Monday, 31 July 2017

Evidence in the care continuum - one of the keys to the telemedicine’s success or failure?

Josep M. Picas

It’s notorious that there are a great number of experiments, publications and studies on the application of telemedicine. Over the last few years, this phenomenon that we could label as the "apps revolution" has given telemedicine a great boost. However, the results, in many cases, have not reached the expectations. 

Many studies have tried to identify the causes of this unsuccessful outcome. In a brief reference, we could mention the professionals’ inertia and resistance to change in their work processes, errors of design, i.e. not being focused on patients, regulatory aspects, lack of resources and patient adherence problems caused by, to name just two, little health literacy or the digital gap issue.

Perhaps the two most important reasons are: firstly, the lack of integration of electronic medical records used by health providers, in these cases, the information from devices, sensors and records sources are not shared among patients, physicians, nurses and other professionals involved in the health care process. At the moment, the data management approach, big data, coupled with the IoT (Internet of Things) concept, is trying to help solve this issue. The second reason, and perhaps the key, is the payment models, which are mostly following a very conservative approach of not paying for value or results and, therefore, not offering enough incentives for more cost effective actions using ICT.

I would like to add another reason, as far as I know, little commented upon. It’s interrelated with the previous ones and at the moment approaches collaterally the subject, nevertheless I believe that it will end up being at the centre of the thematic one. The question is: Where is the evidence in referrals between primary care and consultant specialist for a particular disease? The derivative of this question is: Where is the evidence in the use of telemedicine in integrated health models? Working on this topic I have found a recent, interesting, rigorous methodological and extensive publication of the National Institute for Health Research, done by researchers from the University of Sheffield that I found interesting enough to share.

As discussed in the conclusions of the review work, carried out in the English context, but applicable to any setting, for example, their references to the complexity of referral management, factors related to the heterogeneity of physicians, patients and situations. Finally, a very important topic for future research is highlighted: the importance of obtaining intermediate results as an indicator of the effectiveness of the interventions in order to determine barriers or facilitators of the global impact.

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