E-health and communications technology have progressed to an advanced stage while their costs have been decreasing, but does e-health represent a useful investment opportunity for NHS trusts, ask Esther de Weger and colleagues.

E-health is the umbrella term for telehealth, telecare and clinical internet and mobile phone applications. It refers to the use of electronic media to support the provision of clinical and non-clinical health services.

Already, telehealth devices can be used in the treatment of conditions such as COPD and diabetes. Patients can monitor their condition from their own home. The telehealth device records, for example, the oxygen and glucose levels in the patient’s blood while at the same time transmitting the data to health care professionals who can then advice the patients from their own base.

Telecare can be used to care remotely for older and physically less able patients with devices alerting the health professionals when a patient has fallen or forgets to turn off the gas or water tap.

In mental health services, internet applications can be used to deliver treatment for depression and eating disorders, and high quality video conferencing equipment can be used to conduct assessments.

Integrating e-health services within the mainstream of NHS organisations may present an opportunity to deliver the same (or even better) quality of care for less money. Studies over the past two decades have all pointed to the fact that e-health can be cost-effective and efficient way to deliver care, though it has been difficult to pinpoint exactly how much money has been saved by delivering care through e-health methods rather than “traditional” face-to-face methods.

E-health has been shown to enable staff to “see” more patients and to see them more frequently as it reduces the need for both staff and service-users to travel. Furthermore, organisations like Oxleas Foundation Trust who have embraced e-health and communications technology, are finding out that meetings via video conferencing are shorter and more efficient, saving even more staff time and thus resources.

Such savings are relatively easy to calculate, but there has been evidence of e-health contributing to savings in areas more difficult to determine.

Evidence from the first large-scale study in regards to e-health, the Whole Systems Demonstrator, is pointing to the fact that it can reduce hospital admissions and re-admissions; while Oxleas Foundation Trust have found that video conferencing has helped to streamline referral systems and enhanced collaborative working (between community teams and ward staff).

In terms of quality of care, studies have shown that the majority of patients are happy with their e-health services, invariably stating that they feel empowered by it as it enables them to be more involved in their own treatment.

Introducing e-health and remote communications technology does require a significant upfront investment. Some organisations which currently have enough cash, but worry about what their cash situation will look like, for instance two years down the line, may seriously want to consider this as an invest-to-save opportunity. Organisations placing bulk orders on such devices will usually receive a more palatable “pricing strategy”. For other services struggling with their shrinking budgets, there are still other options available.

An especially interesting option may be to form a commercial partnership with an e-health or remote communications company. Commercial partnerships may range from the most profitable - for both the health service and the health company - where the two work together to develop a completely new e-health device to one where a sort of direct debit scheme per patient is taken up - such a scheme tends to be most successful when local councils are involved.

When introducing e-health it is important to have a clear understanding of the local service context as different e-health approaches are likely to be appropriate for different contexts. In this way, the e-health solution can be tailored to maximise efficiency and quality of care.

It is also vital to have active clinical and managerial staff involvement in the planning and implementation of e-health technologies. Otherwise the risk is that the technology is installed but is used infrequently and could be met with significant staff resistance.

Oxleas Foundation Trust has found that engagement is being significantly improved by:

  • Consultations with staff an service-users prior to the implementation of the technology
  • Practical training on the use of the technology to build confidence and alleviate anxieties
  • Support from an e-health trainer and a team-based e-health champion when the technology is first used in practice
  • A transparent feedback process that allows staff and service-users to inform changes to the implementation
  • Direct experiences of the technology being effective and efficient

Investing resources in the development of new services may be challenging in the current economic climate, however, e-health technologies can present a chance to increase resource efficiency while at the same time maintaining excellent quality of care.

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