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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


British Journal of Healthcare Computing "The VA’s starting point is a comprehensive, electronic care record to which patients have access - we should be aiming for the same goal within the NHS"

Image "The VA’s starting point is a comprehensive, electronic care record to which patients have access - we should be aiming for the same goal within the NHS"

2020health′s John Cruickshank was invited earlier this year to visit the US′s Veterans′ Health Administration (VA) in Washington DC ‒ the world′s biggest telehealth user. He returned inspired with a vision for more joined-up, effective healthcare for our own elderly – which includes an EPR to which patients have access and secure, integrated apps for both patients and carers. The interview below is part of the BJ-HC Vox Pop "The growing problem of elderly care: Can technology be an enabler?"

Do you think that technology can help resolve the problem of an increasingly elderly population?
Yes! Technology is helping transform so many other sectors, so why not health? However it′s only part of the solution. The starting point is cultural – society respecting and celebrating that we live longer; us all accepting that we need to take more responsibility in taking care of our health, and not relying on the NHS to fix us when we are ill. I recently visited the US Veterans Health Administration (VA) in Washington DC, along with several leading NHS figures, to see how well it is exploiting digital health. Its hospital bed capacity is around one-third of what it was in the mid 1990s, yet outcomes and satisfaction have vastly improved. Part of this is as a result of a pronounced shift to digital channels, to the point that in two years′ time, 50% of its patients will receive elements of their care virtually. The VA is currently the largest user of telehealth in the world.

Do you think ‘joined up′ healthcare for the elderly is an issue? How so?
I would go wider than this. It′s social care too. The VA addressed this by redesigning their whole system around the patients′ needs and convenience ‒ and that of their carers. Rather than giving their GPs sole responsibility for coordinating care, they broadened it to a primary care team including social care, whose role it is to consider preventive care needs as well, enabling them to reduce emergency care needs dramatically.

Do you think ‘seamless service′ between primary care and community care and primary care and social care has the potential to become a reality? How can we best create a culture where this is possible?
I believe the new structures will help to make this possible, with clinical commissioning groups (CCGs) focusing attention on the ‘frequent flier′ patients with complex long-term conditions (LTCs) who would benefit from better care outside hospital. Telehealth has a key role here in enabling such patients to be safely monitored from home and opening pathways of care that previously were not available. One VA patient we spoke to said, rather memorably, that telehealth gave him “tremendous benefit, psychologically, knowing I am being monitored”. In the VA, care coordinators perform a vital role in ensuring patients use the technology effectively and act as a triage service into the wider healthcare system.

Is technology a key to patient-centric care for the elderly? How so?
Through technology, particularly videoconferencing and secure messaging, the VA now guarantees access to its primary care teams within 24 hours. The choice offered to patients is clear: between same-day virtual care, or wait and travel for face-to-face care. In this way, telehealth is accepted as part of everyday care delivery just as much as a face-to-face consultation is. The VA′s starting point is a comprehensive electronic care record to which patients have access ‒ and shortly there will be a comprehensive, secure and integrated set of apps available to patients and carers. We should be aiming for the same goal within the NHS. To make it succeed, we need to improve clinical engagement with regards to confidence that new technologies work under firm and clear leadership, working to a sustained plan.