Background This paper summarises a series of presentations on telemedicine given at a UK eHealth Week conference session in 2016. The formal evidence base for telemedicine is equivocal, but practical experience suggests that implementations of technology that support telemedicine initiatives can result in improved patient outcomes, better patient and carer experience and reduced expenditure. Objective To answer the questions 'Is an investment in telemedicine worth it'? and 'How do I make a telemedicine implementation work'? Methods Summary of systematic review evidence and an illustrative case study. Discussion of implications for industry and policy. Results Realisation of telemedicine benefits is much less to do with the technology itself and much more around the context of the implementing organisation and its ability to implement. Conclusion We recommend that local organisations consider deployment of telemedicine initiatives but with a greater awareness of the growing body of implementation best practice. We also recommend, for the National Health Service, that the centre takes a greater role in the collation and dissemination of best practice to support successful implementations of telemedicine and other health informatics initiatives.

The development of telecare services across the UK has been supported by grants from the respective governments of Scotland and Wales, and by the DH in England. New services are being established to sometimes operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce the use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed so that service users can choose appropriately if offered direct payments. Two different service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e-care and m-care, and telemedicine where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three different technology groups designed to make people more independent or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term-ARTS (assistive and remote technology services)-to describe this area of support.

We have attempted to quantify the benefit to both patients and professional users from introducing 'self-service' kiosks into the waiting rooms of general practitioners (GPs). We conducted a series of interviews with practice managers, GPs and patients in practices where kiosks had been used. We then estimated the time savings and other benefits. There were significant time savings both for nursing and GP staff, and similar time savings for patients. We estimate that the total time savings would be equivalent to one health-care assistant for a practice size of 10-12,000. Practice income was enhanced as a result of the improved information gathering made possible by the kiosks. These effects resulted in improved patient outcomes. The key to successful implementation appears to be strong support, particularly from reception staff to encourage and facilitate the use of kiosks. To maximise the benefits, GPs and nurses must be prepared to change their ways of working.

The development of telecare services across the UK has been supported by grants from the respective governments of Scotland and Wales, and by the DH in England. New services are being established to sometimes operate alongside existing community equipment services and community alarm services. Elsewhere they are embracing a wider range of services including rehabilitation, intermediate care and health services designed to reduce the use of unscheduled care services. This paper discusses the difficulties in understanding the scope of telecare services, and the definitions of services that will need to be confirmed so that service users can choose appropriately if offered direct payments. Two different service models are offered, one of which uses telehealth as an umbrella term to cover all telecare, e‐care and m‐care, and telemedicine where the former includes all such services offered in the service user's home, including those of a medical nature. The second model views telecare alongside assistive technologies and telemedicine as one of three different technology groups designed to make people more independent or to bring care closer to home. There is significant overlap between the three groups, which justifies the introduction of a new term ‐ ARTS (assistive and remote technology services) ‐ to describe this area of support.

This paper is an argument for a more holistic approach to independent living. Telecare and telehealth, as these services are being delivered in practice, risk increasing the isolation of vulnerable people. Though undesirable in its own right, this isolation often leads to depression, which in turn typically increases the costs of medical treatment substantially. The resultant lack of mental stimulation also creates the conditions for earlier onset of dementia. Finally, loss of identity exacerbates both depression and lack of stimulation. To overcome these problems, the technology should also be used to encourage users of telecare and telehealth to maintain and grow their engagement with wider society and to promoterather than restrict -their mobility.

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Few doubt that there will be substantial benefits from the deployment of apps on smartphones to improve the delivery of health & social care. Evidence, particularly on the cost effectiveness of medical apps, is currently very sparse though. This paper will report on a project carried out as part of the TSB-funded dallas programme to determine what was necessary to improve the perception of medical apps by doctors, with the expectation that they in turn will recommend them to their patients. The vision is to get to a position where doctors are able to offer patients a choice of app or drug (or both) to deal with appropriate conditions, such as depression or anxiety.

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