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  1. Surgical telemonitoring – the next milestone for telemedicine?

    The ATA conference has just included an interesting session on surgery as the next milestone for telemedicine. While telesurgey has long been an area of interest in remote care, pressures in the health system and developments in technology are combining to create new opportunities for supporting surgeons in their work. But many of the familiar implementation challenges are also looming large. So what were the reflections from the panel and discussion?

    The consensus was that we need to shift the state of the art in operating room practices from considering volume and quality to broader notions of ‘value’ embracing cost, quality and access. Hospitals will be increasingly rewarded on outcomes and patient satisfaction, and telesurgery potentially helps improve both.

    Two kinds of broad telesurgery model are envisaged – the expert surgeon ‘broadcast’ their operations to a wide audience and a more 1:1 relationship where the expert is remotely located and provides support for a specific operation. The ‘new telesurgery’ will involve three things.

    1. Just phoning another surgeon for advice in the middle of an operation is no longer good enough. There will be much more collaboration between surgeons, using new collaborative tools for bringing people together at a distance. The possibility of virtual environments around the operating room is already here and should be widely embraced.
    2. Large peer-supported integrated surgery networks will emerge with surgeons paid for the time they spend providing advice or moderating discussions. Spending 10% of your mentoring other surgeons – perhaps around the world – will become part of the norm.
    3. A pool of recognised expert mentors will develop. Mentors can be ‘in the room’ virtually during the procedure.  Or they can be invited to participate in situations where there is an ‘index case’ - a rarely encountered procedure – where the pool of knowledge is spread thinly.

    All this is going to clash with the inherent conservatism of surgeons and their unwillingness to change tried and trusted approaches and technologies. The big challenges for moving forward in telesurgery are:

    1.  ‘Network effects’ need to kick in – there has to be a critical mass of users and installed technology to generate the biggest benefits.
    2. Inevitably there are incompatibilities in technical standards for data transfer.
    3. The focus so far has been on audio and video, but integrating patient data into telesurgery and back into patient record systems is also essential.
    4. Tools for virtual collaboration are rapidly developing, allowing crystal clear video, remote access to laparoscopic images, virtual laser pointers, and doing all this on tablets. These need to be made widely available.
    5. Reimbursement and business models – who pays for what? Can we find ways of reimbursing hospitals / surgeons providing experts? How do we schedule expert mentor time and build this into their contracts?
    6. Medico-legal. There are cross border (or cross state issues here in the US) licensing issues and big problems of responsibilities in the event of problems arising in a telesurgery procedure.


  2.  Maxine Myers 24 January 2013

    The UK could be at the forefront of using technologies that enable patients to be cared for in the comfort of their home

    The UK could be at the forefront of using technologies that enable patients to be cared for in the comfort of their home if the government adopted more imaginative approaches to supporting the NHS and industry working in this field, according to a report released today by researchers from Imperial College Business School.

    It is estimated that approximately 350,000 NHS patients in the UK currently use technologies that remotely monitor their vital signs, mobility and general safety at home. In 2012, the Government decided to dramatically extend the use of these technologies to up to 3 million people, following calls for its widespread adoption. However, the complex relationship between health, social care services, the NHS and local authorities could jeopardise the implementation of these services in the community.

    The researchers in today’s report highlight how the UK is already a global testbed for the use of these technologies, which is collectively known as “Remote Care”. However, they warn that without a more radical approach to encourage its adoption, the Government could see a failure of its current policies, which could lead to the NHS and the remote care industry losing confidence and commitment in developing and delivering these technologies.

    The report, entitled “Remote Care PLC: Developing the capacity of the remote care industry to supply Britain’s future needs” recommends:

    • Reform of NHS payment systems that currently financially disadvantage hospitals if more patients are treated at home.
    • New relationships between suppliers of Remote Care and the NHS and local authorities
    • Consideration of new Public Private Partnerships (PPP) in healthcare, reflecting innovations in Europe. These PPPs could encourage the NHS, local authorities and Remote Care suppliers to collaborate over the long-term and so increase dramatically the use of remote technologies in the home.
    • Greater collaboration between health and social care providers so that purchasing is less fragmented and clear market signals are sent to suppliers.

    Launching the report, Professor James Barlow, Chair of the Technology and Innovation Management group at Imperial College Business School, said:

    “If you speak, as we have, with companies gearing up for Britain’s ‘Remote Care’ revolution, the levels of scepticism are unmistakeable and worrying. Faith in the future is shaky. If the remote care revolution is to take off, shifting healthcare out of hospitals and into homes, we will need more action than is currently proposed under government policy. Current political commitment, though considerable, is insufficient to achieve a great potential prize – a more rational, higher quality, perhaps even cheaper, health and social care system, and a vibrant UK export industry based on remote care technology.”

    'Remote PLC’, by James Barlow et al, is published by the Health and Care Infrastructure Research and Innovation Centre, and was funded partly through the Whole Systems Demonstrator (WSD) programme and the EPSRC’s IMRC programme.

    Read the full report  'Remote PLC' (pdf)

    A commentary on the report by James Barlow is published on 24 Jan 2013 in the Health Service Journal and can be accessed as the lead blog on the home page of