Select Committee on Health Written Evidence


APPENDIX 8

Memorandum by Medtronic Ltd. (MT 30)

1.  SUMMARY

  Medtronic welcomes the opportunity to submit evidence to the Health Select Committee, addressing the important issue of the utilisation of telemedicine, and its future potential for improving services within the NHS. Medtronic provides advanced, implantable medical devices for patients in the United Kingdom. Our most recent innovations in the area of telemedicine have the potential to significantly advance not only the quality of care for chronic disease patients, but also improve the efficiency of overall health care delivery within the NHS. The purpose of this submission is to provide the Committee with evidence of some of the benefits of telemedicine in chronic disease management, and to highlight some of the barriers to adoption.

  2.  We would like to offer the following evidence, appropriate to the Committee's terms of reference. The evidence reflects our experience in the use of telemedicine applications throughout the world.

  3.  The utilisation of telemedicine and its future potential for improving services.

  3.1  Telemedicine is broadly defined as the use of electronic information and communications technologies, to provide and support health care when distance separates the participants. [12]The applications of telemedicine are increasingly important in the context of chronic disease management. Medtronic is advancing such applications for the remote monitoring of patients with cardiac rhythm management devices (implantable pacemakers and defibrillators), diabetes patients using insulin pumps and in patient data reporting for its emergency response systems (external defibrillators and ambulance based monitors). Remote monitoring allows medical professionals to access clinical information from devices without the patient having to be present in the surgery or clinic. This submission will focus on evidence concerning the remote monitoring of implanted cardiac rhythm management devices.

  3.2  Cardiac arrhythmias, where the hearts beats abnormally slowly, quickly or in an irregular manner, are a chronic condition affecting millions of people in the UK, including the 110,000 who die from sudden cardiac death each year. Many of these patients can be effectively treated with implantable medical devices such as cardiac pacemakers for bradycardia (slow heart rates), implantable defibrillators for tachycardias (fast heart rates), and cardiac resynchronisation therapy for heart failure. It is estimated, that in the U.K. there are currently more than 200,000 patients with implantable cardiac rhythm management devices[13] and approximately 40,000 new implants are performed every year[14]. The U.K. is well behind other developed nations in its level of device therapy utilisation, a fact being addressed by the Cardiology community, and additional increases in the number of new implants are expected in order to meet the recommendations from various technology appraisals and clinical guidelines, either published or in preparation by the National Institute for Clinical Excellence (NICE)[15]. All device patients are required to have periodic follow-ups, to review their condition, device parameters and to adjust the therapy if appropriate. Each such visit lasts about 30 minutes and is a considerable inconvenience for patients, as it requires travel to and from the hospital, usually during normal working hours and, in many cases individuals require an escort. Additionally, the periodic routine checks create significant demand for hospital resources (physicians, cardiac technicians and facilities). As many follow-up checks are routine and no action is required, more efficient patient screening would enable the shifting of resources to other activities. This might be focusing on patients who require more attention, or the redeployment of highly qualified clinical staff to other functions within the cardiology department, making better use of their skills and. It is widely acknowledged that there is an acute shortage of trained technicians in the NHS. Any reduction in the number of, and attendees at follow-up clinics also has obvious benefits from a capacity perspective.

  3.3  In 2002 Medtronic introduced a remote device monitoring solution called Carelink Network, a telemedicine application enabling data stored in the memory of implanted devices to be retrieved by medical professionals in locations removed from those individuals with the devices . This system allows patients to download the information from their device to a secure server, making it available to clinicians for review almost instantaneously. Remote monitoring of implantable pacemakers and defibrillators provides benefits in three key areas.

  3.4  Quality of care—better patient outcomes and improved quality of service delivery. CareLink Network service was assessed in a multi-center study[16] as a practical tool for routine device management, which may also allow timely identification of clinically important issues. Clinicians involved in this study found the quality of this service comparable to a device interrogation carried out in a clinic.

  3.5  Efficiency in clinics—resource utilisation and workflow efficiency. Remote device monitoring allows for a reduction in the number of hospital visits and better access to device data. The implications of these improvements are a reduction in waiting time in clinics, a streamlined device follow-up process and the ability to free up resources used in clinics for other activities[17].

  3.6  Additional reassurance for patients. Patients using remote follow-up technologies have the additional reassurance of being able to rapidly send data for investigation in times of concern. The discharge of a potentially life saving shock from an implantable defibrillator can be an alarming experience for an individual. Yet the overwhelming majority of shocks are entirely appropriate, the defibrillator merely having done its job. The ability of a patient in this situation to quickly and easily verify that the shock was necessary, and that the device needs no alteration, has obvious advantages for that individual. Additionally, patients have to make fewer trips to clinics, and, with many device patients being elderly, this has a major impact on the transport requirements for ambulance services, family and friends, as well as being more convenient for the individual themselves. Finally, remote monitors are portable and allow patients to travel freely.

  3.7  Note: Carelink Network does not carry a CE mark and is not currently available in the UK.

4.  THE SPEED OF, AND BARRIERS TO, THE INTRODUCTION OF NEW TECHNOLOGIES

  4.1  Whilst the benefits of telemedicine applications such as CareLink have been well recognised and documented during the two years of successful use in the USA, the introduction of this type of technology is not straightforward in the United Kingdom. There are three principal obstacles to adoption.

  4.2  Funding. Current funding methods do not adequately recognise the value of telemedicine. Whilst Medtronic is encouraged by the attempts of the Payment by Results team to capture appropriate tariffs for telemedicine, there must be clear methodologies described to collect data in a meaningful way to create appropriate HRG labels, and realistic tariffs attached to them subsequently. Both the NHS and industry need to have proper incentives to develop productivity-enhancing technology.

  4.3  Guidance. There are presently no guidelines advocating the use of telemedicine applications within the NHS. The development of, for example, NICE guidelines in this area would be welcome, and it will also be important to follow any such recommendations with an adequate set of measures to properly track their implementation.

  4.4  Value recognition. Due to nature of their delivery, telemedicine applications provide benefits to various stakeholders. Whilst such benefits undoubtedly occur, they are not always recognised in their entirety, and as such the value of the technology may be underestimated. For example, travel costs and inconvenience incurred by patients are largely not recognised in hospitals, or, indeed, the wider NHS, but their societal impact is significant.

5.  THE EFFECTIVENESS AND COST BENEFIT OF NEW TECHNOLOGIES

  5.1  Remote patient management technologies improve the quality of care. Telemedicine applications provide clinicians with timely access to information about acute events, which require immediate attention. Remote patient management may also provides savings for patients by reducing the burden and cost of travelling to a clinic and spending time away from work.

  5.2  The use of telemedicine is an important way of modernising services in clinics. The expected growth in the device patient population could either require extensive investment in resources and clinic capacity, or the additional resource requirement could be minimised through the application of technologies such as CareLink.

6.  RECOMMENDATIONS

  6.1  Telemedicine has the potential to improve the quality of patient care. Clinical and practical benefits of applications should be considered by NICE and appropriate guidance issued, and measures should be in place to track implementation.

  6.2  The use of telemedicine within the NHS should, through favourable tariffs and other appropriate mechanisms, be incentivised, thus focusing efforts on ensuring rapid adoption.

  6.3  Introduction of telemedicine technologies can help the NHS to achieve waiting list reductions and other goals set in the National Service Frameworks, NHS Plan and other guidance documents. Investments aimed at achieving current NHS goals should include monies targeted for advanced telemedicine applications.

  6.4  The cost of introducing telemedicine technologies can be rapidly offset through the reconfiguration of services across the health economy, and non-healthcare impacts on individuals. It is important to capture the true benefits of such technologies. A wider societal perspective, as well as the costs to the NHS should be considered when assessing the benefits of telemedicine.

  6.6  Telemedicine is a rapidly developing field. A clear pathway for the introduction of telemedicine into the NHS should be defined, such that the potential these technologies have is fully realised.

7.  COMPANY OVERVIEW

  7.1  Medtronic provides lifelong solutions for people with chronic disease. During the past year alone, Medtronic technologies treated more than five million patients throughout the world. Products include those for bradycardia pacing, tachyarrhythmia management, heart failure, atrial fibrillation, coronary and peripheral vascular disease, heart valve replacement, extra corporeal cardiac support, minimally invasive cardiac surgery, malignant and non-malignant pain, diabetes, gastroenterological ailments, urological disorders, movement disorders, spinal disorders, hydrocephalus, and ear, nose and throat (ENT) surgery. Founded in 1949, the company's world headquarters is in Minneapolis, USA, with research, manufacturing, education and sales premises in more than 120 countries. Medtronic employs approximately 31,000 people worldwide. [18]

  7.2  Medtronic has been present in the UK for over 15 years, and all its businesses have sales, marketing, customer services and distribution operations here. Now employing over 200 people, Medtronic Ltd. is based in Watford, where there is also one of the company's Bakken Education Centres, a facility used by employees, medical professionals and patient groups. Medtronic's Clinical, Technical and Education groups have strong links with the programmes of numerous professional bodies, including the British Cardiac Society, providing, amongst other things, tuition for technicians taking professional exams. The Medtronic Foundation has supported the work of various Patient Advocacy Groups in the UK.












12   M. Field, J, Grigsby "Telemedicine and Remote Patient Monitoring", JAMA, 2002 Vol 288 No 4. Back

13   Source: Dr. David Cunningham, Central Cardiac Audit Database. Back

14   Estimate, Medtronic Ltd. Back

15   National Institute for Clinical Excellence, Technology Appraisals on Implanatable Cardioverter Defibrillators (2000 and currently in review), Dual Chamber Pacemakers (expected Jan 2005) and Cardiac Resynchronisation Therapy (expected March 2007). Clinical Guidelines on Chronic Heart Failure (July 2003) and Myocardial Infarction-Secondary Prevention (tbc). Back

16   M Schoenfeld et al "Remote Monitoring of Implantable Cardioverter Defibrillators: A Prospective Analysis", PACE June 2004. Back

17   R Owen "Pacer/Arrhythmia Clinic Improves Patient Satisfaction" EP Lab Digest, October 2003, Vol 3, No 8. Back

18   Medtronic, Inc. Annual Report 2004. Back


 
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Prepared 15 April 2005