Expected revolution in medicine, telemedicine, has simply not happened

Despite high expectations, telemedicine and telehealthcare systems, which enable doctors to interact with patients many miles away via video, digital imaging and electronic data transmission, have had only limited impact on the National Health Service, according to a study sponsored by the ESRC.

The expected revolution in medicine, overcoming problems of access to specialist care and speeding up referrals and diagnosis, has simply not happened, say researchers led by Professor Carl May, of the University of Newcastle upon Tyne.

"Telemedicine" is disappearing, in stark contrast to the apparent success of telephone services on which clinical staff decide the urgency of patients' injuries or illnesses, and advice lines such as NHS Direct.

Resistance from professionals is often blamed, but the real reason is often a failure to think through the organisational problems involved in integrating new technology into everyday NHS activity.

Telemedicine lets doctors deal remotely with patients over a live video-conferencing link where a face-to-face consultation may be difficult or time-wasting, such as when patients live in isolated rural areas. And it makes it easier to share pictures and data with experts in different parts of the UK or, potentially, other countries.

But while "telemedicine" is on the wane, new portable "telecare" systems for monitoring people with illnesses such as diabetes, asthma, and respiratory and cardiovascular disorders, are under development.

These new systems connect patients with the NHS using mobile or fixed phones to send data about health problems, enabling early intervention when needed, and potentially reducing hospital admissions. But they face similar problems of integration in a health service which is not a single organisation, but rather a federation of more than 700 NHS trusts, each with its own procurement and management structure.

Professor May said: "We were struck by the strong claims made about the promise of telemedicine. But we found that despite significant support in policy documents and very active champions of the cause in the clinical world, these systems have largely failed to become integrated in routine healthcare delivery."

The study shows that patients and other users are rarely consulted in any meaningful way about development and implementation, and it is often assumed that the needs of NHS service providers and of patients are the same.

Professor May said: "Instead of involvement, we found abundant studies - often very poorly designed - of patient satisfaction. These show high levels of support for new systems, but often represent highly selected patient groups. They often focus on 'hotel' aspects of care rather than important questions concerning patients' confidence about the diagnosis and quality of life. Concerns about security and confidentiality are rarely addressed."

Some patient groups and clinicians say telecare actually distances people with chronic illness from the NHS. And there has been little investigation into how useful these systems really are to users.

Professor May said: "The economic benefits have been claimed by many proponents, but in the absence of real evidence are assumed rather than actually demonstrated.

"This is important, because a key policy issue in the UK is the growing number of older people with multiple chronic health problems and pressure on the health service. It could mean that telecare systems are used as a substitute for personal care, and along with this could come a shift in the burden of social costs to often disadvantaged people."