres to be established – has awarded over £1.1m in its first two years. This, as a technology-enabled care programme backed by the Scottish Government to the tune of £30m, saw 41 projects share the first funding pot earlier this year.
A pilot in NHS Lothian that will see up to 2,500 patients’ blood pressure readings monitored remotely by health professionals is one of them. “Patients are better than doctors and nurses in terms of taking their own blood pressure because they’re relaxed when they do it in their own homes so you’re less likely to get a ‘white coat effect’,” says Professor Brian McKinstry, a GP and professor of primary care e-health at the University of Edinburgh.
McKinstry leads the Telescot programme – the largest programme of like-for-like randomised control trials of telemonitoring worldwide – which initially tested the concept. At the end of six months, patients who had been using home telemonitoring had lower blood pressure than those who had normal care, researchers found. The intention now is to scale up, with patients able to measure their blood pressure and submit results by text. Depending upon the patient, a report will then be sent to their GP either every month or every quarter.
The intervention remains in the pre-pilot phase during which five GP practices across Lothian have recruited 29 patients. Around 40 practices have expressed an interest with 27 signed up ahead of full recruitment getting under way in the next week or so. “It has been the easiest thing I have ever had to recruit to,” adds McKinstry.
The statement stands in stark contrast to the resistance often alluded to within the field. That, as far as McKinstry is concerned, stemmed from the technology being “touted at too early a stage by the industry… so fingers got burned all round”. A failure to fit in seamlessly with the workloads of doctors and nurses also stymied initial take-up, he suggests, a barrier that is being overcome under the TEC programme by beginning to put frontline professionals at the centre of its development.
Ferguson clearly remains to be convinced. “At the moment there is a complete gap between what is being thought through at the high level and what is actually being delivered at the grassroots level. There is still really passive but also some active resistance to that change [in how we deliver care] in certain sectors because people don’t like change.”
Ferguson is part of an eHealth-led initiative with SCTT looking at clinical decision support. Proposals the group is hoping to implement at scale include use of video conferencing to help manage patients within care homes as well as an equivalent of NHS24 for healthcare professionals to get instant advice from specialists rather than patients being admitted unnecessarily to hospital.
Meanwhile, guidance setting out arrangements for the allocation of TEC programme funding for each of the next two years will be issued later this month. Its launch – as well as that of the DHI – signals a shift in spend at least, offering some optimism for Ferguson a mere 15 years on. “The final part of the jigsaw in the next year or so will be actually making clinicians and the public accept this and use it.”