Connected or disconnected health?

A theme that abounds in both my own and in blogs that I admire, is choice of language.  Working with people who live with long-term conditions, I’m acutely aware of the effect communication skills (good, bad & ugly) can have on the “doctor-patient” relationship.


There is much good evidence for this relationship being the most critical factor predicting good outcomes in conditions like type 2 diabetes. So. Language really matters.

Then why is it that I cringe when I hear the various terms that get used to describe modern means of communication between healthcare professionals and the people they serve?

You know what I mean: m-Health, digital healthcare, virtual consultations, “Technology enabled care services”, “Messaging enabled care services”, Telehealth, Telecare… the list goes on and on… and on, what’ll be next…


Yet these terms do describe means of communication that are immensely helpful to the people I serve as well as myself.  In my opinion we need to find a better descriptor if we are to effectively market these tools and allow them to become business as usual in NHS healthcare. I like the term connected health, there’s even a #connectedhealth 🙂

Today has been a good example-

This morning started off with an in-patient ward round, I was providing advice and guidance to our teams looking after people with diabetes within the hospital.  Much of that work is now accomplished remotely, the big difference being access to the right information upstream.  Being able to view both our electronic health record and also the Summary Care Record (medications prescribed by her GP) meant that I recommended a big change in treatment plan for one patient who has a very low HbA1c and is on insulin.

Such decisions can be scary, for healthcare professionals as well as patients!  Do nothing and this patient would be at risk of severe hypoglycaemia: act incorrectly and the patient risks poor glucose control…

Yet the safety of my decision was assured because we can remotely monitor the effects of this change on the patient’s capillary blood glucose levels.  If things aren’t working out I can quickly reverse the decision.  We’ve had the ability to offer advice in this way only for around six months now.  It feels good. It feels safe. It feels connected.

It also means I have more time to fit in other tasks & duties, so by late morning I had a scheduled telephone consultation. The background was that this person wished to cancel their clinic appointment with me for tomorrow, work was just too busy for them. Yet my excellent secretary offered a “virtual consultation” as an alternative, giving them the option of Skype, FaceTime or a simple telephone call.  They opted for the latter, as they were at work &

  • we had a cordial conversation
  • I exchanged information about her lab test results
  • we agreed a change to her treatment plan
  • we wished each other a Merry Christmas

She was more than delighted with the experience, she said. Now that gave me a warm glow too and I tweeted about it

Screen Shot 2014-12-15 at 16.00.36

No sooner had I tweeted, an iMessage popped into my inbox.  It was from a person whose preference is for a mix of Skype consultations with SMS.  Our exchange went something like this, the times are real-

11.58- Had my blood tests on Friday thanks for letting me know how they look

13.05- test look marvellous [result supplied], how do you feel about cutting down the dose of your tablets? Would you like to Skype later on today?

13.10- that’s great news [tells me dose of tablets], I feel well and don’t have other questions so if you just let me know what to do about the tablets that will be fine

13.18- Great, suggest you please halve your tablet dose, I can fix you up with a prescription if you like or we can do this through your GP? Will also give you another blood test form for next time 🙂

13.21- yes please, if you could leave a prescription for the first supply of the new dose on your reception desk I will pick it up on my way to work in the morning.  Plus I already have a blood test form for next time.  Have a great Christmas!

13.25- all done and waiting for you at reception. I’m around in the morning, so please do say hi when you pop in, otherwise Merry Christmas to you too! 😉

And that too felt good. It felt safe. It felt connected.

It’s now been over a year since we’ve been offering virtual consultations in my department. This meant 1st having a fit for purpose Wi-Fi system, then acquiring the hardware was easy, we use iPads.  So technology has not been a barrier.

More difficult has been convincing the people we serve & my colleagues too, that communicating in this way can be really useful.  Taking this to any kind of scale & thinking of it as business as usual is a huge challenge.  On a microscopic level ours is an important lesson for those seeking to ensure success of the ‘NHS Five-year Forward view’ and the ‘Personalised Health and Care 2020’ agenda.

So I like to refer to this as connected health.  Do you want connected health? Yes? OK!  Together, let’s make #connectedhealth business as usual.  We’ve all had enough of the alternative for far too long 😉



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