Telehealth is something I’ve touched on a number of times in the past few years, and indeed studies have suggested a number of benefits, both in terms of financial and health outcomes.

As with many technologies however, there is a risk that the hype cycle runs wild and we start treating telehealth as a silver bullet that will save all of our healthcare woes, especially given the considerable resource constraints faced by many health systems around the world.

Whilst I wouldn’t wish to dispute the benefits of the technology, there is growing evidence that we need to be careful with its implementation.  For instance, a recent study published in the British Medical Journal revealed that telehealth is not the answer for everyone.

“We found some evidence that the Healthlines Service led to modest improvement in overall cardiovascular risk for a minority of participants, but had no impact on average risk. But the Service did have other benefits, such as improvements in diet and physical activity, and patients were more satisfied with their access to care and the treatment they received,” the researchers say.

The Heathlines Service was further put through its paces in a second study, this time published in Lancet Psychiatry, that looked at its impact on patients with depression.  In this instance, small improvements were seen in areas such as depression and anxiety, with patients also happier with the support they were receiving.

“The results of our studies show that while a telehealth intervention such as this can be beneficial to some patients, it is not the magic bullet that some policy-makers seem to think it is. However, it is a relatively low-cost intervention that can make health care more accessible for conditions that affect a large number of patients, so there is good reason to continue exploring ways to make telehealth more effective in future,” the authors conclude.

Advanced care

Suffice to say, Healthlines is a fairly bog standard telephone service, so do different forms of service do better?  A recent study from Bristol University explored an online symptom service that is being used by doctors in the UK.

The system in question is called eConsult, and offers patients the chance to submit their symptoms electronically.  The analysis found that across all 36 practices where the system was tested, usage levels were very low, with an average of just two e-consultations per 1,000 patients per month.  This figure was especially low outside of normal opening hours, and especially at weekends.

What’s more, most e-consultations were for low-level, administrative reasons such as requesting sick notes for work or getting test results back.

Suffice to say, eConsult is another fairly rudimentary system, and studies of more comprehensive systems have shown more promising results.  These gains were reflected in a study conducted by a team from UC Davis, which explored the cost savings possible with telehealth.  It reveals that such savings are particularly pronounced in rural areas that use telemedicine to connect up emergency departments with doctors at much larger hospitals.  It suggests that even once the costs of installation and maintenance are considered, the savings work out at around $4,662 per use on average.

Nonetheless, the eConsult study does have some valuable lessons for us.  For instance, the system wasn’t integrated with existing IT systems at each practice, thus making it outside of the workflow of staff and a challenge to use.  If these kind of systems are to stand a good chance of success, the implementation needs to be more thoroughly thought through than appears the case with eConsult.  It’s a fact that the authors themselves admit.

“Our research shows that they need to be carefully implemented and effectively marketed to yield the benefits that politicians are hoping for,” they say. “Online consultations may have value for some patients, such as straightforward medical enquiries, but they cannot replace face-to-face consultations in situations which are more complex.”