How’s this for a statistic? The UK’s NHS spends 70 percent of its budget on the 15 million people who are coping with one or more long-term conditions. A nd the country’s aging population means that figure will only grow in the future. It's also a typical piece of data for a western country. It explains why remote monitoring of patients has become such a major subject. The UK’s government recently announced its 3 Million Lives Programme. A new report by non-profit think tank 2020health.org has also keyed in on the same subject with a new report entitled “What can the NHS learn from experience at the US Veterans Health Administration?”.
Another question of course is Why the VHA? The answer is that the organisation runs the largest telehealth deployment in the world. It has been working on the technology for a decade, says the report, and in 2011 served 50,000 patients with telehealth services, a number that is predicted to grow. Another sign of the VHA’s innovation is its backing of a mobile strategy which that will involve distributing smartphones and tablets to patients, it has been reported. The organisation has also publicly said it wants its own app store. Sizewise the VHA is smaller than the NHS but not that small (the think tank reckons about a quarter of the size).
Dr Kenneth Kizer, the VHA’s under secretary for health during its transformation, is quoted as saying: “Telehealth has helped VHA to be both vertically and virtually integrated”. This refers to how the organisation defined its needs nationally but also how it has established care agreements with non-VHA health providers so that it can share access to patients' electronic health record, an approach needed to underpin home monitoring.
2020health.org provides eight pithy recommendations that the NHS should take away from studying the VHA. These include a goal “to achieve the staffing and logistical efficiencies seen in the VHA, the NHS needs to find ways to deliver a step-change increase in the scale of telehealth implementation”. Elsewhere the report notes there are over 100 telehealth pilots running within the NHS but many are small scale and not well integrated into healthcare systems.
A second recommendation is for those who manage the delivery of telehealth not needing to be local to the patient but having to interact closely with the responsible clinician in primary or community care. Another recommendation is that telehealth should be established as “a centralised core coordination service on local/regional basis” rather than adding to workloads of local caregivers. Telehealth services benefit from national design, for instance the UK’s National Institute of Health and Clinical Excellence, according to the report. It also says clinician engagement is “essential” based on evidence of the benefit to specific patient groups. Funding should be addressed through “sustainable reimbursement policies, in particular revisions to tariff”. Finally, targeted patient selection is considered another essential recommendation based on the criteria of who benefits. Likewise, says 2020health.org, national oversight is key “in terms of commissioning, procurement and best practice adoption”.
The emphasis on acting nationally is what comes across strongly from these recommendations. The same point is made again later in the report where it talks about how the VHA defined its telehealth model nationally and then employed a team of care coordinators in each locality who managed patients in their immediate area. Crucially vendor contracts were awarded nationally meaning a limted choice of equipment: Standardisation, or something close to it, carries a lot of benefits.
In the background of so much that the report likes about the VHA’s telehealth deployment is the value of scale, and the benefits that accrue from implementing health technology based on that principle. That’s a lesson that not just the NHS but many other organisations could learn when it comes to introducing mobile health services.
The editorial views expressed in this article are solely those of the author(s) and will not necessarily reflect the views of the GSMA, its Members or Associate Members.