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How telemedicine can turn consultants into teleworkers

September 14, 2011 | Hogan Keyser
Patients can benefit from faster access to drugs and greatly reduced travel times when specialists can work remotely

Steve Gold - Tuesday 13 September 2011 09:00 BST (via The Guardian)
- The introduction of high speed broadband across the UK in recent years means that 80% of the adult population now has easy access to the internet either at home or at work. But so far, this has made surprisingly little difference to the way in which healthcare services are provided by clinicians and nursing staff.

Despite a lot of talk at healthcare conferences, the reality is that you need to look hard to find examples of where telemedicine - as internet-enabled healthcare is known as within the NHS - is starting to make a difference.

According to an NHS Confederation report published last January, the government must support the uptake of telemedicine in the health service. Although face-to-face contact remains important - especially for older patients - telemedicine will form the backbone for how we access many healthcare services in the future.

According to the report, Remote control: the patient-practitioner relationship in a digital age, the NHS has some catching up to with the rest of the world when it comes to telemedicine as, for too long, the development of digital health has been stifled by assumptions about what patients want.

The problem, says the report, is that the potential for telemedicine is being ignored in favor of face-to-face services, even where the patient actively seeks a remote consultation.

For those patients living near hospitals, general telemedicine is clearly not required. But when it comes to speciality services - which are often provided to a regional by a single unit - telemedicine comes into its own.

Bristol's Royal Hospital for Children, part of University Hospitals Bristol foundation trust, is a clear example of this. A new telemedicine system last month started offering remote fetal and pediatric consultations to Royal Cornwall Hospital in Truro and the Royal Devon and Exeter Hospital, where previously many patients faced up to a six hour round trip to Bristol.

According to Dr Andy Tometzki, Bristol Royal's lead consultant in pediatric and fetal cardiology, the use of the Radvision-supplied telecardiology system offers high definition images at both ends of the broadband link. "The real-time interaction is an intuitive, natural and easy-to-use experience for both patients and doctors alike, making it easy for me to accurately assess the condition of our patients," he says.

Dr Tometzki adds that he routinely uses the telemedicine consultations after a routine obstetric scan, where a possible heart abnormality has been identified. Rapid remote assessment, he explained, helps reduce the intense anxiety of the family who would otherwise have a stressful and long journey to and from Bristol. The trust has linked the three hospitals together with Radvision's Scopia XT1000 series videoconferencing system, routed over the NHS's secure national N3 network.

Homework for consultants

Pediatric cardiology is not the only area where telemedicine is taking off, as strategic health authority NHS East of England and the East of England Stroke Networks have been rolling out remote stroke consultation, as well as remote ECG and allied cardiac tests, to many trusts across the UK over the last two years.

What started as stroke thrombolysis (clot busting) pilot involving four units in Southend, Peterborough, Watford and Addenbrooke's in Cambridge back in 2009 has now expanded across the East of England region, where cardiologists claim that it saves more than 100 lives a year.

Today, more than 30 acute trusts are tapping the technology to allow consultants - from their homes on an out-of-hours basis - to talk to patients using video and audio links, as well as view their scans using a laptop. This allows them to make care decisions on rapid drug treatment that can then be provided in the patient's local accident and emergency department or stroke unit.

According to NHS East of England, the most recent trust to start using the telestroke system is NHS Lancashire and Cumbria, where 10% of 4,000 stroke patients in the region can now benefit from thrombolysis treatment. The service is said to transform the diagnosis process for patients showing signs of an acute stroke, as well as saving the trusts in the region around £8m a year.

The service is accessible by 15 specialist clinicians working from home, and who are using video conferencing to assess out-of-hours patients. According to Virgin Media Business, which supplies the communications network, the facility will give patients much faster access to out-of-hours care across the geographically diverse area.

Using a live video and audio conference system between their home and hospital units, clinicians can see and speak to the patient, as well as access an image exchange portal, where they can view the patient's CT scan and medical records.

The system, which uses about 4 megabits per second of bandwidth, has been live since the middle of July, allowing medical staff to provide remote consultations to as many as three or four patients in an out-of-hours session from a laptop and allied console in the clinician's home. Links to N3 are provided by BT or Virgin Media.

Within accident and emergency, a portable video conferencing telecart is placed by patient's bedside. According to Dr Paul Davies, consultant stroke physician with North Cumbria university hospitals trust - and lead stroke clinician for the new telestroke network - this will save lives as well as improve the quality of care for other patients.

The trust says that 24 more patients in the region will survive a stroke each year than without the new service, whilst a further 40 patients are expected to recover with no symptoms or significant disabilities, while 30 fewer patients per year will require full time care.

The net savings from the remote telestroke service will save the NHS an estimated £6.6m a year in social care costs and provide standardised care across eight units in Lancashire and Cumbria: Cumberland Infirmary, Carlisle; West Cumberland Hospital, Whitehaven; Furness General Hospital, Barrow; Royal Lancaster Infirmary; Blackpool Victoria Hospital; Royal Preston Hospital; Royal Blackburn Hospital and Southport General Hospital.

According to Davies, for some patients who have a stroke thrombolysis treatment can be very effective and lead to reduced levels of disability. But it can only be given to patients within 4.5 hours of the onset of their stroke, meaning that speed is crucial.

"Telestroke will help improve the speed of patient diagnosis. We are using technology to take the stroke specialists to the patient, rather than moving the patient long distances around rural areas to where the specialists work. In an acute stroke, time is of the essence and the sooner treatment can be provided, the better," he says.

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