Is telehealth coming at last?

Yesterday at Cisco's C-Scape analyst briefing, we were treated to a
presentation by one James Ferguson. And what a treat that was. Cisco
chose wisely. He was a good speaker, passionate about his subject
(telemedicine, which he prefers to call telehealth) and a medical
practitioner to boot. It was a real person talking about real things,
not some propellor-head from technoland or, worse, a marketeer. This
background, of course, made him a devastatingly effective salesman, and
it wasn't until the Q&A that some of my (Scotch?) mist of
enthusiasm started to clear.

His pitch was essentially
simple. Because the coverage of the Aberdeen-based Scottish Centre for Telehealth (SCT) includes highlands, islands and oil-rigs, it faces
some rather unusual problems. Popping into the local hospital is hardly
convenient. And doctors can't easily get to where they're needed. Not
always in time, anyway. So SCT's been working on getting diagnoses done
remotely in order to a) help people to get the right treatment locally
and b) to identify those who need hands-on professional treatment
urgently. The filtering questions are: "Is this time dependent?"

(urgent), "Is it experience dependent?" (need an expert) and "Is it
facilities dependent?" (need particular facilities).

We saw
people sticking their tongues out and waggling their tonsils in kiosks
while remote experts tried to figure out what's wrong. Apparently
ninety percent of diagnoses can be done by looking at someone,
listening to their chest and looking in their ears, noses and down
their throats. It's a slightly dehumanising way of doing medicine: in the
same way that we all like to meet in person rather than through a
computer screen or over the phone. The truth is, when you're ill and
you're far away from help, anything is better than nothing at all.

Ferguson
was not afraid to mention the dangers of turfing up at hospital. He'd
rather sit on a telepresence or videoconference consultation than face
God-knows-what in person. And patients eliminate the risk of
catching hospital-borne infections if they don't have to go near the
place.

The benefits are piling up.

The downside, of
course, is that this stuff has to be paid for and the bandwidth has to
be there. On payment, Cisco has a cash mountain so this, presumably, is
why it's happy to consider spreading payments over time, essentially
turning the customer's capital expenditure into operating expenditure.
It can still recognise its own revenue at point-of-sale. Although it's
a different issue, we're also seeing gradual acceptance this
pay-as-you-go approach in the various kinds of cloud-based services.

The
harder part of the equation is the communications infrastructure.
Covering highlands, islands and oil-rigs with high quality broadband
connections is a political and economic challenge, given the relatively
sparse populations. Oil rigs have, apparently, been trialling a
satellite-based facility called OPTESS. And some of the ground-based
services have been using ISDN but, of course, the higher the bandwidth
and the further the reach, the more services can be provided remotely.

Ferguson
pointed out that medicine is now so good at patching us up when we get
a major illness, we keep on living only to get more and more illnesses,
until we end up with some chronic condition. All of this puts
increasing demands on an already overstretched health service much of
which, in theory at least, could be alleviated with some kind of home
monitoring and self-treatment service, escalating to the professionals
as and when needed.

But that's to get ahead of ourselves. Right
now, the SCT has run trials inside hospitals running telehealth

'kiosks' in parallel with conventional assessments, in order to compare
the quality of results. (It has a clever way of eliminating bias.) It
is extending this facility to multiple hospitals and has started home
monitoring trials. All of which are testing the principles of
telehealth and capturing feedback from users on the experience.

As
with so many things in the computer world, the big question is whether
it will be able to scale. And that depends largely on either an
appropriate infrastructure or a system which can adapt successfully to
lower bandwidth connections.