Telecare

Telecare — healthcare technology of the future?

February 2006

Traditionally, NHS patients have travelled to hospitals for tests and consultations with clinical specialists. With the UK population set both to grow and age, however — and with the consequent greater demands for new healthcare procedures and treatments — this may no longer be possible. Long-established patterns of healthcare such as these may have to transform if the NHS is to meet Government and patient expectations within its budget.

The reality, of course, is that healthcare has been changing for some time in order to reduce costs and increase efficiency. The need to liberate funds for reinvestment and to change spending priorities has been substantial. Specialist clinical resources are being relocated into regional or national centres, and an increasing number of hospitals no longer have specialists in every discipline. Patients are being monitored at health centres or in the community, rather than in hospital, especially when suffering from chronic conditions.

The natural consequence of this has been some reduction in contact between the patient and the clinician. However, many believe that the innovative use of IT and network technologies can help redress this situation, and there have been many attempts to introduce telemedical and telecare services in recent years. Unfortunately, many of these services have not been successful, often because of the lack of suitable network technologies. It is instructive to look at recent major advances in this area and see the huge potential for networking to drive advances in telecare.

Networking technology

Telecare services depend critically on the availability of standards, and on ready access to the right local (LAN) and wide-area network (WAN) services (see Jargon buster). In the past these have not always been available, hampering service development, but advances have recently occurred in three areas interconnection and inter-working standards, high speed, video-capable links between NHS sites, and high-performance network links into the home.

Interconnection and interworking standards

Standards are critical for the development and effective delivery of all aspects of IT. Telecare requires standards for physical connection to medical devices and system end points, and for logical communication between end points. Physical connection to systems and end points is now, in practice, by Ethernet local area network (LAN), or by IEEE 802.11 wireless connection (WiFi). Both of these can be provided easily and cost-effectively in the hospital, clinic or at home, and many hospitals have already implemented overlay wireless LANs (WLANs) for telecare and other mobility projects. Logical communication between end points uses Internet Protocol (IP) the communications protocol that drives the Internet and most networked IT applications. The information modes used in telecare data, voice and video are all now fully standardised to operate IP.

High-speed, video-capable links between NHS sites

Many attempts to introduce telecare services in the past were based on the use of NHSnet the old NHS national network for communication between NHS sites. This was not always successful, as NHSnet did not provide sufficient bandwidth or adequate quality of service both being prerequisites for voice and video traffic. Projects either had to change the scope of their services, or were forced to install special-purpose network links, the cost of which often eroded business benefits.

The Government has recognised the importance of enabling network infrastructure for all aspects of healthcare delivery. The NHS National Programme for IT (NPfIT) will deliver N3, the new national network, to provide robust, secure and standardised network connectivity to all NHS clinical locations. N3 has the ability to support multimedia traffic for telecare, and positions trusts very favourably for the development of site-to-site telecare services.

Network links into the home

In the past it was only possible to link into patients homes via standard telephone connections. These connections were slow and inflexible, and furthermore affected patients use of their telephones. The Governments Broadband Britain initiative, however, has accelerated the availability of high-speed digital subscriber-line (DSL) connections across the country. While DSL also uses existing telephone connections, it does not affect normal telephone use and can be provided in a matter of days without any changes to home wiring. DSL has the additional benefit of ever-decreasing cost points.
Within the home, medical monitoring devices can connect to a DSL service via very simple plug and play methods a simple Ethernet cable, or a WiFi connection for greater flexibility. In the future, DSL may not be required at all, at least in urban areas, as medical devices in patients homes will be able to connect directly to WiFi broadband services.

Business need and technology driving innovation

We have mentioned the business need for more efficiencies in the use of clinical resources. The very substantial developments in network technologies and the availability of enabling network services through N3 make this now possible.

This combination represents a clear platform for innovation. If fully exploited in the future, it could lead to the next major step in the transformation of healthcare services after the current deployment of the National Programmes IT applications suite. Indeed, it is possible that telecare services such as teleconsultation, telediagnosis and telemonitoring could be incorporated into the National Programme in the future.

Linking the patient and clinician

Teleconsultation services provide direct video links between patients and clinicians. This benefits patients by increasing access to specialists and reducing the need for travel. Teleconsultation over ISDN circuits is already in use in the NHS, for example for out-of-hours consultations between community and acute hospitals, although video quality can be poor. These services are likely to become commonplace with N3, which has been designed to support high-quality video connections. Video telephony is now available in a form fully integrated with voice telephony, so there is no need to provide special-purpose networks for patients to consult clinicians. Looking to the future, 3G wireless telecommunications devices will support a suitable quality of video, and it will be possible to extend consultation directly into patients homes.

Centralising diagnostic services

Telediagnosis services permit a patients scan or image to be sent to a remote specialist for diagnosis and report. The benefit to the NHS of this approach is the more effective use of skilled and centralised clinical resources. The benefit to the patient will be faster reporting following scans and tests.

Scan images may be sent over IP via file transfer or attached to emails, but image files can be very large and require significant bandwidth. Images of external, eg dermatological, conditions, can be handled photographically or over video links. N3 provides high bandwidth and is video-capable, offering an excellent vehicle for the development of these telediagnosis services.

Remote monitoring in hospital, clinic and in the home

Telemonitoring, often referred to as telemedicine in the past, permits medical devices attached to patients to be accessed and controlled from a central monitoring station. The network links connecting device and monitoring station may take a variety of forms wired or wireless LAN links within hospitals, links over N3 between clinical locations, and GPRS mobile-phone-network or DSL links from patients homes and in the community.

Telemonitoring can be found in many guises within the NHS. In its simplest form it can provide a link between a bedside medical device and a nurses station. Nowadays medical devices are becoming WiFi capable, permitting active monitoring as a patient is moved from ward to ward, or from ward to theatre. In the future, telemonitoring will be increasingly available in the community and in patients homes. This will be particularly important for successfully managing chronic conditions without taking up valuable hospital bed space.

In conclusion

The NHS is witnessing the fortunate co-incidence of business need to deliver healthcare services more cost effectively, and the tools to do so new network technology standards and highly capable, but low-cost, network products.

This offers an excellent opportunity for NHS trusts to exploit networking for telecare to benefit patients and clinicians, particularly as the National Programme is providing the enabling N3 infrastructure.
There are already many examples of telecare in operation, particularly teleconsultation and telediagnosis, and every trust should have the development of business plans high on its priority list.

Chris Blenkhorn is a Consulting Systems Engineer with Cisco Systems Ltd and a member of Ciscos UK public sector team, where he specialises in healthcare networking.