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
Older carers with elderly relatives
Fewer NHS professionals
Pensions / NHS changes
Matching care to user needs
The Pyramid of Doom
Case
Management
Disease
Management
Supported
Self Care
NHS
Wellness
Level 3
Highly complex
(5%)
Level 2
Level 1
POPULATION WIDE PREVENTION
High risk
(15%)
Low risk
(80%)
Level 3
Level 2
Level 1
The general public:
•Smoking
NHS Health
Risks
Program
•Drinking
•Eating
•Sedentary
•Bad habits
•Mental health
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.
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
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
Telecare
eHealth
Assistive
Telemedicine
Technology
Telehealth
Proactive
Environmental
Lifestyle
calling
controls
monitoring
Social
Supported
Vital signs
Dementia
alarms
discharge
monitoring
monitoring
Homecare
Patient
Care
monitoring
reminders
information
What is telehealth?
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
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
Bloodpressure
Cuff
Cholesterol
Monitor
Scales
NHS Care Record
Glucose
Sensor
Pulse
Oximeter
Telehealth Care
Record
Medication
Tracking
WWW
Elderly
living independently
Separate
Health & Social
Care Systems
Home Hub
Appliance
Coordination
Required
Healthcare
Professionals
Social Worker
eSAP
Home Automation
Security Wireless Network
• Lights
• Doors windows
• Motion / Activity
• Bed
• Drawers
• Kitchen
• Bathroom
NHS Direct
Step by Step Development?
Tailoring of service to patient needs
Suitable patients
Numbers / cost
Suitable patient contact channel
£500 to call ambulance
£50 to visit your GP
£20 to call NHS Direct
£1daily for Telehealth
£0.13 to assess digitally
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??
Different Types of Health Hubs
What is monitored?
Patients health, symptoms , well-being
Metrics
Weight
BP
PO2
Temperature
Glucose
Linked by wire / Bluetooth / Patient entry
What do patients say?
N Yorks PCT Questionnaire 4/11
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
The future?
The Present!