Can technology help people with COPD stay well at home? Lessons from a UK rapid evaluation
As the NHS expands digital support for long-term conditions, our rapid evaluation examines how technology-enabled remote monitoring is working for people with COPD. By exploring patient and staff experiences across four NHS sites, the study highlights what TERM can offer, where it falls short, and what services need to ensure remote monitoring genuinely supports people to stay well at home.
Imagine feeling short of breath after walking just a few minutes or needing to pause after a shower to catch your breath. For people living with chronic obstructive pulmonary disease (COPD), this is daily reality. As one patient recently told me: “When I have a shower, if I go for a walk, I'll probably have to stop and get my breath even on the flat after a few minutes.”
This experience of breathlessness is widespread. COPD affects around 1.2 million people in the UK. It is a long-term condition that causes airflow blockage and breathing difficulties. Flare-ups of symptoms (exacerbations) are the second most frequent cause of emergency hospitalisations. These episodes reduce quality of life, increase healthcare costs, and bring frustration and anxiety.
With NHS services under significant pressure, interest has grown in how technology can support COPD patients at home, helping to detect problems early, give people more confidence in managing their condition at home with remote support as needed, and reduce hospital admissions.
To explore how this actually works in practice, our team conducted a rapid qualitative evaluation in 2024 across four NHS sites in England. The work formed part of the DECIDE programme, funded by the National Institute for Health and Care Research (NIHR) to examine how technology-enabled remote monitoring (TERM) is being used across health and social care.
We spoke with national and local stakeholders, clinicians, patients, and carers to understand how these services are being implemented and experienced, and what helps or hinders their success.
What is Technology-Enabled Remote Monitoring, and why is it relevant for COPD?
Technology-enabled remote monitoring (TERM) involves patients using devices or apps to track their symptoms, such as oxygen levels, heart rate, breathlessness and mood, and sharing this information with healthcare professionals. Clinicians may monitor a dashboard of patient data, respond to alerts, or follow up when patients report worsening symptoms.
In our study, we found that there is no single approach to TERM for COPD. Tech-enabled remote monitoring services reflect local needs, priorities, and capacities. They offer anything from light-touch self-management apps that offer education and symptom logging, through to hybrid models combining patient input with some staff oversight, and to proactive monitoring of high-risk patients with daily check-ins and case management.
Approaches to technology-enabled remote monitoring for COPD patients, ranging from self-management through to proactive monitoring
TERM sits neatly within the UK government’s new 10-Year Health Plan, published in July 2025, which emphasises three transformational shifts: moving care out of hospitals and into communities, embedding digital services, and focusing on prevention as much as treatment. Remote monitoring is seen as a key tool in this future vision.
In the context of COPD, tech-enabled remote monitoring services have the potential to offer earlier interventions, more personalised support, and fewer emergency admissions. But evidence from the last two decades is mixed. Systematic reviews have found some small benefits in quality of life and service use, but many trials are small, underpowered, or fail to capture the wider system impact. The evidence also suggests a high degree of organisational variation in the introduction, delivery and maintenance of technology-enabled remote monitoring for COPD. Key questions remain unanswered about whether, when and how to introduce – or extend - remote monitoring technologies into COPD care pathways, for whom and why.
What we did
To address this gap and understand how TERM is being used in COPD services, we conducted our rapid qualitative evaluation in 2024 across four NHS sites in England. We interviewed 29 national and regional stakeholders, carried out 19 in-depth interviews with staff, reviewed 18 documents, and spoke with 6 patients. We also held a stakeholder workshop with 23 participants and a co-design workshop with 9 patients and carers.
This gave us a rich picture of how TERM for COPD is currently being imagined, implemented, and experienced. In the sections below we summarise some of our key findings.
Patients’ experiences of using tech-enabled remote monitoring services to support their COPD at home
For patients in our study, TERM brought both reassurance and frustration. Several described feeling more connected to their healthcare teams and less alone in managing their illness. One patient explained that “you feel very isolated when you’re terribly ill” and that they felt comforted by the sense that someone was watching over their data. Another described it as empowering: “It backs up some of the things you’re feeling in your own body, and it’s data you know that shows trends that you can’t argue with (…) it just makes you feel more part of the process.”
Not all experiences were positive. For some, monitoring heightened health anxieties, while others found the tools confusing or demotivating when feedback was absent. As one person told us, “Just (…) handing somebody an app, it’s completely useless really… feeding this data into thin air.”
Inconsistent funding meant that tech-enabled remote monitoring services were not always sustained, even when they had been embedded into routine care. Patients could be acutely impacted by this. In one case, a valued tech-enabled remote monitoring programme was withdrawn, leaving people distressed. One summed it up starkly: “I was devastated.”
What mattered most to patients that we spoke to was not the technology itself but the technology-enabled service which provided additional reassurance of human connection and continuity of care. Much of the perceived value lay in feeling seen and supported.
Staff perspectives
For clinicians and care teams in our study, TERM sometimes opened up new and enjoyable ways of engaging patients. One clinician described how time spent onboarding patients to the TERM service gave them a novel opportunity “to have a conversation with patients and set their agenda (…) you know, what matters to you.” Another noted the warmth they observed when colleagues spoke with patients through TERM services: “You just… you can feel how much people care and how lovely they are when they speak to patients.”
Staff were also candid about the challenges. Monitoring patient data created new responsibilities and risks. As one put it, “As soon as you have data, you have a duty of care to respond to that data (..). And the more you do, the more you find. There’s a lot of risk that it (…) creates noise, but not value.”
A recurring frustration on the part of staff that we spoke to was the difficulty of demonstrating value in the narrow terms required by commissioners. Staff could see benefits for patients (e.g. reassurance, reduced anxiety, fewer crises) but these were not easily quantified. One commented, “Things cost money to set up and to do differently, and we’re pretty sure we’re decreasing pressure across the system, but we can’t prove it because there’s not the data.”
In other words, staff perspectives revealed both enthusiasm and unease: they valued what TERM could enable, but sometimes felt constrained by limited resources, interoperability issues, and evaluation frameworks that did not reflect the realities of care.
The service is about much more than just the technology
A recurring theme across sites in our study was that the technology itself was never the whole story. Staff stressed that apps, dashboards, and devices only worked when embedded in wider services. As one workshop participant put it, “The tech is a tool, it’s not the service.”
Behind every device were processes of onboarding, triaging, data interpretation, and follow-up, all shaped by local teams. What counted was not the technology in isolation but how/if it was woven into care pathways and sustained over time.
Some services elected to focus on reassurance and empowerment, others on reducing admissions. As one manager explained, “It’s about adding value to an existing service and managing demand for care.” Yet staff also worried about fostering dependency: “We don’t want to create dependence on the service.”
Services differ in how ready they are to introduce TERM (and keep it going)
In the NHS services that we visited, successful implementation required strong local readiness and capacity to deliver the new service and respond flexibly to the shifting demands of novel working practices. Services with motivated teams, supportive leadership, and digital infrastructure unsurprisingly found it easier to adopt and then embed TERM in existing workflows and pathways. But many struggled with workforce pressures and short-term funding. A regional commissioner told us, “You have to invest time and resources to develop the infrastructure necessary to support the transition.”
Even where tech-enabled services were well received, sustaining them proved difficult. The largest and most established site was decommissioned despite strong patient and staff support because it could not demonstrate direct, short-term financial savings using specific evaluation metrics. Patients were upset, and staff frustrated that indirect benefits, such as patient engagement in care, reduced ambulance conveyance and long-term admissions, and improved patient and professional wellbeing, were overlooked.
The problem of techno-optimism
The 2025 10-Year Health Plan situates digital technologies positively, in terms of contributing to a shift from “a sickness service to a health service.” Remote monitoring is framed as a way to extend care into homes and prevent illness before it escalates. Our findings suggest this optimism needs to be tempered by realism. Technologies do not transform services on their own. They interact with existing practices, infrastructures, and human relationships in complex and unpredictable ways.
Research from Human–Computer Interaction (HCI) has long shown that technologies are “situated”: their meaning and impact depend on the contexts in which they are used. Complexity theorists likewise remind us that healthcare systems are adaptive and dynamic: interventions ripple across the system, producing unintended consequences as well as benefits.
The optimism that drives digital health policy often overlooks these realities. Our study on TERM for COPD illustrates this well: while patients and staff can derive real value, particularly through reassurance (and the improvements in self-care that can follow), those benefits may not fit neatly into the metrics policymakers rely on. Indeed, our work highlights a major weakness in current evaluation frameworks used to examine the impact of TERM services, which can often focus on short-term, quantitative and financial metrics. By focusing narrowly on such outcomes, evaluations often miss the softer, but no less important, benefits that matter to patients, like reassurance and confidence, and the distributed system-wide gains that are harder to capture.
Our study highlights the need for creative, mixed-method evaluation approaches that combine qualitative and quantitative data, including both formative (process-focused) and summative (outcome-focused) assessments. Such approaches would strengthen an understanding of key mechanisms of action in such services and how they ‘work’, for whom and which contexts.
Lessons for the future
Our study highlights both the potential and the pitfalls of TERM for COPD:
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Technology is not the service. Success depends on the people and processes that surround it.
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Clarity of purpose is crucial. Is the goal reassurance, prevention, or cost saving? Or perhaps all three? Services should be explicit and evaluate accordingly.
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Evaluation must evolve. Current metrics undervalue reassurance and indirect impacts. Broader approaches are needed.
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Equity must be addressed. Not all patients can or want to use digital tools; multiple pathways are essential.
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Sustainability requires investment. Short-term pilots risk cycles of enthusiasm and disappointment; longer-term planning is essential.
Final thoughts
Our study has shown that technology-enabled remote monitoring for COPD can offer a wide range of benefits in the form of the potential for earlier intervention, personalised support, reduced emergency admissions, improved quality of life and service use, as well as the provision of reassurance and connection. But these benefits are fragile. Without sustainable funding, broader evaluation measures, and attention to equity, there is always the potential for services to collapse.
The value of TERM lies in how well it can be sustained, integrated, and assessed across multiple dimensions: clinical, financial, technical and human. For the NHS, that means building services that are financially sound and operationally sustainable, while never losing sight of the fact that, for patients, feeling connected and supported can be the outcome that matters most. Ultimately, technology-enabled remote monitoring will succeed not by replacing care, but by being woven into the complex web of relationships, resources, and responsibilities that define the NHS.
Newhouse N, Ulyte A, Marciniak-Nuqui Z, van Dael J, Marjanovic S, Brennan S, Shaw S. Implementation and use of technology-enabled remote monitoring for chronic obstructive pulmonary disease: a rapid qualitative evaluation. [published online ahead of print November 19 2025]. Health Soc Care Deliv Res 2025.
We thank the staff, service users, and family/carers of the participating case sites, members of our project advisory group, and the DECIDE steering committee for engaging with the study and providing invaluable input. We are also grateful for the interest and support of the NHSE Lung Health @home team as our policy partner throughout the project.
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