Telephonic Care Management: Paving the Way for Telehealth and Telecare

1. Telephonic Care Management: Paving the Way for Telehealth and Telecare John Procter and Dr. Pejman Azarmina Pfizer Health Solutions BCS Health Informatics Interactive Care Specialist Group 16 October 2007

3. Starting from the end What are the outcomes that we need? Independent living, less reliance on health and social care Fewer unscheduled admissions and A&E visits Feeling better Better monitoring of LTCs (preferably at home) Equality in health, accessibility of care …

4. A bold statement eHealth alone is key in achieving the following outcomes: Independent living Self-care Reduction in unscheduled admissions Better quality of life for people with LTCs Improving access and reducing health inequalities

5. Another bold statement System redesign is key in achieving the following outcomes: Independent living Self-care Reduction in unscheduled admissions Better quality of life for people with LTCs Improving access and reducing health inequalities

6. A Compromise? System redesign consisting of eHealth is key in achieving the following outcomes: Independent living Self-care Reduction in unscheduled admissions Better quality of life for people with LTCs Improving access and reducing health inequalities

7. Now let’s see what eHealth is … … and what it can do?

8. Definitions and hierarchies

9. Other definitions “e-Health refers to the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers.” [EU definition] “Telecare is a combination of equipment, monitoring and response that can help individuals to remain independent at home.” [DoH] “Telehealth is the delivery of health related services and information via telecommunications technologies.” [DoH] “The knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promote health.” [DoH]

10. Stand-alone Telehealth and Telecare Building blocks Feasibility Evidence Verdict

11. Building blocks

12. Feasibility

13. What does the evidence say? Patchy nature of evidence in telehealth Confusion about terminologies Huge variety of models Quality of evidence RCT vs. quasi-experimental and pilot studies Nature of studies Proof of concept, cost effectiveness, effectiveness, system validation, etc. Assessment of the evidence Meta-analyses, CONSORT checklist, etc.

14. Verdict Telehealth and telecare are feasible There is little evidence supporting high tech and high cost telehealth/telecare models Little evidence to support cost-effectiveness Some evidence to support cost-effectiveness of low band width, low cost, telephone-based models Some evidence to support cost-effectiveness for certain conditions Very difficult to generalise or conduct meta-analysis.

15. Integrated Telehealth and Telecare Models eHealth in the redesigned system Evidence Verdict

16. Chronic Care Model NHS and Social Care Model

17. … and the pyramid

18. So, where is eHealth? Home monitoring equipment Assistive technologies Computerised decision support systems Web-based tools Information prescription Self-monitoring Some home monitoring Some AT QMAS Decision support for HCPs

19. The detailed picture of how …

20. PHS detailed picture of how …

21. And a very simplified picture of how …

22. Evidence and verdict Evidence is very similar to stand-alone telehealth and telecare Generally poor and patchy Insufficient for building a business case Not necessarily better than traditional care Everything seems to be “technically” possible, but … Commissioners buy redesign better than just technology eHealth through system redesign has better chance of multiple stakeholders’ engagement CfH is part of the NHS modernisation and redesign. Why do we think that eHealth and its children are an exception?

23. 2 case studies or Lessons from practice OwnHealth Why telephone? Why DM/care management? Why NHSD? Why NHS needed a private partner? WSDS Why work with local authority? Why not use a kit for every member? Finding the right patients? When to graduate?

24. Birmingham OwnHealth Introduce team From BOH a pro-actice care management service to support people with a long term condition in some of the most deprived wards in the UKIntroduce team From BOH a pro-actice care management service to support people with a long term condition in some of the most deprived wards in the UK

25. The Challenge in Birmingham

26. The life expectancy gap is growing…

27. There is a stark difference between known prevalence of CHD and the CHD SMR

28. Inequality in Birmingham ANDREWANDREW

29. Why OwnHealth? Commitment to addressing the equality gap Need to find new ways to engage people Proactive not reactive care Recognising the need to personalise care Telephone model is high coverage Willingness to engage the private sector

30. E-Health elements of OwnHealth Currently Primary engagement over the telephone Web-based decision support software Member contact via e-mail Data extraction from GP systems

31. Moving to a whole system service

32. Current Situation

33. The Programme

34. Participant Identification

35. Assigning a Level Of Care

36. Identifying Appropriate Individuals for Assistive Technology

39. Time for Question and Answers … Pejman.Azarmina@pfizer.com John.A.Procter@pfizer.com