Telehealth – Benefits for the people of Northern Ireland

Commissioner PerspectiveEddie Ritson (ECCH)

Provider PerspectiveJim O’Donoghue (TF3 / S3 Group)

• Improved quality of life, health & well-being• To be supported & enabled to self-care & to live as

independently as possible• To be involved in decisions about them and to have

some choice & control over their care & support• To have services which are integrated, flexible,

proactive & responsive• To have services that are high quality, efficient &

sustainable

What do People Want?

NI Chronic Disease Challenge

Department of Health (2008 ) Raising the profile of long term conditions careINIsPHO (2010) Making Chronic Conditions Count

Population 1.8M

H&SC budget £4.3Bn

Rising to £4.66Bn in 2014/2015

• Bring information to professionals, enabling more proactive, effective and co-ordinated community based care

• Provide greater support for self-care and for carers

• Part of a new way to manage increasing burden of chronic disease which is both more efficient and better quality

“…investing to build the capacity to cope”

Vision for Remote Telemonitoring

• Requirements– Scaleable, mainstream service– end-to-end service adding clinical value– flexible enough to respond to individual needs and local

circumstances

• Supporting the modernisation of service delivery

• Framework to support other developments including telecare

NI Remote Telemonitoring Service - Requirements

RTNI Service Requirements - Considerations

NationalLocal

Clinical OutcomesPatient ExperienceClinical StaffFinancial

Service ModelRoles/ResponsibilitiesPathway ChangesDelivery model

Clinical outcomesFinancial benefitsImplementation costs

RTNI Service Requirements – Iterative Approach

Commisioner Provider

Programme Structure

• 6 year contract awarded March 2011

• Procurement, service definition and implementation process led by ECCH – a part of Public Health Agency

• 1 Service Definition, 5 customers

• 3,500 patients per annum

• 12 condition categories

• 2 - 52 week monitoring periods

• >2.8 million monitored days

• £18m investment

• Comprehensive and robust Office of Government Commerce contract detailing all aspects of Authority and Contractor responsibilities

• High level of detail of service definition & contractual requirements:

• Detailed definition of every aspect of the service to be provided (221 Authority requirements)

• Detailed service levels and associated penalties (20 for ‘core’, 8 for ‘additional’ & a further 19 quality markers)

• Extensive reporting, automated performance monitoring

• 1 Service definition with 5 customers:

• Joint specification, governance and central infrastructure• 5 local implementation plans• Provision of ‘Core’ and ‘Additional’ services

Unique Elements of RTNI - Managed Service Approach

• Contract Structure• 6 year contract – Long term commitment• Flexibility : patient-days, monitoring periods, monitoring conditions • Bottom-up activity models per condition• 3,500 patients per annum, 2.8m monitored days

• Agreed charging regime• Standing charge for service availability – risk sharing• Per patient day monitoring charge• Installation & de-installation charge

• All backed up by detailed and fully transparent financial model

RTNI Managed Service - Financial Model

• Promotion of ‘logic’ and evidence base

• Pilots are helpful but need to be strategically aligned, of sufficient scale and designed to be tested

• Scaling an application is significantly more complicated than piloting and takes time

Critical Success Factors - Learning to Date

• Alignment with strategic and operational health and social care agenda

• Securing local, clinical and corporate support and ownership is vital. Focus on quality, safety and patient experience – efficiency is a by-product

• Design, procurement and implementation are complex – requiring regional leadership, drive and resourcing

Critical Success Factors - Learning to Date

• More & better targeted proactive support to patients. Enabling them to:

– have greater control– learn more about their condition– live more independent lives

• Bringing timely information to professionals to inform patient-centred case managementEnabling:

– improvements in the quality of care & quality of life for patients– reductions in inpatient admissions– optimised use of staffing resources

Anticipated Benefits

Telehealth – Benefits for the people of Northern Ireland

Provider PerspectiveJim O’Donoghue (TF3 / S3 Group)TF3 Service Development and Deployment Director

RTNI – The Managed Service Model

• Providing all aspects of a joined-up service involving people, process and technology

• Responsible from Referral to discharge

• Meeting defined service requirements & SLAs

• Technology selection, maintenance and equivalence

• Incentivised to generate service delivery efficiencies

RTNI Managed Service - Provider Responsibilities

Service Delivery Components

RTNI Service Design Processes

Pathway redesignProcess definitionSLA planningStakeholder Engagement

Solution designTechnology selectionIT Design

Clinical processesNon-Clinical processesTrainingQA Planning

Program GovernanceClinical GovernanceEvaluation

Service ReadinessSolution ReadinessTechnology Readiness

Service Design – Collaborative Process

Commissioner

Provider

RTNI Service Delivery Processes

Enrol Patients Patient planInstallTrain ActivateReview

Triage CoachEducatePatient SupportCarer Support

Issue MgmntPerformance MonitoringReportingAsset Mgmnt

Clinical GovernanceProgram GovernanceEvaluation of outcomes

Service EfficienciesFurther IntegrationNew ConditionsNew ServicesNew Technology

Partnering to deliver integrated servicesUnderpinned by a strong contractual framework

Partnering to deliver integrated servicesUnderpinned by a strong contractual framework

Building a provider consortium

• Form early – provide consistency through procurement and delivery• Define the consortium core values • Build relationships and trust

Managed Service Model

• Significant up-front investment on both sides to define requirements and operating model

• Creates a service based, technology agnostic framework for identifying needs and solutions

• Demands a high level of working in partnership• Asks the provider difficult but very good questions

Provider Lessons Learned to-date

Working together to deliver

Thank You