So it’s official – no one knows if the first major study published into the results of the UK’s Whole System Demonstrator (WSD) telehealth trial proves if it was a success or not. Or, more accurately, no observers can agree on their own interpretations of the findings from the Nuffield Trust study.

First there is the “anti” camp which is sceptical about the benefits of remote monitoring. They accept the Nuffield Trust’s finding that telehealth seems to keep patients out of hospital (a smaller proportion of telehealth patients in the trial with COPD, diabetes and heart failure were admitted to hospital than from a non-telehealth control group). However they have some quibbles about how the trials were conducted, for instance around the use of placebos and randomisation.

While accepting remote monitoring benefits patients critics raise an important question. What exactly is patient motivation? Did patients benefit from the increased clinical input to their care, to their increased understanding of their condition or to the presence of the technology?

This can be added to an argument in the Nuffield Trust study itself which suggests that remote monitoring alters patients’ perception of when they need to seek help (and doctors or nurses’ perception of when they need to intervene). This might account for lower hospital admissions, it says. How to get a firmer idea of patient (and doctor) motivation is the unanswered question.

Critics also advise caution of the UK’s NHS in making a major investment in remote monitoring. As they point out, the organisation has a poor record of procuring new technology and there is a risk that the same could happen here.

Finally, they question how any cost savings from telehealth can actually be realised (the Nuffield study describes possible cost savings as “modest”). If remote monitoring reduces the need for admissions then that implies a need for less hospital beds. So realistically will telehealth lead to the closure of some hospital wards? It's hard to believe the two will be linked.

Next is the “pro” camp which unsurprisingly points to the benefits for patient health from remote monitoring but also tries to address the Nuffield Trust point about modest cost savings. Dr Julian Neal (also in an article on the Pulse website) says his own experience is that cost savings “can only be generated by having nurse-led triage at the heart of the service”.  

He also argues that cost savings from economies of scale were lost in the WSD trial because of a lack of service redesign. In a better designed system he says one specialist nurse could keep an eye on hundreds of patients simultaneously.  And again greater savings could be achieved with careful patient selection, he says. Plus the Department of Health should encourage the use of lower cost solutions that use smartphone and apps, he says.

A similar point is made by Mobile Health Live’s own blogger Chris Crockford who describes the technology used in the trial as “too old”. He also says the level of NHS bureaucracy behind the trial meant the numbers involved were too small and it lacked “the right levels of ambition."

“The key change that needs to happen is changing the structure of healthcare to support the technology, not just bolt the technology on,” says Crockford.

Finally, after the anti and pro camps comes the downright cynical (or accurate perhaps?). A comment piece in The Guardian says the Nuffield Trust’s conclusion of modest savings will not persuade the NHS to opt for a widespread rollout of telehealth. “Money is what matters to the NHS. It has to save £2 billion. If telehealth does not save money, it is a no-no, not only with the Department of Health but also with the commissioning groups,” it says.

Mind you, as the same report also says, this particular study only covers 3,000 patients (out of a total of 6,000 in total in the WSD trial) and only looks at telehealth for chronic diseases. This is only the first of five studies by UK academic institutions that will look at various aspects of the WSD trials. The next study to be published might be from the London School of Economics. The story could change as different perspectives emerge with later studies, which for instance will look at social care as well as chronic conditions.

Where everyone does agree is that this study, and the others that follow, are important. The scale of the trials give experts in the UK and globally a meaningfully large number of participants to properly judge whether remote monitoring of patients can be realistically deployed on a widespread basis. Bring on more confusion.

Richard Handford

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.