A Strategic Approach to Telehealth


Last month we saw how a range of new technologies, often familiar consumer tools like Skype, are driving interest in telehealth. However, said Andy Dunbar of Microsoft specialist healthcare Partner, Risual, the live deployments were mainly fragmented; developed piecemeal, and often by interested clinicians or ICT decision makers without well-developed adoption & deployment strategies to truly exploit the technology.

To grow from the interest of early adopters to mainstream and accepted technology, the concept of telehealth must develop to show not just incidental or aspirational benefit, but value which is scalable, secure, manageable and ultimately delivering an equal or better ‘service’ to the patient. Unfortunately, whilst there are many success stories bubbling up from end users on consumer-grade devices, the end user is exactly the wrong place to start for strategic IT deployment.

Says Dunbar, “Senior executives love telehealth, mobility and flexible working – it has the power to change healthcare delivery in all sorts of ways. But the problem is, public sector technology can be five to ten years behind the curve. In some cases, it can still take a clinician  circa 20 minutes to log into a machine which has been one of the intrinsic blockers to deploying or even trying the telehealth technology to date. So, a pair of clinicians will try out videoconferencing on their own phones, without the IT team’s knowledge. They will be highly successful and word will soon spread around the Trust.

“IT stakeholders, meanwhile, worry about networks becoming insecure, and clogged up with users’ personal devices. That’s not a ‘Telehealth agenda’, that’s ‘Shadow IT’ - people ‘doing it anyway, despite the technology’. IT teams need to control, manage, embrace and support telehealth, but the basic infrastructure needs to be right first.”

Furthermore, many NHS trusts have dipped their toe in the water and completed a Proof of Concept - but that’s where it stops. This is symptomatic of another strategic blind alley: leading telehealth from an exclusively IT perspective. “Telehealth should be driven from not just IT strategy (to drive down costs,  increase efficiencies,  reduce travel etc.) but should be initially borne from the Patient engagement or workforce enablement strategy.”

Developing a strategic approach to infrastructure, and ultimately an  end-user computing experience which supports telehealth and flexible working is not as hard as it might look. The aspiration from end user clinicians is clearly there. The patient impetus is also obvious: the ability to engage with clinicians from the comfort of the sofa on a range of devices and media increases engagement and supports the choice agenda. The investment argument is also very strong as many of the security requirements for mobile and flexible working will be fulfilled with basic current infrastructure (Windows 7 or 8 on all desktop PCs and devices, for example) and much of this technology, trusts have access to already (through EWA), although not fully deployed. Equally, each investment delivers continued benefits – integrating Lync, for example, drives not just telehealth but also ongoing patient support, archival of interactions and service interoperability. It also connects seamlessly with CRM/PRM solutions and SharePoint for compliance and knowledge management.

So what needs to happen to unlock these benefits? Dunbar proposes two key changes. “Firstly, Foundation trusts, CSUs & CCGs must not be organisations which ‘just’ fix things. They need to be visionary organisations which commission IT around the services they plan to provide.” In this sense, the technologies used fall out of the equation. It might be mobile, it might be cloud, or a desktop deployment; what matters is that NHS organisations move from a break-fix mentality where the best possible outcome is maintaining the status quo, to a proactive mentality whereby new deliverables like flexible working become achievable. “The public sector, including the NHS, has always been resistant to change. When new technologies come along, even if deployment isn’t instant, best practice IT should be a constant and fluid engagement, rather than a series of five-year upgrade projects which never ‘catch up’” – these new organisations must embrace a strategy ‘to change’ as opposed to a strategy ‘not to change’.

Secondly, Dunbar says that the current slew of tech developments: telehealth, mobile, flexible working and BYOD all require a similarly proactive approach to governance. “Remember; the use case today is that people are working on their own devices”. Either compliance and governance specialists can create a workable governance layer, or medical professionals and their patients will continue to find ways to bypass the network. Dunbar continues, “Flexible working needs a quality of service regime and excellent security, and then there are other considerations like degradation [the fact that with time and usage, devices become less pristine and secure, and users install their own software]. Trusts need clear and workable governance policies from day one, to which users can easily and controllably adhere.”

The new regime of CSU’s / CCGs needs time to bed down, but there is an opportunity for local commissioning and technology expertise to support the groundswell of interest in telehealth and mobile. Few tools have ever received as much early interest or enthusiasm from the clinical level; and, with the right strategic overview, the required enterprise-grade security and deployment tools are now available for IT managers to meet that need.

by Nick Saalfeld
Wells Park - on behalf of the Microsoft UK in Health Team

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