The argument that the NHS should use more video calling technologies is frequently made. But there needs to be an appreciation that Skype and teleconsultation are not synonymous, argues Ian Jackson.

When the NHSmail 2 Portal was introduced to healthcare around three years ago, Skype for Business was added in a primitive form, mainly as an instant messaging tool. Since then there has been an increasing focus on the potential of teleconsultation in the NHS – including suggestions in the Long Term Plan of increasing numbers of digital first appointments.

But if teleconsultation is really to work in the NHS, we need to consider the core aspects any solution is going to need.

So, as a clinician, what do I need from my teleconsultation technology?

  • I need a simple click to start my teleconsultation
  • I need a system that shows me my video appointments for the session, and which of my patients are logged in, ready to be seen
  • I need confidence that the patient I am talking to is who they say they are, as I may not have met them before. That means secure login and linking to NHS number is essential, with clear identity points that I can verify with my patient from the start
  • I would then need the ability to link the system to my electronic patient record, initially so staff can organise and record appointments. But in fullness of time I would like the ability to record conversation and either have it transcribed or stored directly in the patient record.
  • If I organise group sessions, such as in mental health, I would like the ability to have a simultaneous link to multiple patients
  • A reporting tool that provides information such as the number of teleconsultations completed, average duration and patients having multiple teleconsultations would be useful.

I think this points towards the NHS needing to looking at digital solutions holistically, rather than as a point solution. My belief is that if you decided to use Skype for patient consultations or for instant messaging, you would actually be creating silos of technology. So I do not believe healthcare should use the terms ‘Skype’ and ‘teleconsultation’ as synonyms.

And to make teleconsultation effective, I think we also need to consider related aspects. For instance, we need to think about how instant messaging can sit with such a setup, and how that messaging in turn supports more appropriate triage. That includes reflecting on:

  • Suitability for primary care networks. Instead of enquiries coming to a GP surgery through a phone call, imagine if they came via messaging. This could be coupled with immediate clinical triage – ensuring patient requests went to the most appropriate member of the team immediately – and messages back to the patient to keep them informed.
  • The ability to have secure two-way messaging to patients. Again, these could be routed to the most appropriate person and the response a message back or a teleconsultation if appropriate.
  • The ability to provide support to patients post-discharge. Surgical patients currently are offered phone numbers to call, should they support after discharge. But messaging could replace this as would allow these enquiries to be dealt with by an on-call team. And patients could have a teleconsultation as part of their follow-up process – allowing clinicians to see wounds and drains, or see the patient walking in their home, as part of the assessment.

In addition, messaging platforms could be used to send results to a patient, or to gather feedback.

For me, CIOs and CCIOs need to build a picture of the possible benefits of such a setup – moving away from speaking of Skype and towards talking about an integrated messaging and telecommunications platform. There also needs to be a tight focus on outcomes. Moving to teleconsultation in and of itself shouldn’t be the goal: it should be offering better, more efficient care for patients.

Ian Jackson is medical director and clinical safety officer at Refero

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