Telehealth

Telemedicine is a subset of telehealth. There are, however, multiple subsets of telehealth that include mHealth (mobile health) accessed via smartphones (Lynch and Fisk 2017); health and clinical disciplines and roles such as telepsychiatry, teledermatology, telecardiology, teleradiology, and telenursing (Schlachta-Fairchild et al. 2008; Gogia 2020); and social care including social alarms and telecare (Fisk 2003). A characteristic of telehealth is the differential rate by which it has been integrated within more traditional health services.

Telehealth services can be accessed by people through the simplest of telephones or linked devices (as with social alarms, personal emergency response services) including for information, and advice; through smart services, i.e., mobile devices (with greater functionality and access to apps); or through communication networks with video and audio connections which can carry substantial data, including images, relating to their activities and/or vital signs (whether to help with self-management or to facilitate diagnoses, treatments, or other interventions). The format of telehealth that relates to tele- and video-consultations has come to the fore as a consequence of the COVID-19 pandemic in 2021 (Fisk et al. 2020; Greenhalgh et al. 2020; Lieneck et al. 2020; Salisbury. 2020). Darkins and Cary (2000) noted in the opening sentence of their book that “telecommunications technologies are changing ways of thinking, acting and communicating.” They set out to explore how these changing ways were impacting or could impact on the established health-care systems that, they affirmed, “until comparatively recently” had been “the exclusive preserve of the health professions.” Their work focused on the United States and the United Kingdom, but the issues they attempted to address have global resonance. The point they made regarding ways of thinking carries a particular truth in view of the adoption of telehealth frequently requiring changes in operational procedures and the adoption of mindsets that increasingly focus on the enablement (and empowerment) of patients. Telehealth development, in addition to and in the wider context of ‘digital health’, is enabled by advances in communication technologies and relates to a wide and changing context of health disciplines and service types (Lupton 2018). The driver for the changes is, in part, people’s aspiration to have control over their health. Advances in communications technologies in the ensuing two decades have enabled the development of telehealth. Dinesen et al. ( 2016), in another transatlantic review (United States and the European Union), pointed to the “greatest strides in the use of remote monitoring technologies” that have occurred – telehealth. Most notable are the increased capacity of communications networks; and the increased intelligence embedded within smart and often portable devices by which information or services can be accessed and/or remote monitoring can take place. Some of the wide range of technologies has been noted by McGee Lennon et al. ( 2012), including TV, personal computers, mobile phones, and (normally wrist-worn) “wearables.” Within the range of telehealth technologies, apps have an important place. A growing and potentially crucial role, furthermore, is beginning to be played by voice-activated technology (Barnett et al. 2020).

Health care (including that element which may carry the telehealth label), as a consequence, becomes a matter within wider service “menus” – ready to be accessed and used in ways that people themselves choose as well as that necessitated by the clinical need.

With issues relating to broader well-being in mind, telehealth includes aspects of social care. This means that part of telehealth is closely positioned in communities and people’s homes rather than institutional settings such as the hospital, clinic, or nursing home. It creates a context where its role can be both clinical and preventative health – carrying the potential to influence and support people (with, where needed, the involvement of social care and community nursing staff), not just in relation to their health but also their behaviors and lifestyles. This is also a pointer to telehealth’s potential benefits within the most remote rural and island communities – where clinic- and hospital-based services may be scarce or unavailable. The same applies for areas that experience conflict or natural disasters.

Dineson et al. (2016) posed three questions regarding telehealth: (1) How will the market players (designers, manufacturers, service providers) respond to the changing technological context? (2) To what extent will they recognize the inevitable shift away from established models of clinically (and institutionally) driven health-care delivery? (3) How rapidly (and in what way) will the demand for services change as more people access and use new technologies in ways that fit with their lifestyles, behaviors, and needs? An additional question must now be posed relating to the last of these, viz. (4) To what extent will the COVID-19 pandemic lead to permanently changed patterns of health service provision?