Is Telemedicine What The Doctor Ordered?

I am a genuine believer in the revolutionary power of ICT to reduce inefficiencies within society, but just occasionally I come across an example of when this ‘digitalisation’ trend goes a step too far.

A report released on 20 January by the NHS Confederation – which represents about 95 percent of trusts and other NHS bodies – enthusiastically embraces telemedicine and IT programmes, claiming that “active and passive resistance” from clinicians is holding back technological innovation in the healthcare sector.

“For too long the development of digital health tools has been stifled by assumptions about what patients want,” the report states (pdf). “There are doubtless many patients for whom remote services have little appeal or value. However, the current approach is an indiscriminate one – predominantly offering only a face-to-face service regardless of what patients themselves prefer.”

I am no more a fan of visiting the doctor than the next person, but this report makes my blood boil. Since when has public healthcare been about what patients prefer? Surely it should be about what they need.

How important is face-to-face?

The report acknowledges that the resistance to digital healthcare is nothing to do with clinicians being “technophobic” – advanced technologies are increasingly being used by doctors to support diagnosis and treatment. Instead, it comes from a reluctance to undermine the value of face-to-face consultations.

Quite frankly, I think we should be listening to the doctors rather than trying to “bypass mainstream clinical practice”, as the report suggests. If the doctors say that an accurate diagnosis depends on a thorough physical examination of the patient, then we owe it to ourselves as patients to make that effort to visit our GP.

The report warns that “failing to develop ways to reach out electronically risks disastrous consequences for the long term health of a large section of society.” This sounds to me like scaremongering. Anyone who has a disease that is threatening enough to entail “disastrous consequences” should be seeking immediate examinations and treatment from their doctor, not fannying around on their computer.

Taking a more active role

The report also states that “The digital communications that have become commonplace in society tend to encourage users to take a more active, self-managing role in the services they receive”. While in many ways this is a positive development, self-management is not always the best course to take when it comes to healthcare.

Conducting an examination “virtually” could potentially prevent doctors from picking up on more subtle symptoms – either because the patient chooses to conceal them out of embarrassment or because the they don’t regard them as relevant. Patients may also abuse the system, either by to scouting for physicians who more readily issue prescriptions or by simply overusing it.

Furthermore, there is a whole host of risks associated with self-diagnosis – which is encouraged by websites such as NHS Direct making lists of symptoms for various illnesses available online. This could lead to failure to diagnose a serious illness, or even over-diagnosis of serious diseases, due to lack of medical expertise.

Telemedicine also poses a number of privacy and security issues for patients. For example, transferring personal health information electronically raises the possibility of private medical data being lost or stolen. In 2010, the Information Commissioners’ Office revealed that the NHS had been responsible for almost a third of all recorded data breaches in the United Kingdom over the previous three years.

IT can’t solve everything

I realise I am being rather dogmatic here. There are of course many benefits to managing healthcare remotely through modern communication technologies, such as online appointment booking, personalised medicines management programmes, electronic medical record management – and indeed online consultations for people who live at some distance from their local GP’s surgery.

My beef is with the attitude of the NHS Confederation, assuming  that the problems of the NHS can be solved by simply putting things on a computer, regardless of the advice of practitioners.

I suspect a major driver behind this strategy is the need for cost-savings, as the NHS faces the prospect of drastic government budget cuts. However, the industry needs to plan this carefully, after suffering repeated embarrassments in the past due to costly failed IT projects. An internal review last year revealed that NHS websites were costing £86 million per year, and were not meeting the public’s needs.

With increasing importance being placed on the preferences of patients, we need to take a step back and ask ourselves what we really want from the NHS, rather than letting others tell us what we want. Maybe virtual health services are the future, but for now I will continue to brave the long walk down to the the GP’s surgery, because telecare is not yet a viable substitute.