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.
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Decent of you Steve. Thanks.
Posted by: David Tebbutt | June 19, 2009 at 10:14 AM
Great post which I have just referenced on: http://www.telecareaware.com/
Posted by: Steve Hards | June 19, 2009 at 09:18 AM