How can telehealth help in the provision of integrated care?

Key messages

Policy issue

• Demographic change, rising incidence of chronic disease and unmet needs for more personalised care are trends that demand a new, integrated approach to health and social care. Professionals must work across sectors as a team with common goals and resources to deliver a coordinated response to each individual’s care requirements. Advanced information and communications technology provides a major new opportunity to realize care integration, superseding today’s chain of disjoint responses to discrete threats to health.
• Telehealth, the provision of care at a distance, is a key component in future integrated care. Today’s segregated telehealth applications still require linking into more comprehensive eHealth strategies, in which clinical pathways and service delivery processes are fully coordinated and patient data safely shared. An increasingly solid evidence base is emerging indicating that telehealth can be used effectively to respond to the growing call for improved care, in particular for those with chronic conditions. Mainstreaming remains a challenge; market forces alone are likely to remain insufficient.

Policy approaches

• Making the case for investment in telehealth applications requires better marshalling of existing evidence, not only to show that telehealth works, but also to show where – in what organizational context – it will work. Evidence from large scale pilots and the few mainstream implementations requires careful synthesis, taking particular account not only of clinical dimensions but also of indicators relating to successful deployment in normal care: change management, human resources, organizational interfaces, financing requirements, technology integration and ethics for everyday practice.
• Financial flows in health systems must be critically assessed for their ability to act as incentives or disincentives for telehealth provision, acknowledging that the “business case” for telehealth is often very different for different players. Medico-legal and regulatory regimes can also pose critical barriers to the exploitation of telehealth. The various regimes should be compared to identify best practice and opportunities for regulatory and legislative reform, so as to facilitate better integrated care through the use of telehealth.
• The use of telehealth, as a tool to help support better integrated care, can be helped through initiatives that bring policy responsibilities together. This could include setting up financial and organizational vehicles (joint budgets, joint ventures) to support partnership across sectors.

Facilitating implementation

• To bring about change, mechanisms should be put in place to foster dialogue, instilling a sense of ownership of reform and reducing resistance to change; process innovation driven by clear health policy priorities should precede telehealth design – technology push can not be expected to deliver; change management must fully engage all involved actors; full attention to ethical issues should be mandatory and the usability and interoperability of today’s ICT systems can, and should be, much improved.