Volume 2

The use of new medical technologies within the NHS : fifth report of session 2004-05 / House of Commons, Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee.
Date:
2005
Catalogue details

Licence: Open Government Licence

Credit: The use of new medical technologies within the NHS : fifth report of session 2004-05 / House of Commons, Health Committee. Source: Wellcome Collection.

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    8. It is also important to realise that the fact that a 12 lead ECG unit has a data port and is “communications enabled” does not make it a telemedicine unit. Telemedicine requires appropriate data communication and trained personnel. And what does “communications enabled” mean? Often it means that it can communicate with a computer, which is also potentially very misleading. Those with PC experience you will know that even if everything works correctly now, if you try and install a new program or device, while it may or may not work, other applications and systems that were previously working may now not work! This is not an acceptable outcome for a medical device. There is a serious lack of understanding, outside the regulatory bodies, about the use of computers in the medical field and about what is and what is not a medical device and where responsibility for failure lies. 9. Companies that produce these devices sometimes also produce a range of other devices that link together to make a total “solution”. While this overcomes the problem of a “stand-alone” device, it does create an additional problem that you have to use their components, their terminals, their software etc. This is how the computer market was before the advent of the IBM Personal Computer (PC) 25 years ago. Nowadays you can buy any PC software and it will run, any hardware and it will connect. You can take data off your PC and run it on someone else’s. 10. We take this interconnectivity for granted, and businesses have grown up that only make certain bits of computer hardware. Perhaps less well known is the fact that specialist programmers write pieces of code which are used by other programmers to incorporate into their own offerings. Before the “PC” this could not be done. Not only could you not take a floppy disk from one computer and run it on another, the disk probably wouldn’t even fit. Programmers not only had to write programs for specific makes of computer but they might also have to restrict users to a set of known printers and other peripherals. 11. Just as the PC market changed, so too must the medical market. For the PC this was brought about by an open hardware platform (the IBM Personal Computer or “PC”) and a common operating system or user interface. The medical market must change in a similar way but with one important additional item, the adoption of common practices and standard clinical procedures on a national basis. This is nothing to do with clinical or regulatory standards, which are already well catered for, but a clear set of “Standard Operating Procedures” to ensure different people in separate locations know what is going on, where in a process things are and what comes next. 12. Most professions have clearly defined rules and procedures, and as circumstances change then the rules change. Medicine is practised by highly qualified professionals but (and this is really serious) they practice medicine in their own particular way. Imagine if this was how air traffic control was handled. With the advent of e-health, many clinical interventions will be done without the physical presence of a clinician, or by a less qualified clinician remotely supported. For this to work smoothly there need to be clearly defined operational procedures and processes. We are not referring to aspects already adequately covered by existing standards bodies and agencies but the specific elements that pertain to remote use and the interaction and interoperability of people and systems when connected electronically. 13. As has already been mentioned, the term “Telemedicine” now comes under the broader banner of e- health, along with Telecare. However, the intended focus of this Inquiry is presumed to be the use of e-health systems and services to deliver remote medical interventions (telemedicine) and ongoing remote care at home or other non-medical facilities (telecare). The key word here is “remote”, which simply means that one or more elements of the solution are not at the same locality as the patient. Remote can, therefore, be as diverse as the care of an airline passenger by a doctor on the ground or a patient receiving care at home from a community nurse with remote access to patient records, hospital booking systems etc. Large distances are NOT a prerequisite! 14. At the moment, instances of telemedicine and telecare tend to be looked at in isolation, a bit like looking at flour, eggs, sugar etc as the end product without looking to see how these things can be put together to make something that is more than the sum of the parts. Indeed, very little consideration is given to telemedicine despite the huge cost being incurred in building NPfIT, which will enable telemedicine and turn it into a major form of medical intervention. 15. NHS Direct is telemedicine, in the sense that the initial activity is telephone based (and therefore remote). Despite doing a reasonable job for many, it does a less than adequate job for most long term or repeat illness patients, who need an enhanced system where they reach a clinician with direct access to their notes and, in the case of longer term illness, perhaps even real time medical parameters, blood pressure, ECG etc. It is not that the capability does not exist to provide such enhanced service; it is just that there is no high level support for such initiatives. 16. Instances of telemedicine and telecare are currently run as local “pilots” where there is a clinical lead that is willing to support the initiative. Often funding for such “pilots” dries up or the clinical lead moves on. This lack of high-level support means that the same initiatives are piloted again and again all over the country, the outcomes of previous pilots being completely unknown to anyone other than those intimately involved in the project. 17. There is also a sense that telemedicine systems, because they connect to computer systems, which are getting cheaper and cheaper, should also be significantly cheaper than hospital systems. An over the counter blood pressure unit from Boots can cost you less than a hundred pounds, while a hospital unit often costs