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06th June 2013

New initiative in Telehealth

I remember working on a Scottish island and taking part in a discussion on `telehealth`.  The idea then was to place stand-alone booths in remote village halls, and even pubs, where people could plug themselves in and consult a GP remotely.   Now, ten years later, technology is used to enable practices to remind patients to take medication using SMS texts.  I get text and email reminders about appointments in both primary care and outpatients departments.  Thank goodness, because I`m getting on a bit and do forget!

The surprise for me is that the latest initiative in remote access is not being led by someone in a rural community but by the Clinical Director of Stoke on Trent CCG.  Professor Ruth Chambers has taken the one-way SMS communication that we are now familiar with and developed the concept of a two-way flow of information.   In one direction, a patient would receive both reminders of actions to take, as well as positive health messages and instructions, which are customised to their particular condition and circumstances.  In the other direction, they can send in (following training) previously agreed  information such as blood pressure, weight or oxygen saturation.  This information is regularly monitored by the clinician and can be responded to with encouragement and further advice.  This initiative is called FLORENCE, or FLO for short.

An example quoted is that of a patient being monitored for chronic lung disease.  Following a previously agreed management plan, they could start standby antibiotics and steroids in response to the signs of an acute infection.  The experience of using FLO is that patients receive this treatment hours or even days before they would by seeking an actual appointment at the surgery.  The importance of viewing this as an aid and not a replacement for clinical management is important.  It will work well with the agreement and cooperation of all concerned.

A concern expressed, though, is whether a busy practice will become heavily dependent on this type of communication.  It will be more difficult to back-track on this, once well-established, should there be any loss of personal care.  Inevitably, if it becomes part of mainstream medical care, some people will be disenfranchised from receiving best care if they are not able to cope with a new technology.  Remember, there are still people `out there` who don`t own or use a mobile phone!

More information at

-Dr John Shapter

Topics: GPs


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