Well-implemented telehealth systems can reduce the total costs of care by reducing emergency hospital visits and unnecessary treatment. Telehealth is especially well-suited to supporting patients with chronic, complex or co-morbid conditions. A substantial body of research – much from the USA – documents the value of a commercially-available system which supplements remote monitoring with daily questions about the patient's health and behaviours. However, there are still very few large scale deployments of telehealth because the best practices needed to implement it are still being developed.

We interviewed nurses and patients with heart failure who were participating in a research trial of home telemonitoring in which weight data were monitored automatically by a call centre. A total of 35 interviews were conducted and the transcripts were analysed thematically. The results indicated that nurses disagreed about the role of weight monitoring and the practicalities of telemonitoring in their daily practice, indicating that the process was idiosyncratic to each user. The lack of personal feedback and nursing contact discouraged patients from weight monitoring, suggesting that a feedback mechanism may have to be adapted to suit patients. There were other factors which created barriers to acceptance by patients and staff. Home telemonitoring for heart failure cannot be evaluated effectively using the standard approach commonly employed. New studies are required.

A telehealth system that can transmit vital signs data, and also empowers patients to maintain their autonomy and learn how to manage their disease better, can improve patients' quality of life. Such a system can form part of a high-quality and efficient health-care service. The Bosch telehealth system, which focuses on self-management, has been used by thousands of patients with long-term conditions in the USA and Europe. The efficiency of the programmes, as well as their positive effects on quality of life and compliance, have been proven for a number of chronic conditions, as well as for patients with multiple co-morbidities.

We identified the need for a tele-ophthalmology service at the Tywyn hospital in Wales. During a two-year period, 22 emergency patients were managed by telemedicine, thereby reducing the need for ambulance transfer. We expect that there will be increased use of tele-ophthalmology in north Wales as the technology improves and the equipment becomes easier to use.

We started a telemedicine service for paediatric cardiology work in 2006, enabling transmission of echocardiography images via videoconferencing equipment to the specialist paediatric cardiac department at Cardiff for review and/or diagnosis. The system has been used regularly for a range of paediatric cardiology cases. Despite increasing the transmission bandwidth to 1 Mbit/s the transmission of live echocardiography was still considered to be suboptimum. Nonetheless, the implementation of a simple telemedicine service has demonstrated the feasibility of transmitting echocardiography images via videoconferencing equipment for diagnosis and second opinions.

We have attempted to quantify the benefit to both patients and professional users from introducing ‘self-service’ kiosks into the waiting rooms of general practitioners (GPs). We conducted a series of interviews with practice managers, GPs and patients in practices where kiosks had been used. We then estimated the time savings and other benefits. There were significant time savings both for nursing and GP staff, and similar time savings for patients. We estimate that the total time savings would be equivalent to one health-care assistant for a practice size of 10–12,000. Practice income was enhanced as a result of the improved information gathering made possible by the kiosks. These effects resulted in improved patient outcomes. The key to successful implementation appears to be strong support, particularly from reception staff to encourage and facilitate the use of kiosks. To maximise the benefits, GPs and nurses must be prepared to change their ways of working.

We investigated the use of surface electromyography with biofeedback for telerehabilitation. The aim was to investigate the therapist's point of view, and the general acceptability of the system for the patient and for the therapist. The system allowed a therapist to modulate the rehabilitation protocol remotely, by changing the configuration variables, e.g. threshold and duration. The case study focused on a patient with arm impairment following a stroke. After two weeks of daily usage, there were some differences between the patient and the therapist about the ease of use of the equipment. However, there was general agreement about the usefulness of the system, ease of the performed tasks, appropriateness of the performed tasks and overall opinion. Wireless technology would reduce the complexity of the tasks required of the patient.

We conducted a retrospective review of the digital images in the clinical records of 50 patients with pressure ulcers. Ten nurses independently assessed one image from each patient. There was a total of 414 responses from the nurses about the stage and location of the ulcers (83% response rate). The average agreement about the stage and location of the ulcers was 85%. The overall agreement declined as the stage of the ulcer increased. The average agreement regarding the wound descriptors was: necrosis 85%, granulation tissue 81%, ischaemia 83%, cellulitis /infection 69%, erythema 68%. Almost all nurses felt the need to change the current management of the wound (460 responses, or 92%). The nurses judged that most digital images were of good quality (17%) or very good quality (79%). The present study suggests that a high percentage of assessments for patients currently travelling to specialist clinics could be performed in the community using digital images and telemedicine.

An observational study was conducted of two different videoconferencing services offered by the Royal Brompton and Harefield NHS Trust (RBH), a tertiary centre for cardiology in London. In the first, specialist cardiology advice was provided by telemedicine (384 kbit/s bandwidth) to four district general hospitals in England. In the second, specialist cardiology advice was provided via a low-cost videoconferencing system (128 kbit/s bandwidth) to the Mother and Child Institute in Belgrade. The hospitals chose to use the equipment for different purposes and in different ways. However, at the end of the study, they continued to use telemedicine for the normal provision of clinical services. The success of the projects can be partly attributed to the staff involved and in particular, to the telemedicine champions at the RBH. The needs of the patients were identified and then the telemedicine service was designed by local clinicians to meet those needs.

Detailed information about the composition of the carbon footprint of the NHS in the Grampian health region, and in Scotland generally, is not available at present. Based on the limited information available, our best guess is that travel emissions in Grampian are substantial, perhaps 49,000 tonnes CO2 per year. This is equivalent to 233 million km of car travel per year. A well-established telemedicine network in the Grampian region, which saves over 2000 patient journeys a year from community hospitals, avoids about 260,000 km travel per year, or about 59 tonnes CO2 per year. Therefore using telehealth as it has been used historically (primarily to facilitate hospital-to-hospital interactions) seems unlikely to have a major environmental impact – although of course there may be other good reasons for persevering with conventional telehealth. On the other hand, telehealth might be useful in reducing staff travel and to a lesser extent, visitor travel. It looks particularly promising for reducing outpatient travel, where substantial carbon savings might be made by reconfiguring the way that certain services are provided.

We studied the patient experience of a telephone booster intervention, i.e. weekly reinforcement of the clinic advice regarding lifestyle modification advice to support weight loss. Forty six adults with Type 2 diabetes and a body mass index >28 kg/m2 were randomised into either intervention (n = 25) or control (n = 21) groups. Semi-structured interviews were conducted with the intervention group participants to explore their views and experiences. The patients were satisfied or very satisfied with the telephone calls and most would recommend the intervention to others in a similar situation. The content of the telephone follow-up met their need for on-going support. The benefits arising from the telephone calls included: being reminded to comply with their regimen; prompting and motivating adherence to diabetes self-care behaviours; improved self-esteem; and feeling ‘worthy of interest’. The convenience and low cost of telephone support has much potential in chronic disease management.

We have developed a personalised self management system to support self management of chronic conditions with support from health-care professionals. Accelerometers are used to measure gross levels of activity, for example walking around the house, and used to infer higher level activity states, such as standing, sitting and lying. A smart phone containing an accelerometer and a global positioning system (GPS) module can be used to monitor outdoor activity, providing both activity and location based information. Heart rate, blood pressure and weight are recorded and input to the system by the user. A decision support system (DSS) detects abnormal activity and distinguishes life style patterns. The DSS is used to assess the self management process, and automates feedback to the user, consistent with the achievement of their life goals. We have found that telecare and assistive technology is feasible to support self management for chronic conditions within the home and local community environments.

Endnu en sten er ryddet af vejen for, at hospitalerne i Region Midtjylland kan få et fælles journal-system.

13.000 gange om året rejser bornholmske patienter over Østersøen til Rigshospitalets specialister. Det er krævende for patienterne og dyrt for regionen. Pilotprojekt med konsultationer via computeren telemedicin viser et stort potentiale og nogle få knaster.

Norske kol-patienter får nu også en såkaldt patientkuffert, som giver mulighed for behandling i eget hjem.