Telehealth: benefits for primary care
Shahid Ali GP & National Clinical Lead Commissioning intelligence
Clinical Lead Primary Care NHS Yorkshire and Humber
Telehealth
The use of
electronic
information and
telecommunications
technologies to
support longdistance clinical
health care,
professional healthrelated education,
and public health.
Telecoaching
Telecoaching uses a
one to one
interaction with
audio, visual and/or
interactive
communications,
used to support the
practice of health
care/social care,
enabling self care
and improved
condition
management.
Telemonitoring
Remote monitoring
tools capture
physiological
measurements and
relay them to a
central location for
review normally an
suppliers intranet
site.
Telemedicine
Remote video
consultations
between healthcare
professionals and
patients which
support care
outside of hospital.
Used to reduce LOS,
support early
discharge, and
admission
avoidance.
Why use Telehealth? The Case for Change
Increasing numbers of people have multiple long-term conditions
•188% rise just in Diabetes by 2050
•60% increase in multiple LTCs by 2013
•252% rise in over 65 year olds by 2050
We currently spend £19 billion on people with 3+ long-term
conditions. This is projected to rise to £26 billion by 2016
There is a need for a more integrated response to manage LTCs
Implications for NHS and General Practice
Long term conditions represent:
•70% of health and care spend,
•77% of inpatient bed days,
•60% of GP appointments and
•68% of outpatient and A&E appointments.
•The average annual health cost of someone without a long-term
condition is around £1,000; this rises to £3,000 for someone with one
condition and to £8,000 for people with three or more conditions
•The biggest challenge to emerging Clinical Commissioning Groups
includes the management of LTCs and urgent care
LTC Population
Complex
cases
Advocacy
&
support
Signposted to
information/advice
services
Self care – fully independent
Drivers for further change
Personalised health care- challenges current thinking of
doctor-patient relationship
Proactive rather than reactive care –challenges current
models of care delivery
Immediacy –challenges speed of care delivery
© NHS Yorkshire and the Humber
More than redesign ……..
Old Pathway
Old Mindsets
New Pathway
New Mindsets
A new approach to care delivery……
Care Planning
Pre
Post
Tele-health
E-consultation
Pre
Post
Before
After
Tele-health
package
E-consultations
Admissions
Discharge
Visits to
GP x 23
Outpatient
visits
Outpatients
x7
Visits to
GP x 7
Outpatients
x1
Early discharge
(monitored
and managed
at home)
Patient level impact of care planning
30
Number of GP visits pre and post care planning
Number of GP visits
50
40
30
20
10
Number of outpatient visits
60
A B C D E F G H
I
J
K
20
15
10
5
A B C D E F G H
L M N O P Q R S
I
J
K
L M N O P Q R S
Patient
Patient
Post care planning
Number of A&E attendances pre and post care
planning
1
0
Number of acute admissions
Pre care planning
Number of A&E attendances
Number of Outpatient visits pre and post care
planning
0
0
2
25
2
Number of acute admissions pre and post care
planning
1
0
A B C D E F G H
I
J
K
Patient
L M N O P Q R S
A B C D E F G H
I
J
K
Patient
L M N O P Q R S
Data extrapolation to practice list sizes
Pre care planning
Practice size (£000)
3,500
872.16
7,000
1,744.33
10,000
2,491.89
Post care planning Difference
(£000)
(£000)
329.00
543.16
658.00
1,086.33
940.00
1,551.89
Care Planning
Pre
Post
Tele-health
E-consultation
Pre
Post
Before
After
Tele-health
package
E-consultations
Admissions
Discharge
Visits to
GP x 23
Outpatient
visits
Outpatients
x7
Visits to
GP x 7
Outpatients
x1
Early discharge
(monitored
and managed
at home)
Patient Centred Care: Immediacy
• A clinical opinion in a different way ....
• Cohort of 16 GP practices / Nephrology (John Stoves,
John Connolly et al, Bradford)
• E-consults for renal problems
• Channelled to single consultant
• Record reviewed / opinion written into e-notes
• Need for face to face consultation reduced by 80%
A world class solution……
Care Planning
Pre
Post
Tele-health
E-consultation
Pre
Post
Before
After
Tele-health
package
E-consultations
Admissions
Discharge
Visits to
GP x 23
Outpatient
visits
Outpatients
x7
Visits to
GP x 7
Outpatients
x1
Early discharge
(monitored
and managed
at home)
• Bradford care home telemedicine pilot
• Benefits
• Provides immediacy – patients can be assessed and treated
sooner rather than waiting for a home visit.
• Electronic Patient Record (EPR) is available during the
consultation so the GP can look at the record at the same time, and
be better informed of the patient’s history, medication, hospital
communications and any other important information that may be
required during the consultation.
• Clinical triage- GP can assess the patient’s needs can give advice,
prepare a prescription or indeed visit if needed.
• Increased efficiency- up to 80% of calls for home visits could be
dealt with via telemedicine with only the minority still needing to be
seen in person.
• Benefits
• Releases capacity -Time saving, cost saving, safer, manages risk
more effectively, and is a simple way of conducting consultations.
Improved efficiency releases capacity in the Practice which is
important as complexity and demand increases in primary care.
• Reduced admissions- the quicker you get to see a patient the
easier it is to address their need. If you don’t get a clinical opinion
early enough, the patient is more likely to end up in A&E or be
admitted.
• Patients satisfaction high – patients and care home staff like it they can see and speak to the doctor and get seen quickly.
• Simple to use and there is no training needed.
Regional T-health Programme - Role of the “Hub”
Distributed
specialist
networks
Top Tip: “Don’t be afraid of new technology and
don’t assume it’s difficult or complicated to use
until you’ve tried it. It really is so simple, so do
it!”
Contact details:
Shahid.ali@yorksandhumber.nhs.uk
Shahid.ali@bradford.nhs.uk