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Developing Patient based Telehealth services

Developing Patient based Telehealth services. Dr Nicholas Robinson MA MRCGP Clinical Director Long Term Conditions. Why Telehealth? . Demographic problems Patient numbers growing Elderly Long term conditions (15m) Carer numbers falling Single households

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Developing Patient based Telehealth services

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  1. Developing Patient based Telehealth services Dr Nicholas Robinson MA MRCGP Clinical Director Long Term Conditions

  2. Why Telehealth? • Demographic problems • Patient numbers growing • Elderly • Long term conditions (15m) • Carer numbers falling • Single households • Older carers with elderly relatives • Fewer NHS professionals • Pensions / NHS changes

  3. Case Management Highly complex (5%) Level 3 Disease Management High risk (15%) Level 2 Supported Self Care Low risk (80%) Level 1 POPULATION WIDE PREVENTION Matching care to user needs The Pyramid of Doom NHS Wellness

  4. Level 3 Level 2 Level 1 • The general public: • Smoking • Drinking • Eating • Sedentary • Bad habits • Mental health NHS Health Risks Program

  5. What do patients want? 1 • Care close to them (at home) • Feeling secure and safe • Feeling they have someone they can contact • Feeling someone is watching over them • Understanding medications – new/changed/why/side fx/need for repeats • what to do if something goes wrong.

  6. What do patients want? 2 • At Home • Regular contact with NHS services • Support /education • Enhanced understanding of diseases • Ditto drugs (and improved compliance) • Supported self-care

  7. How can we improve Patients experiences? • Part of improved service offering • From admission to discharge to life in the community • Planning starting at admission • Problems / suitability defined for follow-up service • Need for 30 day support (Home testing / monitoring) • Need for longer term support (Telehealth service) • Tailoring device to patient

  8. Proactive calling Environmental controls Lifestyle monitoring Social alarms Supported discharge Vital signs monitoring Dementia monitoring Homecare monitoring Patient reminders Care information Telecare eHealth Assistive Technology Telemedicine What is telehealth? Telehealth

  9. What do Telehealth services offer currently? • 7000 patients monitored daily (1.2m for Telecare) • Focus on COPD / CCF • Current WSD pilot results pending (RCT for 6000 patients) • Developing 30 day discharge agenda • Challenges • Not acute service (5 days / 8-6pm) • 7 day installation delay • Excluded patients (20%) • Fixed installation for stationary patients! • Limited clinical engagement

  10. What is needed for widespread take-up of services? • Patient engagement • not about cost-saving • may be only option • Clinician engagement • Not about cost-saving • Allows focused services based on current needs • Commissioner engagement • Evidence • Value for money

  11. Social Worker Community Alarm Centre e.g. Text alerts Emergency Services Care Response Service, Warden etc Family, friends and volunteers NHS Direct Elderly living independently Healthcare Professionals Home Hub Appliance Coordination Required WWW eSAP • Home Automation • Security Wireless Network • Lights • Doors windows • Motion / Activity • Bed • Drawers • Kitchen • Bathroom Telehealth Care Record NHS Care Record Cholesterol Monitor Blood-pressure Cuff Scales Glucose Sensor Pulse Oximeter MedicationTracking Separate Health & Social Care Systems Step by Step Development?

  12. Tailoring of service to patient needs £500 to call ambulance £50 to visit your GP £20 to call NHS Direct £1daily for Telehealth £0.13 to assess digitally • Suitable patients • Numbers / cost • Suitable patient contact channel • Web / phone / text based service interaction? • 24/7/365 call-centre support • Phone-based service (30 day discharge) • Evolution to Telehealth monitoring if suitable • Suitable device • Fixed hub / Mobile device / Tablets • Telehealth TTA??

  13. Different Types of Health Hubs

  14. What is monitored? • Patients health, symptoms , well-being • Metrics • Weight • BP • PO2 • Temperature • Glucose • Linked by wire / Bluetooth / Patient entry

  15. What do patients say? N Yorks PCT Questionnaire 4/11

  16. Where are we going? • Urgent Care matrix • NHSD / 111 / OOH / Urgent GP / WICs • Large scale telehealth services • Working with Bosch, Docobo & Honeywell • Need data exchange to prevent duplication and improve effectiveness and timeliness of care • Consider needs / expectations of patients for care channels now and in future • Web / Voice / face to face

  17. The future? The Present!

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