Advances in information, communication and bioengineering technologies will change the ways healthcare is delivered.  Most believe that Telemedicine and Telecare technology has proved itself both technically and clinically.

The key issues concern the way the introduction of these services is managed so as to maximise the benefits for patients and healthcare services.  Telemedicine and Telecare already encompass a very wide range of applications using varying degrees of technology from standard telephone to ultrasound video by satellite.  They include:

Radiology and imaging, Cardiology, Information for patients and carers, Dermatology, Pathology, Telephone triage, Endoscopy, Home monitoring, Telephone follow up, Opthalmology, Prompting Services, Continuous education of clinicians, Psychiatry,            Community nursing,  Access to expert advice, Trauma and minor injuries, Primary care advice, Links with social care.  Parallel developments in technology are taking place in the field of social care, especially in the area of alarms and the monitoring of daily living activities.

Telemedicine and Telecare, by changing the way in which services are delivered, have the potential to provide a wide range of benefits.  The most important benefits are improving access to services and expertise; improving the quality of services; supporting teaching and research.  Telemedicine and Telecare will change the place of care and the configuration of health services, with more care provided at home and in the community and less in hospitals.  If realised as an integral  part of the way in which services are delivered, it could reduce in-patient stays, A&E and OP attendances, also home visits.  Patients can benefit from reductions in the amount and cost of their time and travel.  Assessment and discharge can be speeded up, and waiting lists reduced.  This implies significant productivity gains.

The main difficulties appear to be that these technologies bring with them the need for changes in the way people work.  Telemedicine and Telecare do bring problems about the loss of personal contact between the clinician and patient; however studies have shown this to be less significant than expected.

There are now  a number of important clinical, technological, economic and political factors, including the White Papers, coming together to create a strong impetus for the development of Telemedicine services.

Relationships between patients and clinicians, also between health authorities, their staff and the wider communities are of the upmost importance in managing the changes.  Training is a key issue.

- Department of Health have a vital role at national level in supporting these developments by providing a strong lead and ensuring that the right framework and infrastructure are developed.
- Health Authorities, when deciding the range and location of services and developing Health Improvement Programmes, will need to take into account the potential of Telemedicine and Telecare to provide better healthcare.
- Trusts should consider how to realise any benefits for improved patient care and greater efficiency.
- Primary Care will experience the changes in the relationships with secondary care, the way that referrals can be made and how patients can be better supported at home.

Developing a multilevel approach will stimulate discussion of the issues and facilitate the development of services.  It would be best driven by a co-operative partnership between government, health services, the professionals, industry and patients' representatives.