Implementing Telemedicine / e-Treatment

Implementing telemedicine

Successful implementation of telemedicine depends on various factors including:

* Having a clear idea of why you are doing it–Is it to raise the standard of service or to reduce its cost?

* Confirming that purchasers want it and that providers are willing to do it

* Evaluating it–Since there is so little experience in Britain you would do best to regard it as a pilot trial: in other words, accept that it may not work, run it with proper monitoring, and publish the results for the benefit of others. Wyatt has set out some criteria for evaluating telemedicine as a new health care technique20

* Understanding that telemedicine is not driven by technology–Purchasing the equipment will not guarantee success (any more than buying a scalpel will turn you into a surgeon).

It cannot be overemphasised that simply buying the box won’t enable you to practise successful telemedicine. In this respect certain commercial companies are doing the medical profession a grave disservice by implying that, say, videoconferencing equipment is all that is required for telemedicine. The NHS has an unfortunate history of introducing information technology, and parts of the country have been littered with the Ozymandian carcasses of past “initiatives” at huge expense to the tax payer. Successful telemedicine requires not only the right equipment but, perhaps more important, a change in the way that medicine is organised and services are contracted for. For example, it may be necessary to develop a mechanism for reimbursement of telemedicine episodes.

The future

Telemedicine is here to stay and is likely to play an increasing role in future health care.1 Pressure from patients, and an increasingly litigious environment, make it important that in cases of doubt an appropriate professional opinion is sought. Telemedicine offers a method of seeking that opinion quickly and cheaply, thus providing a solution to an increasing problem in the delivery of health care.

If telemedicine were to be adopted widely, it might have a considerable impact on the NHS. In areas where it was shown to be cost effective, which are likely to include particularly the interface between primary and secondary care, it would facilitate the decentralisation of healthcare delivery. This might increase the pressure at district hospital level. However, it should not be viewed as posing a threat to specialist hospitals–rather the reverse, since telemedicine offers a mechanism for exporting their expertise (for money) further down the healthcare pyramid.