|
The Telemedicine Project - (D.W.Green August 1999) Importance of Telemedicine to the government and the NHS executive 'Information for Health' This NHS Executive (NHSE) Document, promising a £1 billion investment to put information to work for NHS patients and staff, underlines the government's faith in new technologies, such as Telemedicine, to bring real improvement in healthcare (Burns 1999). "Telemedicine will undoubtedly come to the fore as a way of providing services in the future and a framework to guide the development and application of Telemedicine will be an early priority". Government drivers for Telemedicine implementation
he NHSE believes that information and communication technologies (ICT) in general and Telemedicine in particular are such technologies that can help achieve its mission. This is stated as, "to continuously improve healthcare delivery by making it more proactive and responsive to the needs of the population and to make it freely and equally available to all irrespective of race, gender, income or geographical location". As part of this process a National Institute for Clinical Excellence (NICE) has been established to determine the evidence base of key drugs and interventions. (NHSE, 1998). This body could be crucial in assessing the role of Telemedicine. 2.4. What are the problems with implementing Telemedicine? Introduction A review by Wootton (1998), the first established Professor of Telemedicine in the UK, saw Telemedicine as effective in many clinical situations but very complex and with many interlocking technological factors and people issues involved. Thus, despite isolated successes, it was far from being a force for improving healthcare in the UK NHS. Indeed, an article in the Economist (1998) stated "perhaps the clearest example of a medical technology whose time ought to have come but hasn't is Telemedicine". Evidence based approach The need for scientific research into the technologies involved and an 'evidence based' approach was emphasised by the government statement in parliament by Lady Hayman, Parliamentary Under-Secretary, Department of Health, that "telemedicine will only be widely introduced where there is clinical need and evidence from research and evaluation indicates that it is appropriate to do so" (Hansard, 1998). This view is supported by Wyatt (1996) and Yellowlees and Kennedy (1997) who feel that it is 'technology push' rather than 'clinical pull' which is driving many projects at the moment. 2.4.3. Technology management issues Wyatt's (1995) view that the NHS record on ICT implementation is poor is supported by an unfavourable Audit Commission report (1992). There are also many accounts of NHS case studies of major problems in technology management and failures of implementation, cost over runs and poor project management (Adams et al. 1992, Collins, 1992, 1997). Harrison et al. (1996) considered that "there were now converging economic, technical and political trends that make expansion of its role more likely". The problem is a failure of implementation and adoption into healthcare practice, both clinical and educational. Wootton (1996) states that "the goal of current research is therefore to marry medicine with technology, capitalising on the advantages of telemedicine and producing a robust system that delivers an acceptable service at an appropriate price". The project will attempt to review these issues surrounding Telemedicine implementation in healthcare and educational practice. Conclusion Telemedicine has many potential benefits and is clearly a key strategy for the NHSE and has profound organisational implications at all levels including governmental, medical school education, NHS Trust, GPs and the patients themselves. But, a clear technology management strategy must be implemented for success and to overcome the problems outlined above. As part of the project, medical students at GKT medical school filled in a questionnaire. If you wish for any more information on the project, please email me on david@dr-green.co.uk Interestingly, apart from more obvious "hard" technologies such as image transmission and remote reporting, there has been little movement in the roll out of Telemedicine (now called Telecare for political correctness) in the UK. This was predicted from the research carried out for my MBA Project in 1998 and 1999 (see above). For example, there is still no formal teaching in Telemedicine in medical schools as far as I am aware. However, there is little doubt that medical students are much more computer literate than they were in 1998 so they should be more receptive to the benefits of Telemedicine. Interestingly, if you follow the NHS links on the website below there are only 2 NHS Trusts listed as being "interested" in Telecare (as of September 2006). Mmm! One of the best websites you can find out more about Telemedicine is:
|