Cardiac telemedicine has moved decisively from pilot to practice. Joshua Rowe explains how it is revolutionising care and saving the NHS money

With an estimated£34bn being spent on diagnosing and treating cardiac patients and the cost to the taxpayer averaging£305,000 per patient, cardiac care is the single largest financial burden on the NHS.

This problem needs to be addressed and the ability to move treatment away from hospitals into the primary sector and even to home care is the best way to tackle this issue.

Dealing with health issues in a primary care setting, without having to call on the emergency services or secondary care providers, would mean enormous cost and resource savings for the NHS and an enormous reduction in the burden on government health resources.

The great benefit would also be to patients. Immediacy of diagnosis reduces anxiety and tension and enhances convenience and quality of life (and at the same time, makes savings in the economy as a whole: so many working days otherwise lost). Addressing problems at an earlier stage means patients receive more timely and preventative support, ensuring optimal care.

Telemedicine has largely been confined to pilots but thanks to a year-long and highly successful trial by the Cumbria and Lancashire cardiac network and by the cardiac network in Greater Manchester, together with support from the Department of Health, interest in telemedical cardiac monitoring services is increasing.

A 12-month evaluation of Broomwell’s service inCumbriaandLancashire,involving 15 GP practices and two NHS walk-in centres, demonstrated the potential cost and resource savings of implementing a telemedicine service in the NHS.

Data from the pilot predicted that 90,000 accident and emergency visits, 45,000 hospital admissions and hundreds of lives would be saved each year inEngland.Following an electrocardiogram test at the surgeries, 82 per cent of patients did not need to go to hospital. Pilot data estimates that by cutting the level of referrals to A&E (and hospital admissions thereafter), the minimum savings to the NHS would be£46m each year.

The pioneering service is also currently in use in four primary care trusts across Greater Manchester and since its launch in 2006 it has already been used with over 1,500 patients within Greater Manchester.

Reports from the Greater Manchester and Cheshire cardiac network confirm that the service has delivered cost savings and has freed up significant secondary healthcare resources across the region. Following its success, it is now being rolled out to a further five PCTs in the GMC network.

Referrals cut

Broomwell’s own figures show that of around 6,500 ECG transmissions in the past 17 months, 93 per cent of patients did not require referral to hospital. Within those numbers there are some 3,500 ‘symptomatic’ patients and of those, 88 per cent did not require such referral. Without the service, at least 50 per cent of those (symptomatic) patients would likely have been referred to hospital (A&E or outpatient departments).

It is estimated that if telemedical cardiac care were implemented on a wider scale and included such things as arrhythmia monitoring and home monitoring for congestive heart failure and coronary heart disease (to avoid so many repeat visits to hospital), the savings to the NHS could well exceed£250m per year.

The cardiac monitoring service enables clinicians to transmit ECGs using handheld units, via the telephone, to the centre – which is staffed by clinicians – and receive an immediate verbal evaluation, followed by a written report.

The concept is logical and the evidence is clear: telemedicine saves money for the NHS and is liked by clinicians and patients, so the obvious question is, how to implement it in mainstream healthcare?

The good news is that healthcare bodies are beginning to realise the potential of telemedicine and the huge benefits it brings to all parties.

The work in Greater Manchester and in Cumbria and Lancashire has clearly shown how telemedicine can be brought into the mainstream of cardiac care and applied across all PCTs in theUK.This will help PCTs ease the burden cardiac care places on their A&E and outpatients departments, delivering significant financial and operational cost savings, and at the same time improve and enhance the service available to patients.

PCTs can extend the service to monitor CHF and CHD patients at home. This kind of service would drastically reduce the ‘frequent visitors’ who, in some areas, account for 25 per cent of hospital admissions. Most of these visits prove to be unnecessary and patients are discharged after a day or two.

Broomwell’s analysis of current home users of the service indicates that in over 90 per cent of calls, patients are reassured and kept at home. Such a provision would mean enormous financial savings to the NHS while enhancing the quality of life of patients and saving the vast number of lost working days to the economy as a whole.

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