Limitations of new medical technologies
18. While many benefits may accrue from the use of
new technologies we were informed that 'formal studies' have indicated
that they are "by no means a panacea."[25]
In some circumstances telemedicine can be more expensive that
conventional alternatives. Moreover the Department pointed out
that if telemedicine is to succeed a number of important 'process
issues' have to be addressed.[26]
Studies have indicated that unless telemedicine is quick, easy
to use, efficient and reliable, and crucially does not increase
GPs' workloads, it would be unlikely to find widespread acceptance.[27]
19. Mr Wilkinson, of ABHI, informed us that problems
with new technologies can occur when they are installed outside
of a clinical setting, for example, in people's homes. He said:
"If you transfer the focus of care from a highly controlled
environment into a less controlled environment…then you need
to build quality systems to manage that, particularly if patients
are involved…" He added that in this situation patients
"need to be full stakeholders."[28]
Mr Wilkinson recommended that engaging with patients and patient
groups was crucial to the success of effective use of new technologies.
When questioned further on this subject he said: "I think
often technologies are looked at as very technical solutions by
technical people to specific problems and I think further engagement
with patients and understanding the real impacts of these technologies
on their lives can only be good."[29]
20. We are concerned that the installation of telecare
monitoring systems in people's homes could deny patients vital
human and social contact. Professor Ian Philp, National Director
for Older People's Services, Department of Health, when we questioned
him about the possible decrease in human contact, replied: "From
an older person's point of view, the human factor is the most
important." He continued: "We can use telecare at a
low level or a very high level but it does depend on the level
of dependency and the need of the individual, and not to intrude
beyond what would be acceptable for them enjoying an independent
quality of life and a degree of autonomy."[30]
21. We recommend that when telecare systems are
installed in the domiciliary environment, clinicians, technicians,
health and social care workers, formal and informal carers and,
most importantly, the patient are involved in determining the
level of telecare that is suitable and acceptable to each individual
recipient. It is essential that a balance between the use of technology
and the continuation of human contact is an important element
in any such judgement.
22. Furthermore, evaluation needs to take account
of the qualitative benefits for users and carers over time. There
is a need to develop new ways of evaluating the qualitative benefits
of new medical technologies in the long-term budgetary cycles.
Methodologies are needed that can determine the social and economic
benefits of new medical devices that fall outside the direct costs
to the NHS.
23. We recommend that the Department should seek
to introduce a national system for reviewing and tracking the
implementation of new devices over a number of years to ensure
patient safety and efficacy issues are closely monitored. Currently
there is no clear system for determining safety and efficacy beyond
the clinical trials and evidence-based model of the Health Technology
Assessment (HTA) programme while, there is also a need for developing
more sophisticated measures of the utility of systems for patients
that reflect more relevant criteria. Much greater patient participation
in assessing the utility of telehealthcare is required.
24. A balance also has to be established between
national standardisation, that could possibly remove competition
between innovators, and a situation where different and incompatible
types of the same equipment are installed in individual hospitals,
or even wards, due to non-standardisation. Professor Sir Christopher
O'Donnell, Co-Chairman of the Healthcare Industries Task Force,
told us that they were "looking for a clear case for the
benefits [of standardisation] and obviously the costs of any particular
device, but … it is best practice to have one or at most
two [types] per facility - hospital or whatever - and then make
decisions after whatever time to replace the whole lot…[otherwise]
you end up with a creeping mix of equipment."[31]
25. The Department should ensure that Primary
Care Trusts (PCT) and hospital trusts (and if possible SHAs) should
commission new technologies according to nationally approved standards
(determined by the new Device Evaluation Service [DES] in conjunction
with HTA/National Institute of Clinical Excellence [NICE]). Such
standards should provide the basis for the selection of base-line
devices and technologies. It is important that the tendency towards
technology 'creep' and uneven mix of systems that lack interoperability
or require different competences to be used should be avoided.
Standardisation on clinical based systems should be undertaken
in light of discussion with Social Services, who have a greater
responsibility for telecare.
26. While the application of telecare and ICT can
have many advantages for patients and carers, the privacy of the
individual must also be considered. The Department highlighted
the fact that confidentiality and privacy are recurrent issues
in the introduction of new technology. In its submission the Department
noted that technology can facilitate home telecare and home telemonitoring
and alert care teams to a health problem, but this has to be balanced
against patients' rights to privacy.[32]
We were impressed by the approach at QVH which has implemented
a successful protocol to ensure privacy and confidentially in
relation to the photographing and video recording of patients.
27. We recommend that, when new medical technologies
are introduced, protection of confidentiality and the privacy
of the individual are key factors in the decision-making process.
Privacy and confidentiality policies and protocols should be developed,
implemented and audited when new technologies are introduced.
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