158
IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 3, NO. 2, JUNE 1999
Correspondence Telemedicine in the United Kingdom: Current Status and Future Prospects Robert Sh. H. Istepanian
Abstract— The objective of this correspondence is to present an overview of some of the current development and some of the ongoing telemedicine programs in the United Kingdom. The issues of the future integration of telemedicine activities within the National Health Service that promises better access to healthcare with higher efficiency, mobility, and lower cost are also discussed. Index Terms—Health informatics, telehealth, telemedicine.
I. CURRENT STATUS In July 1998, the National Health Service (NHS), U.K., celebrated its 50th anniversary. During the last 50 years, the NHS has established a unique national healthcare system for free health for all and a From Cradle to Grave model [1]. However, in the last few years, the NHS has been facing fundamental changes in its operational structures and the quality of medical services it provides due to accumulated funding constraints. These are currently reflected in long patient and operation waiting lists, shortages in hospital beds, community care, and inadequate medical facilities in intensive care and emergency units. These are paralleled with other problematic issues, such as shortages in nurses, junior and consultant doctors, and other medical support services. In order to face these challenges, the recent policy is designed to tackle these issues and alleviate some of the urgent problems. One such solution is to make healthcare more productive, technologically efficient, and compatible with new information technology (IT) and telecommunication infrastructures to face the socioeconomic changes and the corresponding healthcare challenges for the 21st century. One of the fundamental strides toward this strategic reform is the development of new NHS telecommunications and IT networks for health purposes, which will cover the whole of mainland Britain. This is a major collaborative project between the Department of Health, which manages and finances the NHS, and British Telecom (BT). This new generation of a national health telecommunication network, to be known as NHS-Network, will link all healthcare institutions, from large teaching hospitals to local general practitioners (GP’s), dentists, and pharmacists. A number of different services will be run on the network including telemedicine. Currently, more than 85% of general practices are computerized in the United Kingdom, and most of them are linked to their regional administrative centers and hospitals. Such linkage will eventually allow the rapid growth of telemedicine applications and their ultimate role within a modern computing and communications healthcare infrastructure on both national and global levels [2]. These services will also include the provision of medical education over the Internet, information of services being provided by hospitals and academic medical centers, and access to other Manuscript received July 29, 1998; revised September 15, 1998. The author was with the Department of Electronic and Electrical Engineering, University of Portsmouth, PO1 3DJ Portsmouth, U.K. He is currently with the Department of Electrical and Computer Engineering, Ryerson Polytechnic University, Toronto, ON M5B 2K3 Canada (e-mail:
[email protected]). Publisher Item Identifier S 1089-7771(99)01525-3.
appropriate medical data. It is estimated that the NHS will invest £60 million in the network during the next seven years, with a substantial projected savings cost, such as a 25% cut in their annual telephone bill of £150 million. In order to coordinate this new strategy within an effective and focused research and development program and to allow further integration of telemedicine and health informatics into the NHS, the United Kingdom office of Science and Technology, through its Foresight Panel, in collaboration with the main national funding councils, has initiated the establishment of the United Kingdom Institute of Health Informatics [3]. These nine selected centers of excellence (announced in 1998) will be located in different universities and educational institutions in England, Wales, Scotland, and Northern Ireland to act as permanent national virtual healthcare telematics competence centers. These will plan, coordinate, and implement the research and teaching strategies within a coherent national NHS-IT framework to improve the quality of healthcare and invest in the development of future telemedicine and health informatics programs. The details of the functionality and other coordination issues are still under discussion and debate by the partner institutions. Telemedicine in the United Kingdom has seen a rapid growth in recent years [4], [5]. This is particularly reflected in the large number of telemedicine/telehealth research and application programs in different universities, hospitals, and health institutes, with a considerable increase in funding from the national funding research councils. Telemedicine programs include a wide range of training and applied research in areas such as teleradiology, teledermatology, telepathology, telecardiology, and teledentistry. These are carried out in different universities, teaching hospitals, and medical institutions. Below are some examples of existing programs. Other telehealth education and health informatics disciplines exist in other medical institutions and universities in addition to different joint academic, governmental, and industrial ventures [2]–[5]. A brief list of some current telemedicine educational and research programs include: • the United Kingdom teledermatology center and community care project, Institute of Telemedicine and Telecare, Belfast, Ireland; • automated telematic electrodiagnostic system, Bristol Eye Hospital; • remote antenatal clinics, Edinburgh Royal Infirmary, Scotland; • accident and emergency telemedicine, Central Middlesex Hospital; • remote foetal ultrasound scanning and monitoring, Queen Charlotte’s Hospital, London, and BT laboratories; • telesurgery and medical imaging, King’s College Hospital, London; • teledentistry, Eastman Dental Institute, London; • telemedicine and home telecare monitoring applications, University of Wales, Bangor; • telediagnostics and telecare systems, John Radcliffe Hospital, Oxford. The main medical organization involved in telemedicine is the Royal Society of Medicine, London. The Telemedicine Forum of the Society is one of the main platforms for organizing meetings, conferences (annual Telemed conferences), and publications (Journal
1089–7771/99$10.00 1999 IEEE
IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, VOL. 3, NO. 2, JUNE 1999
of Telemedicine and Telecare) [6]. Other more recent professional organizations, such as TEAM (Toward Education for ALL with Multimedia), have been recently established in London, with the aim of global collaboration in clinical care, telemedicine teaching, and research, and the provision of global health education using all forms of information technologies, such as the World Wide Web and teleconferencing [7]. A recent NHS executive strategy for the modern NHS for the period 1998–2005 has recently been announced [8]. In this strategy, it is declared that telemedicine and telecare will be introduced into the NHS where there is evidence that the methodologies and techniques are cost-effective. The role of telemedicine and a detailed discussion and evaluation of this strategy within the future of the NHS are detailed in [9]. II. FUTURE PROSPECTS The integration of telemedicine into the NHS is an important element in the modernization and restructuring process currently underway. The main driving force for this integration, in addition to the well-known tangible and intangible strengths of telemedicine, are as follows. 1. An exponential increase in the cost of NHS patient care in the last few years. 2. The strategy and outlook for a primary care-based NHS with shift of resources from hospitals to GP’s within an efficient managed care system. This means providing better quality medical care that is accessible to the patient close to the community with cost-effective results and through the use of telemedicine to improve communication links between primary and secondary care sectors. 3. Equitable access to experts and specialists with early diagnosis. This means cutting the waiting list for such processes, better allocation of resources, and easier links with professionals and experts. 4. The need for networked telemedicine and continuing education to provide a comprehensive education of medicine using new technologies, such as the Internet, satellites, and digital broadcasting. However, in order to achieve these goals and the potential role of telemedicine to provide a clinically driven and more productive healthcare system compatible with the emerging technologies of the 21st century, several contentious issues remain open for further discussion and future research: 1. The role of telemedicine in optimizing the gap between the increased population demand for better NHS care and existing financial resources. This requires the proper evaluation of the existing programs and large-scale trials to achieve this aim and maintain the principles between the clinical pull and technology push concepts. 2. The technology gap and unfamiliarity with telemedicine technologies and new advances in IT and telecommunication infrastructures among healthcare professionals and medical graduates. This requires the provision of further interactive educational mechanisms to familiarize healthcare providers, especially within the primary care sector, with the phenomenal
159
growth in the ways that IT and the next generation of telecommunications will contribute to the future of medical practice and healthcare delivery [10]. 3. Training requirements, cost effectiveness, and regulatory issues, such as reimbursements, confidentiality, telemedicine standards, etc. 4. The integration of telemedicine and telecare programs and coordination of international collaboration and research with the strategic requirements of future European and global telemedicine programs [11]. The enhanced role of applied research in this area especially within the European Union fifth framework program and the integration of future health services within the vision of “Citizen–Centred Care” across Europe. This vision implies new innovative services to citizens and networking services with decentralized healthcare structures where services with evidence-based effectiveness are accessible to all and are provided in a way that the organizational boundaries within Europe are invisible to the citizen. 5. The future will see a blurring of the lines between the health information and mobile telemedicine/telehealth systems. This will also include further integration with next-generation wireless, Internet, and computing technologies. This correspondence was meant to provide an overview of the current status of telemedicine in the United Kingdom and the future integration of telemedicine/telehealth activities into the NHS. The future role of these techniques in changing the current healthcare delivery system was also discussed. In the United Kingdom, there is still little formal evidence and economic feasibility for the larger integration of telemedicine within the NHS. However, the trend is moving toward such integration with new strategies and recommendations currently being formulated to achieve this aim. REFERENCES [1] G. Rivett, From Cradle to Grave: Fifty Years of the NHS. London, U.K.: Kings Fund, 1998. [2] Dept. Health Publ., “National Health Service Guidance Note on Telemedicine,” NHS Estates, Dept. of Health, Stationery Office, London, 1997. [3] United Kingdon Institute of Health Informatics, List of focal institutes. Available HTTP: http://libsun1.jr2.ox.ac.uk/ocihi/ukihi.html [4] Proc. Int. Conf. Telemed. Telecare, Telemed’96, J. Telemed. Telecare, 1997, London, U.K., vol. 3, pp. 1–120. [5] Proc. Int. Conf. Telemed. Telecare, Telemed’97, J. Telemed. Telecare, 1998, London, U.K., vol. 4, pp. 1–112. [6] Telemedicine Forum, Royal Soc. Med., London, U.K. Available HTTP: http://www.qub.ac.uk/telemed/tmed [7] TeleMed Europe, Proc. Int. Conf. Telemed., London, U.K., June 15–17, 1998. Available HTTP: http://www.qub.ac.uk/telemed/tmed [8] NHS Executive Summary, Information for Health, “An information strategy for the modern NHS (1998–2005),” 1998. Available HTTP: http://www.imt4nhs.exe.nhs.uk/strategy/summary/1.htm. [9] R. Wootton, “Telemedicine in the National Health Service,” J. R. Soc. Med., vol. 91, pp. 614–621, 1998. [10] S. N. Laxminarayan, J. L. Coatrieux, J. C. Roux, S. M. Finklestein, A. V. Shakian, and S. M. Blanchard, “Biomedical information technology: Medicine and health care in the digital future,” IEEE Trans. Inform. Technol. Biomed., vol. 1, pp. 1–7, Mar. 1997. [11] J. T. Sommer, “Telemedicine: A useful and necessary tool to improve quality of health care in the European Union,” Comput. Methods Programs Biomed., vol. 48, pp. 73–74, 1995.
