Annex E
EXAMPLES OF TELEMEDICINE AND TELECARE APPLICATIONS
There are a number of examples of telemedicine
and telecare in use in the NHS (a more comprehensive list is available
from the UK Telemedicine and E-health Information Service—www.teis.nhs.uk).
At St Mary's NHS Trust in Paddington, ComMedica
Ltd's web-based telemedicine software has been rolled out to form
an electronic image-sharing link between St Mary's Paediatric
Accident and Emergency department and the specialist Burns Unit
at Chelsea and Westminster NHS Trust. The system is to be used
for the instant referral of digital pictures of lacerations and
burns. More patients will be treated at St Mary's under expert
guidance from Chelsea and Westminster Hospital's burns specialists
and plastic surgeons. The software will help Chelsea and Westminster
Hospital to determine better which patients need to be transferred
for specialist attention. St Mary's NHS Trust has already installed
ComMedica's software for an electronic image-sharing link between
St Mary's and the National Hospital for Neurology and Neurosurgery
near Holborn, which has allowed speedier diagnosis and treatment
of critical head injuries since September 2002.
The Royal Cornwall Hospital has a successful
project using videoconferencing to treat minor injuries. Eight
minor injury units are linked to the county's main accident and
emergency centre at the Royal Cornwall Hospital in Truro, via
BT videoconferencing. Cornwall Healthcare Trust is expecting to
save approximately £100,000 a year through use of the technology
which gives patients visiting the hospitals immediate access to
fully trained accident and emergency specialists at the Royal
Cornwall Hospital. The use of videoconferencing is also improving
communications between the hospitals and providing a valuable
new medium for internal training. The experience from the project
has also provided valuable input to the work of the National Programme
for IT in the NHS—it was one of the precursor "Electronic
Record Development and Implementation Programme" projects.
Teledermatology has been a notably successful
application area for telemedicine. Working in conjunction with
the NHS, a commercial company (tds Telemedicine Ltd) provides
a commercial service where specially trained nurses take digital
photos which specialist software routes to consultant dermatologists—who
may be anywhere in UK, and can work from home—for diagnosis.
The highly successful NHS Direct service (and
its counterpart, NHS24 in Scotland) is the biggest telemedicine
project in the world. Trained NHS nurses provide confidential
advice to telephone enquirers, supported by a clinically-proven
decision support system. It is complemented by an online, web-based
information service (NHS Direct Online) that provides a health
encyclopaedia linked to the national library for health, together
with a query service for non-confidential, non-urgent health questions.
NHS Direct Online also allows access "Healthspace"—a
secure facility to allow patients to record health information
of importance to them. In the future it is planned to use Healthspace
to support online patient access to the NHS Care Records Service,
subject to appropriately robust authentication and security measures
being in place. In the longer term these developments could allow
patients to track and control their treatment pathway—allowing
patients to select and synchronise appointments, order transport,
set recalls and reminders with personal diaries and communicators.
The NHS Direct portfolio has recently been further extended by
the launch of the health information service NHS Direct Interactive
on 16 December 2004 on Sky and free-to-view digital satellite.
In 2005, it is planned to launch the service on cable and Freeview.
Great Ormond Street Hospital (GOSH) has a sophisticated
telemedicine system with facilities in the clinical areas directly
linked to the Kennedy Lecture Theatre in the Institute of Child
Heath.[14]
Regular clinical consultations are undertaken with John Radcliffe
Hospital in Oxford. Educational activities are also broadcast
to various institutions, conferences and symposiums around the
world. A separate Tele-Echo service, established in cooperation
with Northampton General Hospital (UK), makes the expertise of
the GOSH cardiac team available to other hospitals. Various other
areas of the hospital are also involved in telemedicine activities.
Watford and Three Rivers Primary Care Trust's
Chorleywood Health Centre uses video-conferencing to bring patient,
consultant, nurse and GP together to discuss diagnosis and treatment.
Many of the tests patients require can be done at the surgery
or in people's homes and the results e-mailed to a hospital consultant,
reducing the number of times a patient needs to attend hospital
for outpatient appointments. Patients are saved lengthy journeys
to see a consultant, and have the support of their own nurse or
GP when seen by the consultant. Chorleywood runs its telemedicine
programme in collaboration with the John Radcliffe Hospital in
Oxford and St Mary's Hospital in London. A treatment room in the
practice houses equipment for ECG and exercise testing, facilitating
prompt diagnosis and treatment of urgent cases.
The Chorleywood example demonstrates very clearly
that the technology needed can be easily bought off-the-shelf,
and with proper training readily usable by local staff. However,
full cost-effectiveness only comes if it used across several specialties
rather than dedicated to a specific disease area. Also crucial
is effectively managing the changes in the relationships between
healthcare professionals that come about through the greater use
of ICT.
A 10-year partnership with Brunel University
has seen all of the computers in the health centre connected to
a local area network that gives access to a multimedia patient
database and through a broadband connection to the secure NHS
national network.
The "MIDAS" project based at Cheshire
County Social Services is piloting the use of an intelligent telecare
system within a social services residential short-stay setting
for older people undergoing rehabilitation as part of an intermediate
care service. Social Services is funding the cost of the equipment
and providing the environment of the community support centre
and its staff. The aim of the project is to evaluate the contribution
of a prototype "MIDAS" intelligent telecare system and
its use as an assessment and monitoring tool. Since January 2000,
Cheshire Social Services and Vale Royal Borough Council have been
jointly working with a company, Technology in Healthcare, trialling
prototype individual social care sensors. These sensors, if successful,
then go on to be developed into a marketable product by Tunstall
Telecom http://www.teis.nhs.uk/jsp/search/person.jsp?person=.
ICES (Integrating Community Equipment Services)
is a DH funded initiative across health and social care to develop
community equipment services in England, remove unnecessary barriers
for users and modernise services.
14 In partnership with Great Ormond Street Hospital
and as part of University College London, the Institute for Child
Health is the leading British academic research institution for
child health. It is co-located with Great Ormond Street Hospital. Back
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