Telehealth Services Meeting changing needs? - Achievements and Challenges

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1 Seminar 2016 University of East Anglia, Norwich Telehealth Services Meeting changing needs? - Achievements and Challenges Dr Malcolm J Fisk malcolm.fisk@dmu.ac.uk

2 Telehealth What do we mean by telehealth? 1 Telehealth is the means by which technologies and related services concerned with health and wellbeing are accessed by people or provided for them irrespective of their location. [Telehealth Quality Group: 2016 International Code of Practice for Telehealth Services. See

3 Telehealth What do we mean by telehealth? 2 Signals fit in relation to Changing service paradigms that follow o demographic imperatives o ethical and rights perspectives o recognition of public and preventative health agendas o political realities Integrated service frameworks Person-centred care Promotion of self-management

4 Domains of Telehealth Absolutely not just vital-signs monitoring! Health and motivational coaching and advice Activity and lifestyle monitoring Safeguarding and monitoring in care settings Gait, seizure and falls prediction / management Point of care testing and diagnoses Vital signs monitoring Mobile Health technology systems (e.g. apps) Medication or therapy adherence Rehabilitation and (re)ablement Responses to adverse events and incidents Tele-consultation and virtual presence [Telehealth Quality Group: 2016 International Code of Practice for Telehealth Services. See and more!

5 Telehealth What do we mean by telehealth? 3 at in work on the move at home in school at college

6 Telehealth What do we mean by telehealth? 4 Not just about the delivery or top-down management of care concerned with clinical and acute conditions about vital-signs monitoring about saving money and avoiding hospital admissions Rather it s about empowering people to manage their own care about maintaining and changing lifestyles and behaviours about better mental health as well as physical health about public and preventative (as well as clinical) health as relevant to a 26 year old managing her diabetes as it is to an 86 year old being helped with his dementia

7 Examples of Telehealth Service Development Dignio (Norway) Svensk Telepsykiatri (Sweden) Fold Group (UK) an indication of the breadth of telehealth

8 Dignio An Example of Telehealth Service Development in Norway Service platform for self-care ( seniors go digital ) and home care The mobile becomes the new social alarm Focus on well-being as well as clinical health Involvement of users and carers including notifications GPS for people with dementia Mobile approach to monitoring as well as through fixed contact centre Support to telecare / telehealth services setting up

of user s location or country of residence Based on video-conferencing o as good / better than

9 Svensk Telepsykiatri An Example of Telehealth Service Development in Sweden Image: Cloudvisit Psychiatric service on-line o diagnosis and treatment o CBT, motivational coaching Irrespective of user s location or country of residence Based on video-conferencing o as good / better than other interventions (for some) Clear protocols for interactions Support and training for other services

Fold Group An Example of Telehealth Service Development in the UK Established telecare service Part of T3 Group delivering tele-monitoring service in Northern Ireland

10 Fold Group An Example of Telehealth Service Development in the UK Established telecare service Part of T3 Group delivering tele-monitoring service in Northern Ireland includes Tunstall and S3 Group 3,000 patients with LTCs helping them monitor vital-signs at home Telecare integral to assessments for dementia care (Northern Trust)

11 Telehealth: Some Ethical Issues 1 Some Reference Points Beauchamp and Childress: Four Principles of Biomedical Ethics o Autonomy, Beneficence, Non-Maleficence, Justice Tronto: Ethical Elements for Nursing Care o Attentiveness, Responsibility, Competence, Responsiveness RRI (Responsible Research and Innovation): Key Dimensions o Ethics, Good and Reflexive Governance, Creative Learning, Engagement & Involvement, Gender Equality, Open Access

12 Telehealth: Some Ethical Issues 2 Inclusion, Engagement and Autonomy Autonomy o how realistic? o what is care? o need for re-think? Inclusion and Engagement o rights o addressing ageism o countering segregation o changing service paradigms o changing thinking o integrating services

13 Telehealth: Some Ethical Issues 3 Control and Dependency Telehealth service operation o how appropriate re. changing paradigms / affording control or self-management? (Traditional) Vital Signs Monitoring o auto collection of data or provided by patients o health practitioners and clinicians decide based on the information from the devices o clinical health gains, greater dependency Webcam / Video-consultations o patients judge their conditions / health o facilitates patient networks / knowledge sharing o well-being gains, less dependency?

14 Telehealth: Some Ethical Issues 4 Privacy, Consent and Confidentiality Telehealth and the World of Big Data o being drawn back into clinical arena (EHRs, etc)? o barrier to service integration? o patients / people marginalised? Privacy Issues o consent issues to be addressed link to confidentiality o some re-assurance through audit trails o big issue of trust The Wider Public Interest o public health gains?

15 Telehealth: Some Ethical Issues 5 Cameras in Care Homes An Ethical re-think? o Observation is OK! o Need to see cameras in wider AT / telecare and telehealth context (audio; activity monitoring; entry-exit) o Need to regard cameras as data gatherers helping ensure privacy thro digital fragmentation reassembly (at different levels) only in specified circumstances and with right protocols and controls

beginning to demonstrate potential of telehealth in public / preventative health

16 Round Up Source: Health IT Outcomes Various imperatives for change Changing service paradigms increasingly evident Telehealth part of the changes Telehealth Services beginning to demonstrate potential of telehealth in public / preventative health arena for all people, all ages Herein lies some good (not great) achievements but the challenges

Telehealth Services The Challenges (and Dangers) Source: Pivotell Source: India Vision Public sector service divisions and bureaucracies linked with failures in imagination need for culture change (?

17 Telehealth Services The Challenges (and Dangers) Source: Pivotell Source: India Vision Public sector service divisions and bureaucracies linked with failures in imagination need for culture change (?) Shortcomings in standards and/or frameworks for service operation Agenda may be re-captured (in context of Big data) by clinicians with narrow perspective Failure to create context for self-care, management of lifestyles, etc.

18 Telehealth Services The Opportunity Source: Pivotell Source: India Vision Doing things differently Telehealth services not delivered but provided Telehealth for all linking with selfmanagement, behaviours and lifestyles Telehealth not as a way of saving money; rather as a way of doing things better more power and control to patients people

19 Power to the People! cassandralathamjones bbc

20 Thank You Diolch yn Fawr Dr Malcolm Fisk

The challenge. What we did. Highlights. Designing and delivering scalable telemonitoring and telecare through partnership.

The challenge. What we did. Highlights. Designing and delivering scalable telemonitoring and telecare through partnership. Telehealthcare Designing and delivering scalable telemonitoring and telecare through partnership The challenge Northern Ireland has a population of approximately 1.8 million people. Around two thirds of