Digital TV – a resource for health service delivery?

Nick Williams MA (Management) PGDip PGCert

Final year mature student, Bristol Business School (UWE), UK.

Pear Tree Cottage, Theale, Wedmore, Somerset, BS28 4SR, UK. E‐mail: nicholas.williams@cwcp.cwplc.com

Introduction

The clearest illustration of our new communication behaviour is the Internet. None of us is able to survey its full extent, none of us knows all the information it contains, and none of us can fully explain it. But many find it great. Why? Because everybody can conjure up on his/her computer screen those bits and pieces of the universe he/she takes a personal interest in provided he/she can manage to find them…the Internet fully corresponds to the needs of our pictogram society. It offers interaction, variety, concise illustrations, a host of disconnected bits of information which we can then assemble ourselves into a coherent body of information. [Meryn, 1998] ¹

Meryn's comments on communication behaviour are as relevant today as when written 4 years ago. Digital media has changed the way we look at information. Perhaps the main difference now is the emergence of digital television (DTV) services. This article considers the significance of digital media for health information made available to the public through DTV services.

Background

Services providing health information remotely to patients and the general public have been steadily growing over the last decade. These have been well received. Munro et al. monitored a telephone helpline for patients in England [National Health Service (NHS) Direct] and found that call rates doubled during the first year of operation. ⁹

Today it is common to be ordering everyday items such as CDs, books, holidays, and accessing travel information and medical information electronically (via Internet, telephone, TV). This has been taken up by millions of people, with approximately 537 billion emails delivered in 2000 alone. ²

Access health information via TV

In terms of current usage, approximately eight million households in the UK currently receive DTV services, about a third of all UK households. ³ This appears to be one of the highest rates of take‐up in the world. The distribution of these DTV services is shown in Fig. 1. The government has committed itself to remove analogue services between 2006 and 2010.

Figure 1.

Types of DTV in use in the UK.

According to Discovery Health, a major broadcaster of health content, traditional information on health services is harming our well‐being. ⁴ Discovery Health surveyed 1000 nationally representative respondents: 96% of respondents said they believed that health is more important than winning the national lottery, and 83% use television as an information resource, instead of more traditional methods (such as reading). What the survey did not address, however, is whether ‘interactivity’ available through DTV is of importance to people, or, whether it makes any difference to people's experiences of the service.

New technology is bringing video streaming to people's computers, and the use of broadband (to increase the speed at which quality images are delivered) is increasing across many parts of the UK. ⁵ DTV can help to improve the rather static ‘image’ that can be displayed on a computer screen.

The technology behind digital TV

Digital TV uses digital video broadcasting (DVB) standards which are ‘open’, and are therefore supported by different systems and manufacturers. DVB refers to the signalling and this is transported into people's homes by three main mechanisms: cable (fibre optic or copper); terrestrial– using a similar method as the traditional analogue, or satellite.

Systems using DVB can be enhanced to carry more than pictures, and can be manipulated to be interactive, carrying signals both ways and allowing a response when an action is performed at the remote end. Different methods of access provide alternative methods of interactivity.

Pictures are transmitted using the same technology employed by the Internet, known as Moving Pictures Experts Group (MPEG) images. The technology is becoming a standard format for companies and organizations developing content. A satellite dish is needed to receive pictures and sound in this format. Terrestrial services using digital signals can utilize the existing analogue aerial. In most cases, cable TV is delivered using fibre or copper cable which must be physically fed into the home, and manually connected to the television.

It is often less expensive to opt for the terrestrial TV service because additional equipment and installation are not needed. However, no individual company offers full geographical coverage, so choice for consumers is currently restricted.

NHS digital TV pilot services

The national health‐care strategy document, the NHS Plan, stresses the need to support well‐coordinated seamless services across ‘whole’ systems. ⁷ The information and IT systems needed to deliver these objectives must be capable of being personalized to meet the needs of the individuals, both to receive and respond to these services. ⁸

Four pilot projects have been carried out to investigate (and experiment with) DTV in health‐care. ⁶ These comprise part of a wider framework of channels being considered by the government for delivery of information services.

A key factor in the implementation of alternative channels is that the public must be able to understand how they can access and use services easily. Importantly, they need to receive confirmation back (electronically or otherwise) as evidence that any requests or questions have been actioned.

The pilot projects carried out by the Department of Health represent an ambitious move forward for the NHS. There were considerable differences between the projects, in terms of initial expectations, how the service would work, and what the outcomes would be.

One finding, for example, was that text‐heavy information was not well received by users of the service, suggesting a need for video‐based information, especially if people in lower socio‐economic groups are to benefit.

Comparison to other ways of working was useful [such as information gained in general practitioner consultations], but stronger criteria will be needed to reinforce the benefits of interactivity (such as on‐line consultations). The research being carried out should offer focused and reliable data on how the services were received and the value they could bring to the public.

Conclusions

There is clearly great scope for DTV in the provision of health‐care advice in the future. The increase in Internet use shows people's willingness to adapt to new technologies, and DTV can provide richer content than a static web page At the same time it has the potential to meet the needs of many people who do not, or cannot get information from other sources.

The quality of consumer health information provided is key. ‘Despite a rapid growth in the provision of consumer health information (mainly on the Internet), the quality of the information remains variable.’ ¹⁰ Mediation between broadcasters and clinicians should help to ensure greater consistency.

Capacity and technology are also key. The volume of information that the public might want is potentially huge, covering many different conditions and diseases. While providing a video clip for each topic is probably unfeasible, innovative approaches to sign‐posting, or linking with other services for additional assistance would be one way forward. This could be provided using conventional telephone helpline numbers, or through interactive services directing viewers to video clips or on‐line chat services. Information presented as text, although cheap to provide, is not liked by viewers. Users appear to want to be drawn into specific fields to learn more about the subject area in which they are interested.

The financial stability of the TV operators (especially cable) could also determine the success or otherwise of DTV in the health field. Recently, a national digital service, ‘ITV digital’, failed. This may have damaged people's confidence in the service. In addition, the technology required to operate the more interactive services needs to be pervasive if it is to become a national, rather than a minority service.

Encouraging individuals to use DTV will be important. This must include the provision of specific programming that is entertaining and interesting to the audience.

The results of the initial research into the NHS DTV pilots and feedback from viewers will provide a fertile ground for further study. There is scope for research into how best to present the information, drawing on experience of the way in which story lines are developed in existing popular programmes.

Delivering health‐care services via DTV could lead to major advances in people's knowledge of health‐care, and interactive discussion forums could help to raise awareness of public health issues.