Analysis: UK telemedicine finally gets into gear

Telemedicine has caught the political imagination this month, following the UK Department of Health's decision to pilot the technology. But the UK is still five years away from a national telemedicine strategy, and NHS plans are lagging far behind offerings from the private sector. Innovative companies need to know where the opposition to telemedicine is, so they can pitch their ideas effectively.

The main problem is that UK healthcare lacks the direct link between demand and supply which would guarantee the speedy take-up of new technologies. Market forces are intercepted by the government's priorities.

The UK government's ambitions are limited - it hopes to cut waiting lists and set up national call centres offering nursing advice. By contrast, private companies such as International Telemedicine Services (ITS), which set up shop in Wales this month, already offer advanced cardiac monitoring services over the telephone.

The US - which boasts a $5bn telemedicine industry - illustrates the difference that privatised healthcare would make. Hospitals there compete for patients and demand innovative technology direct from the suppliers. "In the UK, all money comes from a limited pool of public taxation, so the NHS is forced to focus on basic care," said Roger Wallhouse, director of North European operations for Shared Medical Systems. "UK healthcare is largely impoverished compared to the US," he said.

Governments cannot experiment with public money. They must wait until an application is proven before they can invest in it, and this keeps costs high. Wallhouse doubted that any telemedicine start-up will be able to launch in the UK. "Innovation will have to come from large, international companies such as General Electric, Philips, Siemens Healthcare and Fujitsu - no-one else can afford the R&D," he said.

Local health trusts are making demands for better technology, but they do not have the power to set up commercial partnerships beyond their own region. "This leads to a fragmented approach to development," said Fiona Simpson, speaking for the British Medical Authority (BMA). "We need the government to invest more in fibre optic infrastructure and to provide a central IT strategy which the different NHS trusts can rely on," she said.

But there are other people to blame, besides the government. "Delays in the adoption of telemedicine are mainly because GPs are not interested in its broader cost benefits," said Darren Taylor, clinical services manager at LifeSign, ITS' Welsh cardiac monitoring service. "They would rather refer patients to a consultant than use our service and retain responsibility for them."

GPs are due to get a heavier workload if telemedicine takes off, so their support is vital. Real-time consultations between patient, GP and consultant would have to take place after surgery hours, according to Leo Lewis, who is doing research into the subject for the NHS. "We are aiming to set up a national timetable for consultations and these would all have to be scheduled in created time," she said.

Dr Bob Broughton, Welsh Secretary for the BMA, suggested that hostility to telemedicine comes more from urban authorities, where referral is frequent and the cost benefits of telemedicine are less clear. "GPs in rural areas are used to maintaining responsibility for their patients, because consultants are so far away," he said.

Fortunately, urban authorities are following the lead of the Welsh Institute of Rural Health, which set up initial funding for LifeSign. The NHS has set up pilot trials to investigate different aspects of telemedicine and a strategy is due within three years. "A national plan should be put into action in five years time," said Lewis. So despite the pitfalls of public health management, central coordination is on its way.