THE DAYS OF having to visit your GP for anything but the most urgent problem may be numbered thanks to the brave new world of “telemedicine”, where healthcare providers rely on telecommunications to assess and monitor patients.
In one of the most recent of these “electronic” healthcare schemes, asthma patients are being given Xdas, a state-of-the-art mobile phone and computer combined, which not only senses when their condition is deteriorating but communicates the danger to a GP, who can take swift action.
The Xda is usually found on the pages of high-tech magazines, and is particularly favoured by City types anxious to keep up with the financial markets. However, the “asthma” versions have been specially programmed with software developed originally as an early-warning system for jet engines. As Lionel Tarassenko, professor of electrical engineering at Oxford University and the founder director of e-San (the university spin-off company behind the technology) explains: “In jet engines we need to know as early as possible when deterioration is setting in with parameters such as the temperature and pressure going out of their normal range. The same applies to breathing in asthmatics.”
In an ongoing trial in the Slough area, 100 people with mild to moderate asthma have been provided with Xdas, as well as electronic peak-flow meters which measure the patient’s breath strength. “When someone is in danger of an asthmatic attack, their airways become narrower and this reduces the reading,” says Tarassenko.
Participants are messaged twice a day to find out what asthma medication they have taken, as well as to ask them to grade their symptoms on a scale of one to five, and to blow into the peak-flow meter that is plugged into the Xda. The procedure takes only 30 seconds and can be done anywhere.
The data is then transmitted to a server with the e-San software, and the peak-flow readings analysed. Most of the time these will be fine and are stored on a database to build up a profile for review. But if there are signs that the patient’s condition is deteriorating, the software e-mails the GP or asthma nurse, who then sends a text message to the patient’s phone telling them to adjust their medication, or to go to the surgery for immediate treatment.
The trial, which is a joint venture with the mobile phone company O2, will assess whether the technology results in fewer unscheduled visits to the GP (and therefore savings in time and resources).
As a major chronic condition managed mainly by primary carers, asthma was ideal for a home-monitoring scheme. But with 20 to 25 per cent of the population suffering from chronic conditions, says Tarassenko, the technology has a potential beyond asthma; e-San and O2 are planning similar trials monitoring other conditions, including blood pressure in hypertension and blood-sugar levels in children with type 1 diabetes.
Telemedicine is not just about monitoring chronic diseases at home — another application is so-called “store and forward”; here an image is taken with a digital camera (“stored”) and then sent (“forwarded”) to another location. At its simplest, the technology involves sending X-rays, CT scans and MRI scans to specialists for a second opinion.
This is now being used to help with the shortage of dermatology consultants. Under a scheme in North Manchester a specially trained nurse takes a photograph of the skin problem, then e-mails it to a consultant (employed by Teledermatology Ltd), who decides whether the patient requires an appointment, or can be treated by a GP. “Store and forward” medicine was used by the Armed Forces in Bosnia and Kosovo when a second opinion was required from specialists in the UK — and is probably helping medics in the field in Iraq.
The other widely used technology is two-way interactive television for “face-to-face” consultations, where the patient is in one location and the specialist in another. The technology is already being employed in some minor injury units in rural locations such as Cornwall. These are staffed by nurses and GPs who use the technology when they want a second opinion from an A&E consultant.
Telemedicine conferencing is also helping in cancer care, allowing multidisciplinary teams to come together to discuss a particular case, thereby overcoming geographical distance and specialist shortages. The lack of human contact may have its advantages, says Jim Briggs, the director of the Telemedicine Information Service at the University of Portsmouth. “Some psychiatrists have noted that the detachment produced by technical production helps patients to feel more comfortable in opening up.”
Experts predict that the widespread introduction of telemedicine will lead to a total restructuring of the delivery of healthcare. More care is likely to be provided in the community, says Dick Curry, an independent telemedicine consultant, and there will be less need for hospitals and specialist centres. Specialists, he says, would in theory be able to operate from anywhere in the country and would not need to limit patients to one geographical area.
The current hierarchical system, with medical specialists taking the lead, would be eroded, predicts Dr Sapal Tachakra, president of the Telemedicine section of the Royal Society of Medicine and an A&E consultant. “With everyone on their own patch, the consultant won’t present such a figure of authority. Consultations are likely to be led by the nurse, who will present the patient. It will become a collaboration where no one is in charge.”
For patients it is hoped that telemedicine will bring better access to healthcare, shorter waiting lists and less travelling to appointments. Better home support, says Briggs, is likely to reduce inpatient stays and to allow earlier discharge.
For health professionals it will improve medical education, with staff able to learn from experts. It may help to manage the current shortages of consultants in areas such as cardiology and dermatology.
At the moment telemedicine is at a crossroads, and whether it ultimately becomes incorporated into mainstream healthcare depends largely on funding. For the past five years pilot projects have been funded by small grants. And as Benedict Stanberry, managing director of Avienda, a company specialising in telemedicine, explains: “When the money runs out the services have stopped.”
Many of those working in telemedicine are becoming despondent about the lack of progress, says Tachakra, The immediate priority of the Department of Health — laid down in the NHS Plan — is to deliver integrated care record services (where patient records are available electronically), make national broadband networks widely available in healthcare, introduce e-bookings (so that GPs can make hospital appointments online) and equip ambulances with video and monitoring equipment so that people get appropriate care while being taken to hospital.
With such major reorganisation under way, telemedicine is a low priority. But, says Tachakra, when in place “this technology could provide an infrastructure that would facilitate the introduction of telemedicine”. However, he is concerned that without a major funding initiative by the Department of Health it will be impossible for projects such as e-San’s asthma initiative to reach their full potential.
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