Telehealth: benefits for primary care

Shahid Ali GP & National Clinical Lead Commissioning intelligence Clinical Lead Primary Care NHS Yorkshire and Humber

Telecoaching Telemonitoring TelemedicineTelehealth

Remote monitoring tools capture physiological measurements and relay them to a central location for review normally an suppliers intranet site.

Remote monitoring tools capture physiological measurements and relay them to a central location for review normally an suppliers intranet site.

Telecoaching uses a one to one interaction with audio, visual and/or interactive communications, used to support the practice of health care/social care, enabling self care and improved condition management.

Telecoaching uses a one to one interaction with audio, visual and/or interactive communications, used to support the practice of health care/social care, enabling self care and improved condition management.

Remote video consultations between healthcare professionals and patients which support care outside of hospital.

Used to reduce LOS, support early discharge, and admission avoidance.

Remote video consultations between healthcare professionals and patients which support care outside of hospital.

Used to reduce LOS, support early discharge, and admission avoidance.

The use of electronic information and telecommunications technologies to support long-distance clinical health care, professional health-related education, and public health.

The use of electronic information and telecommunications technologies to support long-distance clinical health care, professional health-related education, and public health.

Why use Telehealth? The Case for Change

Increasing numbers of people have multiple long-term conditions

•188% rise just in Diabetes by 2050•60% increase in multiple LTCs by 2013•252% rise in over 65 year olds by 2050

We currently spend £19 billion on people with 3+ long-term conditions. This is projected to rise to £26 billion by 2016

There is a need for a more integrated response to manage LTCs

Implications for NHS and General Practice

Long term conditions represent:•70% of health and care spend, •77% of inpatient bed days, •60% of GP appointments and•68% of outpatient and A&E appointments.

•The average annual health cost of someone without a long-term condition is around £1,000; this rises to £3,000 for someone with one condition and to £8,000 for people with three or more conditions

•The biggest challenge to emerging Clinical Commissioning Groups includes the management of LTCs and urgent care

Self care – fully independent

Signposted to information/advice

services

Advocacy &

support

Complexcases

LTC Population

Drivers for further change

Personalised health care- challenges current thinking of doctor-patient relationship

Proactive rather than reactive care –challenges current models of care delivery

Immediacy –challenges speed of care delivery

© NHS Yorkshire and the Humber

More than redesign ……..

Old Pathway New Pathway

Old Mindsets New Mindsets

Care Planning E-consultation Tele-health

Pre Post Pre Before Post After

Visits to GP x 23

Outpatients x 7

Outpatients x 1

Visits to GP x 7

Outpatient visits

Admissions Discharge

Tele-health package

Early discharge (monitored

and managed at home)

E-consultations

A new approach to care delivery……

Patient level impact of care planning

Data extrapolation to practice list sizes

Practice sizePre care planning (£000)

Post care planning (£000)

Difference (£000)

3,500 872.16 329.00 543.16 7,000 1,744.33 658.00 1,086.33 10,000 2,491.89 940.00 1,551.89

Care Planning E-consultation Tele-health

Pre Post Pre Before Post After

Visits to GP x 23

Outpatients x 7

Outpatients x 1

Visits to GP x 7

Outpatient visits

Admissions Discharge

Tele-health package

Early discharge (monitored

and managed at home)

E-consultations

Patient Centred Care:  Immediacy

• A clinical opinion in a different way .... • Cohort of 16 GP practices / Nephrology (John Stoves, John Connolly et al,

Bradford)• E-consults for renal problems• Channelled to single consultant• Record reviewed / opinion written into e-notes• Need for face to face consultation reduced by 80%

Care Planning E-consultation Tele-health

Pre Post Pre Before Post After

Visits to GP x 23

Outpatients x 7

Outpatients x 1

Visits to GP x 7

Outpatient visits

Admissions Discharge

Tele-health package

Early discharge (monitored

and managed at home)

E-consultations

A world class solution……

• Bradford care home telemedicine pilot• Benefits

• Provides immediacy – patients can be assessed and treated sooner rather than waiting for a home visit.

• Electronic Patient Record (EPR) is available during the consultation so the GP can look at the record at the same time, and be better informed of the patient’s history, medication, hospital communications and any other important information that may be required during the consultation.

• Clinical triage- GP can assess the patient’s needs can give advice, prepare a prescription or indeed visit if needed.

• Increased efficiency- up to 80% of calls for home visits could be dealt with via telemedicine with only the minority still needing to be seen in person.

• Benefits

• Releases capacity -Time saving, cost saving, safer, manages risk more effectively, and is a simple way of conducting consultations. Improved efficiency releases capacity in the Practice which is important as complexity and demand increases in primary care.

• Reduced admissions- the quicker you get to see a patient the easier it is to address their need. If you don’t get a clinical opinion early enough, the patient is more likely to end up in A&E or be admitted.

• Patients satisfaction high – patients and care home staff like it - they can see and speak to the doctor and get seen quickly.

• Simple to use and there is no training needed.

Regional T-health Programme - Role of the “Hub”

Distributed specialist networks

Top Tip: “Don’t be afraid of new technology and don’t assume it’s difficult or complicated to useuntil you’ve tried it. It really is so simple, so do it!”

Contact details:Shahid.ali@yorksandhumber.nhs.ukShahid.ali@bradford.nhs.uk