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J Peter Robinson Scientific Affairs Manager – Western Europe Diagnostics and Clinical Services

Enhancing the patient experience whilst mitigating the unnecessary cost of cardiac referrals. J Peter Robinson Scientific Affairs Manager – Western Europe Diagnostics and Clinical Services. Primary Care Objectives which YOU want to deliver…. Improved Patient Assessment

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J Peter Robinson Scientific Affairs Manager – Western Europe Diagnostics and Clinical Services

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  1. Enhancing the patient experience whilst mitigating the unnecessary cost of cardiac referrals J Peter Robinson Scientific Affairs Manager – Western Europe Diagnostics and Clinical Services

  2. Primary Care Objectives which YOU want to deliver… • Improved Patient Assessment • Improved the way that we monitor Patients • Improved Continuity of Care • Improved monitoring of Long-Term Conditions • Improved Assessment of Right/Appropriate Care • Improved Handling of Urgent Care

  3. OECD (2012). Health at a Glance: Europe 2012, 16 Nov 2012, www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe_23056088 Total health expenditure as a share of GDP, 2000-10, selected EU member states What does the landscape tell us ? Number of hospital beds, EU-27, 2000-2010 (per 100 000 inhabitants)

  4. OECD (2012). Health at a Glance: Europe 2012, 16 Nov 2012, www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe_23056088 Future hospital commission recommends… “ A Return to General Physicians and Greater Focus on Acute Care” Academia reports.. “Stronger Systems Improve Population Health but require Higher Levels of Spending” Eurostat shows… “ The number of Hospital beds has declined year on year since 2000” BUT “Total Health Expenditure as a share of GDP has risen year on year since 2000” Total health expenditure as a share of GDP, 2000-10, selected EU member states Number of hospital beds, EU-27, 2000-2010 (per 100 000 inhabitants)

  5. EUCOMED - Key objectives for European healthcare 1) Reduce hospital admissions 2) Reduce bed days by promoting earlier discharge 3) Optimise interactions between health workers & patients 4) Increase patient responsibility and self-management 5) Modernise with clinically effective and cost-effective solutions

  6. How can these objectives be met ? “Primary Health Care Activity Monitor for Europe” Project measured the primary care strengths 31 European countries. Concluded that stronger primary care is associated with: • Lower rates of avoidable admissions to hospital • Greater life expectancy • Increased costs and: Greatly Improved Primary Care Services can best be achieved with appropriate use of Technology…. Telecommunication and Information Technologies can facilitate improvements to all aspects of clinical services

  7. Across Europe,Telemedicineand Telehealth are seen to be vital, as health systems struggle to cope with an aging population and rising costs. Digital Agenda for Europe “…to achieve by 2020 widespread deployment of telemedicine services.” www.act-program.eu

  8. Uptake and use of the various technologies varies globally from region to region…. • Telecardiology - Telepathology- Teleaudiology • Telepsychiatry - Teledermatology - Teleophthalmology • Teleradiology - Teledentistry - Teletriage

  9. UK - Whole System Demonstrator 6,000 patients with diabetes, coronary heart disease or chronic obstructive pulmonary disease (COPD) at 238 health care practices in the U.K. over a two-year period Using remote monitoring technology can lead to: • 20% reduction in emergency admissions; • 15% reduction in emergency department visits; • 14% reduction in elective admissions; and • 14% reduction in bed days. • 45% reduction in mortality The study noted, "Going forward, this evidence gives us confidence that we can transform the way services are delivered and ensure that we use appropriate technology to put people at the centre, and in control"

  10. Primary Care Benefits Telemedicine • Reduces hospital admissions • Reduces bed days • Optimises interactions between health workers & patients • Clinically- and cost-effective solution

  11. Primary Care Benefits Telemedicine • Reduces hospital admissions • Reduces bed days • Optimises interactions between health workers & patients • Clinically- and cost-effective solution Solutions exist - Yet we see little adoption within UK Primary care….

  12. Primary Care Benefits TeleHealth • Delivery health-related services & information • Patient-focused services • Aids remote monitoring & management of patients in their own homes

  13. Primary Care Benefits TeleHealth • Delivery health-related services & information • Patient-focused services • Aids remote monitoring & management of patients in their own homes Solutions exist - Yet we see little adoption within UK Primary care….

  14. Primary Care Benefits Telecare Elderly and vulnerable people able to live independently and securely in their own homes by providing person-centred monitoring technologies.  Reduces hospital admissions  Reduces bed days ? Clinically and cost-effective solution (evidence lacking)

  15. Telecare Elderly and vulnerable people able to live independently and securely in their own homes by providing person-centred monitoring technologies.  Reduces hospital admissions  Reduces bed days ? Clinically and cost-effective solution (evidence lacking)

  16. Primary Care Benefits Regardless of the evidence which supports the introduction of these technologies – adoption in the UK remains sporadic and low. Why is this ?

  17. Primary Care Benefits Regardless of the evidence which supports the introduction of these technologies – adoption in the UK remains sporadic and low. Why is this ?

  18. Primary Care Benefits • Poor track record with IT related services • Lack of trust in provider services • Poor support and after sales services • Even Historically - Y2K experiences… Is it surprising that we are hesitant to invest ?

  19. Primary Care Benefits • Poor track record with IT related services • Lack of trust in provider services • Poor support and after sales services • Even Historically - Y2K experiences… Is it surprising that we are hesitant to invest ? Early birds get the worms - But the second mouse gets the cheese Let someone else be the first…..

  20. So what is it that 3M can do to help ?

  21. Six Market Leading Businesses Display andGraphics Health Care Electro andCommunications Safety, Security,and Protection Industrial andTransportation Consumer and Office Providing more than 60,000 different products

  22. 3M’s Corporate Values • Act with uncompromising honesty and integrity in everything we do • Satisfy our customers with innovative technology and superior quality, value and service • Provide our investors an attractive return through sustainable, global growth • Respect our social and physical environment around the world • Value and develop our employees' diverse talents, initiative and leadership • Earn the admiration of all those associated with 3M worldwide

  23. 3M™ Littmann® Connected Solutions We can deliver immediate real benefits without requirement for any additional infrastructure….

  24. 25 3M™ Littmann® 3200 Stethoscope The 3200™ allows clinicians to hear patient body sounds as if they were in the same room with the patient, using the Digital Electronic 3200 Stethoscope wireless connectivity. - These may be “Stored” or “Live” streams.. Software Developer’s Kit - Telemedicine Providers “TeleSteth” – 3M Littmann Solution Primary Care / GP Secondary Care

  25. 26 3M™ Littmann® TeleSteth • Health economics story very important as we consider the introduction of new technologies. • Importance of patient benefits is often overlooked Detailed patient history which is accessible throughout the practice Accurate charting of patient progress with direct comparisons Referral of data to secondary care rather than patients Peer review within practices to reduce referral Patient monitoring in primary care greatly reduces DNA’s Triage of patients being referred from primary to secondary care Wider access to patient screening services and prevention Recordings collected during home visits for better patient care Real-Time assessment of patients who have deteriorated Efficiency and cost benefits to primary and secondary care

  26. 27 3M™ Littmann® TeleSteth We often focus on the health economics story as we consider the introduction of new technologies and it is easy to lose sight of the importance of patient benefits and great improvements which might be achievable in the care which we deliver. Detailed patient history which is accessible throughout the practice Accurate charting of patient progress with direct comparisons Referral of data to secondary care rather than patients Peer review within practices to reduce referral Patient monitoring in primary care greatly reduces DNA’s Triage of patients being referred from primary to secondary care Wider access to patient screening services and prevention Recordings collected during home visits for better patient care Real-Time assessment of patients who have deteriorated Efficiency and cost benefits to primary and secondary care

  27. 3M™ Littmann® TeleSteth Proposal Dr SatishAdwani Consultant in Congenital Cardiology, John Radcliffe Hospital

  28. 3M™ Littmann® TeleSteth Proposal Innocent heart murmurs are sounds made by the blood circulating through the heart's chambers and valves or through blood vessels near the heart. They are sometimes called "functional" or "physiological" murmurs. Innocent murmurs are common in children and are quite harmless. In any group of children, a large percentage is likely to have had one at some time. Innocent murmurs also may disappear and then reappear. Most innocent murmurs disappear when a child reaches adulthood. Murmurs also can be caused by pregnancy, fever, thyrotoxicosis or anaemia and they are not uncommon therefore in adults.

  29. 3M™ Littmann® TeleSteth Proposal In 2012 Dr Adwani had referrals from 1020 such children… • Seen by their GP (many as a part of a pre-school medical assessment) • Diagnosed with an Innocent Systolic Murmur • Otherwise completely healthy • Referred to Cardiologist for Confirmation of Diagnosis • The referral to his clinic took an average of 90 days • The murmurs were all confirmed as innocent by Auscultation • An echocardiogram was performed unnecessarily in each case with no additional relevant diagnostic information being gained from the results.

  30. 3M™ Littmann® TeleSteth Current Patient Pathway – with allotted times (measured)

  31. 3M™ Littmann® TeleSteth Proposal Simple change to the process… Record the heart sounds and send them, NOT the patient……

  32. 3M™ Littmann® TeleSteth Proposal Simple change to the process… Record the heart sounds and send them, NOT the patient…… Let’s look how it works…..

  33. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 Patient Site Patient Assessment requires Consultant’s Opinion

  34. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 Patient Site Patient Site Patient Site 2 Full Digital Sound Profiles saved to local machine 2

  35. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Patient Site Full Digital Sound Profiles saved to local machine 2

  36. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2

  37. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 Auto-email advises consultant that a file is available to download 5 5 Consultant

  38. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Consultant connects to the TeleSteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 Auto-email advises consultant that a file is available to download 5 5 Consultant

  39. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Consultant connects to the Telesteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 File is transferred to the Consultant’s local machine 7 Auto-email advises consultant that a file is available to download 5 5 Consultant

  40. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Consultant connects to the Telesteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 File is transferred to the Consultant’s local machine 7 Consultant reviews the files, adds comments and then re-connects to upload the file to the TeleSteth server 8 Auto-email advises consultant that a file is available to download 5 5 Consultant

  41. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Auto-email to patient site from TeleSteth server to advise that file is available for download 9 Consultant connects to the TeleSteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 File is transferred to the Consultant’s local machine 7 Consultant reviews the files, adds comments and then re-connects to upload the file to the TeleSteth server 8 Auto-email advises consultant that a file is available to download 5 5 Consultant

  42. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Patient site connects to TeleSteth server to select file(s) to download 10 Auto-email to patient site from TeleSteth server to advise that file is available for download 9 Consultant connects to the TeleSteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 File is transferred to the Consultant’s local machine 7 Consultant reviews the files, adds comments and then re-connects to upload the file to the TeleSteth server 8 Auto-email advises consultant that a file is available to download 5 5 Consultant

  43. 3M™ Littmann® TeleSteth Patient Assessment Recorded using StethAssist Software Patient site connects to TeleSteth server to select file(s) to download 1 TeleSteth Server 10 Patient Site Connects to TeleSteth Server 3 Patient file(s) transferred to Patient site local machine. 9 11 Consultant connects to the TeleSteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 File is transferred to the Consultant’s local machine 7 Consultant reviews the files, adds comments and then re-connects to upload the file to the TeleSteth server 8 Auto-email advises consultant that a file is available to download 5 5 Consultant

  44. 3M™ Littmann® TeleSteth Patient site connects to TeleSteth server to select file(s) to download 10 Patient Assessment Recorded using StethAssist Software 1 TeleSteth Server Patient Site Connects to TeleSteth Server 3 Patient file(s) now duplicated on consultant and patient site machine. No copies left of server. 12 9 Consultant connects to the TeleSteth Server and selects file(s) to download 6 File is uploaded to TeleSteth Server and the Consultant is identified 4 Patient Site Full Digital Sound Profiles saved to local machine 2 File is transferred to the Consultant’s local machine 7 Consultant reviews the files, adds comments and then re-connects to upload the file to the TeleSteth server 8 Auto-email advises consultant that a file is available to download 5 5 Consultant

  45. 3M™Littmann®TeleSteth 5 GP Practices in the Oxfordshire area were engaged to take part in a pilot study Practices contributed to the financial assessment of the existing services, sharing their current practice costs. Tariff costs were confirmed to be correct at time of assessment. The component parts of the patient journey were separated out and each was broken down into it’s allocated time with real-time assessment of the actual tasks. The GPs were timed performing the new tasks (StethAssist recordings) whilst still relatively new to the process and it is widely accepted that the allocated time will reduce with experience. The TeleSteth components – upload and download of the files was performed as an administrative task within the practices but once again, real-time assessments of the timings were measured.

  46. 3M™ Littmann® TeleSteth New Patient Pathway - with allotted times (measured) Average 72 Hours

  47. 3M™Littmann®TeleSteth Published on 14th October, Treatment Strategies Cardiology contains a full report of the pilot assessment of the proposed new service, run in Oxfordshire this summer. http://viewer.zmags.com/publication/271b93ad#/271b93ad/1.

  48. 3M™Littmann®TeleSteth • Dr Adwani’s Conclusions….. • Introduction of a reporting service for Innocent Systolic Murmurs would allow us to reassure referring Paediatricians, General Practitioners and parents about a large proportion of children (with an innocent murmur) and in so doing, avoid a full consultation and echocardiogram. This is particularly appropriate when the characteristic still’s murmur is encountered in pre-school assessments. • We can remotely arrive at a diagnosis and convey this information back in a timely manner, reducing the discharge of the patient from in excess of 90 days, to 48 hours or less. • We can reduce the direct cost to the General Practitioner…………………………. • We can introduce a triage process for all new murmurs encountered. • We can significantly improve the current process of referral. http://viewer.zmags.com/publication/271b93ad#/271b93ad/1.

  49. 3M™ Littmann® TeleSteth • Proof of Concept • Patient benefits • Service benefits • OK, so what’s all this going to • cost me ? • ? Robust Health Economics • ? Cost Effective Solution

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