Developing Patient based Telehealth services Dr Nicholas Robinson MA MRCGP Clinical Director Long Term Conditions
Dec 25, 2015
Developing Patient based Telehealth services
Dr Nicholas Robinson MA MRCGPClinical Director Long Term Conditions
Why Telehealth?
Demographic problems
Patient numbers growing
Elderly
Long term conditions (15m)
Carer numbers falling
Single households
Older carers with elderly relatives
Fewer NHS professionals
Pensions / NHS changes
Matching care to user needs The Pyramid of Doom
POPULATION WIDE PREVENTION
Level 3
Level 2
Level 1
Highly complex(5%)
High risk(15%)
Low risk(80%)
DiseaseManagement
CaseManagement
Supported Self Care
NHS Wellness
Level 3
Level 2
Level 1The general public:
•Smoking
•Drinking
•Eating
•Sedentary
•Bad habits
•Mental health
NHS Health
Risks
Program
What do patients want? 1
Care close to them (at home)
Feeling secure and safe
Feeling they have someone they can contact
Feeling someone is watching over them
Understanding medications – new/changed/why/side fx/need for
repeats
what to do if something goes wrong.
What do patients want? 2
At Home
Regular contact with NHS services
Support /education
Enhanced understanding of diseases
Ditto drugs (and improved compliance)
Supported self-care
How can we improve Patients experiences?
Part of improved service offering
From admission to discharge to life in the community
Planning starting at admission
Problems / suitability defined for follow-up service
Need for 30 day support (Home testing / monitoring)
Need for longer term support (Telehealth service)
Tailoring device to patient
Proactive calling
Vital signs monitoring
Patient reminders
Social alarms
Homecare monitoring
Environmental controls
Dementia monitoring
Care information
Supported discharge
Lifestylemonitoring
What is telehealth?
Telecare
Telehealth
TelemedicineeHealth
Assistive Technology
What do Telehealth services offer currently?
7000 patients monitored daily (1.2m for Telecare)
Focus on COPD / CCF
Current WSD pilot results pending (RCT for 6000 patients)
Developing 30 day discharge agenda
Challenges
Not acute service (5 days / 8-6pm)
7 day installation delay
Excluded patients (20%)
Fixed installation for stationary patients!
Limited clinical engagement
What is needed for widespread take-up of services?
Patient engagement
not about cost-saving
may be only option
Clinician engagement
Not about cost-saving
Allows focused services based on current needs
Commissioner engagement
Evidence
Value for money
Elderlyliving independently
Home AutomationSecurity Wireless Network• Lights• Doors windows• Motion / Activity• Bed• Drawers• Kitchen• Bathroom
GlucoseSensor
Scales
Blood-pressure
Cuff
Cholesterol Monitor
MedicationTracking
Pulse Oximeter
Separate Health & Social Care Systems
Social Worker
Step by Step Development?
Home HubAppliance Coordination
Required
eSAP
NHS Direct
Healthcare Professionals
WWWTelehealth Care
Record
NHS Care Record
Tailoring of service to patient needs
Suitable patients
Numbers / cost
Suitable patient contact channel
Web / phone / text based service interaction?
24/7/365 call-centre support
Phone-based service (30 day discharge)
Evolution to Telehealth monitoring if suitable
Suitable device
Fixed hub / Mobile device / Tablets
Telehealth TTA??
£500 to call ambulance£50 to visit your GP
£20 to call NHS Direct£1daily for Telehealth
£0.13 to assess digitally
What is monitored?
Patients health, symptoms , well-being
Metrics
Weight
BP
PO2
Temperature
Glucose
Linked by wire / Bluetooth / Patient entry
Where are we going?
Urgent Care matrix
NHSD / 111 / OOH / Urgent GP / WICs
Large scale telehealth services
Working with Bosch, Docobo & Honeywell
Need data exchange to prevent duplication and improve
effectiveness and timeliness of care
Consider needs / expectations of patients for care channels now and
in future
Web / Voice / face to face