Thursday, July 10, 2014

Telehealth: opportunities and challenges for clinicians 

Recent studies suggest that GPs can view telehealth as a threat to their identity as “gateways” to health care (e.g. Segar et al. 2013). This is because, after referral or hospital discharge, patients mainly deal with a telehealth centre. Yet, GPs can also see telehealth as a means of empowerment by giving them more responsibilities in managing such conditions as Heart Failure (HF) early enough to avoid hospitalisations. That is the case when, for example, GPs go for a specialist pathway, such as cardiology, and become GP with Special Interests (GPsIS). Even though some GPs may see the role of GPsIS as undermining their autonomy and identity as general medical professionals (Currie et al. 2012), some GPs may view these new specialisms as an opportunity to enhance their knowledge and their professional status.

Yet, often General Practices do not have the capacity to lead a telehealth project. Their major involvement would require a considerable investment of resources on primary care. Yet, this does not seem to be much different from the resource needs that the hosting of a telehealth centre in a health care community centre involves. Therefore, we can conclude that, if GPs buy into telehealth and they are given enough resources, their level of engagement in the successful implementation of telehealth may be related to how telehealth impacts on their professional status. Such impact may not necessarily be negative but also positive for the sustainable and scalable adoption of telehealth.

Thus, the issue at stake is to understand how GPs can be enrolled into the innovation process enabled by telehealth. GPs can actually influence the course of an innovation in the health service. For example, GPs’ members representatives bodies and other forms of organizations such as clinical advisory groups can have a say in CCG Governing Bodies’ decisions on whether and how an innovation should be put in place.  It is in these circumstances that the role of CCGs in health care IT innovation takes prominence. Given that GPs have a high representation in their governing bodies, it is legitimate to ask how the interplay between their roles of “commissioners” and “medical professionals” influences the quality of relationships with key health service stakeholders affected by telehealth implementation. 

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