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2011: Is Telehealth cost effective?

 

2011: Is Telehealth cost effective?

Amidst a melee of Telehealth initiatives, how do you choose clinically appropriate and cost effective solutions when "one size does not fit all”?

An article published in the BMJ (British Medical Journal) Clinical Review on 12th February 2011 “Telehealthcare for Long Term Conditions” raised some interesting points about the cost effectiveness of Telehealth in general.    The BMJ article covered a broad range of Telehealth services and equipment from basic Telephone follow-ups through to video consultations and automatic bio-metric monitoring. 

Whilst reporting that most patients saw telehealth as a positive development, the article suggested that industry and policy makers often assumed that Telehealth would be effective.   Evaluations and studies in patient satisfaction and cost effectiveness often lacked depth and so we need to be cautious when we Telehealth Professionals make such claims.

Projects I’ve been involved in have required the study of many evaluations, case studies and industry claims and I have to agree with the BMJ’s conclusions.  Before you implement a telehealth solution you need to be quite clear of the objective, why is it being used?  To raise quality, increase productivity, reduce costs or a combination?  Which group of patients is the system targeted at, a small group of high cost LTC patients or a wider and potentially healthier group.  Then you need to consider where the costs are going to fall and what about the additional staff and workflow costs ?   How are these going to be accounted for ?  Who will benefit, the patient, GP’s, primary care, hospitals, social care ?

Everyone supplying telehealth services and equipment has case studies and “evidence” of just how cost effective their particular solution is.  However, these claims need to be looked at in detail and their sources should be checked.   Many of the circulating case studies and reports about telehealth pilots only cover specific (favourable)  points.   For example, last year there were a number of reports published by respected organisations that failed to take into account cost effectiveness.  How could this be I hear you shouting?  

The simplest and most typical mistake is (cost of equipment v claimed avoided admissions = saving)  the issue with this is that it does not take into account the additional operational and clinical costs of using the solution, nor does it factor in variables around the claimed avoided admissions. 

Factors may include the point that the telehealth system may not have actually contributed much at all to those avoided admissions.   Just maybe when the patient started to exacerbate they would have picked up the phone for help as they had been instructed to by their clinical team?   Maybe the work a clinical team does with those patients, contributes to the avoided admission?   So you see, you can only claim a percentage contribution to an avoided admission.  Then there are the additional costs hidden away in some case studies and reports.  For example, I am aware of a number of projects where the initial equipment cost is between £1,500 and £2,000 per unit, however the real cost of running those units for two years is closer to £5,000 per patient.

The acid test comes with this question:  Would I get a better return on investment if I invest £x in telehealth or more clinical staff ?    Maybe the Department of Health Whole Systems Demonstrator  programme, due to report soon will give us an answer.

In the mean time, to those of us close the cutting edge of telehealth it is obvious that given the right solution, targeted at the right patient, for the right reasons, telehealth can deliver considerable quality benefits for patients.

However, as the BMJ suggests,  it may be only be a handful of low cost telehealth classes (such as telephone follow-up to improve attendance or text messaging reminders for monitoring) when used in certain contexts that are likely to both improve outcomes and reduce costs.