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

Different Types of Health Hubs

What is monitored?

Patients health, symptoms , well-being

Metrics

Weight

BP

PO2

Temperature

Glucose

Linked by wire / Bluetooth / Patient entry

What do patients say?

N Yorks PCT Questionnaire 4/11

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

The future?

The Present!