Telehealth scaling up the benefits 1
Telecare describes any service that brings health and social care directly to a user (generally in their homes) supported by information and communication technology, eg. community alarms and environmental monitors that trigger a warning to a response centre. Telehealth is part of this, but relates specifically to remote monitoring of a person s vital signs, including blood pressure, weight and blood glucose. Telemedicine allows clinical consultations remotely, often by video conference. While telehealth technologies are still new in the UK, there is already good evidence of their positive impact for people with long-term conditions. Where telehealth technologies are in use, people are seeing real benefits in terms of their health outcomes and quality of life which, in turn, is reducing pressures on clinicians and emergency care departments. The patient s perspective Telehealth technologies come in many forms although the market in this country is still quite young and suppliers are working with the NHS to get their products right for UK settings. Commonly, though, the patient will use a selection of simple devices (depending on their particular conditions) to monitor their vital signs. These might include devices for monitoring blood pressure: blood glucose, cardiac varrhythmia, asthma, as well as medication reminder systems. Then: the patient enters their readings on to an easy-to-use monitor in their home these are sent via secure web connection to a response unit sometimes an individual clinician or a wider care team, depending on the local service model the care professional(s) monitors this data; identifying trends; intervening if the readings are outside of normal parameters; or simply offering some positive feedback to reassure and encourage well patients. Early success in preventing hospital admission A well-established telehealth initiative for military veterans in the US is, according to one study 1, achieving a 50 percent reduction in hospital admission. Early evaluations indicate that these sort of cost/efficiency benefits are achievable here too. Kent County Council (KCC) started testing telehealth in 2005. Now, 250 patients across the county with LTCs are using telehealth 1] Neale R. Chumbler, Evaluation of a care co-ordination/ home telehealth program for veterans with diabetes (Sage Journals Online) http://ehp.sagepub.com/cgi/content/abstract/28/4/464 2
technologies on a daily basis. While Kent is intending to publish its full evaluation later in the year, these are some of the early findings: Practice nurse model: 15 patients with LTCs across two GP practices acute care costs reduced from 43k to 10.5k (measured over six months) Generalist community matron model: 60 patients with LTCs 60% reduction in acute care costs (after 4-6 weeks) 40% reduction in GP contacts. However, according to Matthew Rye, telehealth evaluation manager at KCC, the results have as much to do with getting the model of care right as the technology itself. We initially opted for a GP and practice nurse-led model, but we just didn t get sufficient levels of engagement and we didn t see any significant benefits for primary care. This improved massively once we moved to the community nurse-based model and the best results overall have come from a community matron-led approach. (While this is the case in Kent, in other settings the most appropriate model might, of course, be different.) A refined care model with specialist community matrons In Kent, telehealth is moving from strength to strength. The biggest successes so far have come from the county s Shepway district where two community matrons have specialisms in cardiorespiratory disease and diabetes. As well as being able to manage a range of other LTCs, their enhanced competencies mean they can confidently care for patients with the most complex co-morbidities; spot problems earlier; and better understand and control the linkages between different conditions. According to Mathew Rye, this is helping to support people at home even when they have exacerbations and even when they are approaching the end of their lives. Of the six telehealth patients who recently died in our exemplar Shepway site, four died while in their own homes and only two had a hospital admission in the last year of their lives. That s better for the patient, better for their families and better for the NHS 3
Seeking the best service models and exploring the specialists v generalists question will be an important focus for the three Government-funded whole system demonstrators (WSDs) - the sites at the heart of England s biggest and most academically-robust evaluation of telehealth and telecare to date. At least 3000 of the 7,500 patients taking part across the three locations will be using telehealth technologies. Tim Ellis, WSD manager at the Department of Health says: It s not just about the technology. There are major issues to think about and get right with telehealth. What care pathways are most suitable; what will your response package look like; how will the different professionals interact; what will the criteria be for selecting patients; what data will you collect? Getting the technology right Of course, there is clearly a need to support NHS and local authorities to get the right telehealth technologies, and at the right price. The NHS Purchasing and Supply Agency (NHS PASA) has worked hard to develop the National Framework Agreement for Telecare a detailed national contracting arrangement that makes it simpler and safer for local organisations to procure their telehealth kit. (According to estimates, it could cost individual organisations up to 50,000 to run their own legally-compliant procurement exercise.) Driving the framework forward has been a challenge, but it s allowed us to gain a much deeper understanding of the market, says Neil Griffiths, lead category manager on telecare at NHS PASA. Now we re working with suppliers and other key stakeholders to help develop the right technology solutions for patients and clinicians in the UK, while, of course, keeping them affordable. 4
Paddy Howlin, also lead category manager on telecare at NHS PASA, stresses, however, that people still need to be realistic about what they re getting: People have to realise that when they buy the technology, they are not buying the solution Mainstreaming the benefits Outcomes and learning from the three WSD sites: Kent, Cornwall and Newham, will be pivotal to a quick take-up of telehealth across the wider NHS and social care system. As well as being demographically different (a good mix of rural and inner-city settings) each site brings together a strong core partnership of NHS and local authority organisations something that will be crucial in rolling-out and sustaining the benefits in the long term. Find out more: The Care Services Improvement Partnership manages a telecare/telehealth innovation network which is an excellent source of information about telehealth. See: http://icn.csip.org.uk/telecare/ Details of the PASA telecare framework are available at: http://www.pasa.nhs.uk/telecare/ Acknowledgements The Kent telehealth pilot was run from Kent County Council in co-operation with West Kent and Eastern and Coastal Kent PCTs. 5