mHealth in the NHS – Everywhere and Nowhere

If you follow the mHealth blogs and groups on LinkedIn you’ll see a constant debate about where mHealth is in out existing health services.  I’ve been looking at some of the applications which are already in use within the NHS.  As yet, there’s no central policy for mHealth, and it’s debatable whether much of the good practice using mHealth is even acknowledged, but that doesn’t mean it’s not providing benefit. 

Much of mHealth is invisible.  It’s not the high tech monitoring that we find in glossy medical device brochures, but far simpler, everyday applications.   Many of these use SMS, but mHealth extends through voice and video, and we’re already seeing local use of applications on iPhones and Android.  However, there is little coordination of deployment, and almost all that is happening is as a result of local initiatives. 

Let’s look at some of the examples. 

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The need for Patient Accessible Medical Records

I came across an excellent report on homecare and chronic disease management this week, produced by Pam Garside of the University of Cambridge for Healthcare at Home.  Entitled “Lessons from the US” it looks at homecare practice in the two countries.  Healthcare at Home are a commercial organisation with an interest in promoting home care (which you probably guessed from their name), but the report seems to be refreshingly clear independent.

It compares and contrasts the use of remote monitoring technology in the US and UK to support patients at home, both in terms of release from hospital and to manage long term chronic conditions.  Its main conclusion is that the UK is far better positioned to benefit from this than the US.  But there’s one proviso – that the UK needs to put in place a system that allows patient records to be shared between those involved in care, including the patients themselves.

The report acknowledges that this is currently lacking in the UK, but predicts that this will be remedied during the course of 2010 by the introduction on Summary Care Records (SCRs).

Pam’s obviously not spoken to the British GP’s Council.  This week their chairman – Laurence Buckmann, made a presentation to the Local Medical Committee’s Conference calling for SCRs to be scrapped, ostensibly because they require a patient to opt out, rather than opting in.  It’s part of an ongoing campaign against SCRs by the British Medical Association (BMA) that makes Luddites look progressive.  And which seriously threatens innovation within the NHS.

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Can mHealth save the NHS?

There’s an election looming in the UK, which is causing problems for the political parties.  Everyone knows that we need major public spending cuts, but no politician is going to risk votes by committing to anything too great.  So everyone is carefully skirting the issue, particularly where the NHS is concerned.  The British public have a love-hate relationship with the NHS.  They love to deride its inefficiencies and problems, but as soon as anyone attempts to take an axe to it, it transmutes into the most valuable aspect of being British. 

Of course, those of us involved with healthcare know that this is more than just an election issue.  The changing demographics mean that the NHS, and every other health system in the world is heading for financial meltdown.  Rather than acknowledge it, our politicians (even those who have been pushing through the U.S. Health reform bill) are doing little more than being fitted for their lemming suits and asking for directions to the edge of the cliff.  We cannot afford healthcare in its present form and we’re running out of time to address that inconvenient truth.

One straw that is invariable grasped and brandished is the potential of mHealth (or eHealth, telecare or eCare) to sweep away the costs.  So in the spirit of helping our flailing politicians, I thought it might be an opportune time to review how it’s doing.

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Virtual Hospitals – the NHS’ future

Professor Nick Bosanquet – a director of the centre-right think tank Reform ruffled a number of feathers at the end of last year when he stated that the NHS would do well to invest in virtual infrastructure.  The core of his argument is that patients should send their data to the hospital for diagnosis rather than turning up themselves to be measured.  We couldn’t agree more.

It’s surprising that it had the effect that it did.  For several years everyone within the health service has known that it is heading for bankruptcy, as is every other health service in the world.  We’re getting older – by 2010 over 40% of Europeans will be aged over 50, which means that the number of people in work paying taxes to support the growing bulk of the population (in all of its senses) is becoming an intractable problem. 

The solution is generally agreed to be more remote monitoring of patients to try and keep them out of hospital.  However much we bang that drum, the message is largely ignored.  What has engaged the attention of the media is the modest proposal that this means we may need to build fewer hospitals or that we’re building the wrong sort.

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