In theory, the use of technology in healthcare- telehealth can cut the cost of care while at the same time improving its quality of it’s delivery.That’s a powerful argument for governments and health maintenance organisations grappling with the soaring cost of long term care throughout the developed world.
In practice, however, proving telehealth’s benefits is tricky.
The National Health Service- which is hoping to slash the cost of caring for an ageing population, has tried to settle the question by backing the world’s largest trial of telecare.
The Whole System Demonstrator trial followed the progress of 1,500 people with three long term conditions in three different parts of England.
Preliminary results were excellent – the first “headline” results published last year seemed to show that patients using telehealth were 20% less likely to be admitted to hospital and 45% less likely to die than their counterparts in the control group.
Not surprisingly, the government embraced the new way of working.
The Department of Health said telehealth was the answer to the “confused, disjointed, fragmented mess” of today’s health and social care system and estimated that the widespread use of telehealth could save the NHS up to £1.2 billion over five years.
However, the latest detailed findings from the Whole System study paint a more complex picture. A study measuring the quality of life of people using telecare, reported in the British Medical Journal, finds that the technology had no measurable effect on feelings of well being.
“The findings suggest that claims for potentially salutary or deleterious effects of telehealth are unfounded for most patients.
“Telehealth should not be introduced with the aim of improving quality of life or psychological outcomes.”
The researchers, led by Prof Stanton Newton of the School of Health Sciences, City University, London, noted that their conclusions “differ markedly” from those of most previous studies “which are typically interpreted as showing benefits despite presenting equivocal evidence”.
In other words, most studies of telehealth are designed by enthusiasts who are likely to draw positive conclusions even when the evidence may not be there to back it up.
This suggests that past studies of telehealth, usually of small pilot projects, should perhaps be treated with scepticism.
However this is not deterring the IT industry, which is ramping up a new generation of consumer devices to enable people to monitor their health – and relay data to their carers and relatives.
However, a big challenge is patient confidentiality – health data collected by people going about their daily lives is inherently less private than data collected in a one-to-one conversation with a clinician.
Regulators cannot even agree on definitions – for example where a freely sold health and fitness app becomes a medical device, and subject to regulation.
Undeterred by these questions – and an unhappy track record computerising healthcare – the UK’s NHS seems set on a technology-led future.
The good news – so far – from the Whole System trial is that telehealth does not seem to do any harm. But whether that finding can justify the claims made for telehealth is another matter.