iPLATO Healthcare, the leader in mHealth, reported that patient response to a new local support service for COPD patients in Greenwich has been overwhelmingly positive. Over the last few weeks, hundreds of people with COPD have signed up to receive alerts, advice and signposting about how to remain in control of their health and stay well in the comfort of their own home. NHS Greenwich provides this service to patients across the Borough using the iPLATO’s technology platform.
Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe a group of progressive airways diseases including chronic bronchitis and emphysema. There is no cure for COPD but a lot can be done to relieve its symptoms. Preventative interventions include stop smoking and various forms of medication and the flu jab. Contributing factors to symptoms worsening include changing weather conditions. According to the NHS Information Department, an average hospitalisation costs the tax payer £1,946. NHS Greenwich estimates that COPD is the cause of 1 in 20 hospital admissions in their part of London.
NHS Greenwich aims to provide a localised, personalised and holistic service to help patients stay in control of their condition and to avoid unnecessary hospital admissions. To achieve this aim the patient messaging service will – in addition to communicating known triggers such as local weather changes and invitation to preventative services – also help with practical details such as getting necessary medication from the GP before bank holidays and other times when less support may be available.
Initial feedback has been very positive and encouraging: “The COPD support service is a brilliant idea, even though I am normally on top of my condition an extra reminder would help,” says one patient who enrolled to the service after receiving a text invitation from her GP surgery.
“It is important for patients with COPD to be supported to manage their condition and feel more in control of their illness. This new service enables patients with COPD to get the right information at the right time to do this. It will provide the essential support, information and advice that is required for people with COPD to stay well,” says Dr Eugenia Lee, GP.
Jackie Davidson, Associate Director of Public Health says: “In Greenwich, there are over 3,000 people that have been diagnosed with COPD and about another 4,000 people that are undiagnosed and untreated because they don’t recognise the symptoms. This patient messaging service is a great example of how we can use our local knowledge to help people manage their condition to remain well. We hope to bring real benefit and extend the service to even more people.”
Many caregivers who use health IT tools to help care for family members or friends believe emerging technologies such as mobile health devices and personal health records will significantly benefit them and their care recipients, according to a recent study by the National Alliance for Caregiving and UnitedHealthcare, InformationWeek reports.
The study was based on a November online survey of 1,000 caregivers who provide at least five hours per week of unpaid care to an adult relative or friend. All of the caregivers in the survey use the Internet or some other technology to help provide care.
In response to questions about the expected benefits of using health IT tools, the researchers found that:
77% of survey respondents believed the tools would save time;
76% believed the tools would make care easier logistically;
75% believed the tools would make care recipients feel safer;
74% believed the tools would increase feelings of effectiveness; and
74% believed the tools would reduce stress (Lewis, InformationWeek, 1/11).
Top Three Tools
The survey also identified three health IT tools that appeared to have the greatest potential to improve care because they appealed to a large number of caregivers and had minimal barriers to adoption. The top three tools identified were:
Personal health records, with 77% of respondents saying they would find it helpful to have a Web- or software-based PHR to track medications, test results and other data;
Caregiving coordination systems, with 70% of respondents saying they would find it helpful to have a system that logged a care recipient’s medical appointments and helped coordinate care; and
Medication support systems, with 70% of respondents saying they would find it helpful to have a device that reminded patients to take their medication and provided data on side effects (Hobson, “Health Blog,” Wall Street Journal, 1/10).
Scotland has the potential to become a world leader in mainstreaming telehealth, but progress, despite concerns about a rapidly ageing population, has been slow. James Ferguson, lead clinician for the Scottish Centre for Telehealth, explains why, and what the NHS needs to do to move things forward and avoid being swept away
Whilst speaking at a recent conference on care of the elderly at the Royal College of Physicians of Edinburgh, one of my co-speakers referred to the ‘silver tsunami’. This refers to the increasing number of patients with long term medical conditions, approaching or already in retirement. This cross section of the British public is fast becoming a major issue for government, who must address the health and social care needs of a rapidly expanding elderly population.
Issues such as demographic and social changes in the general population, as well as the impact of the largest global recession in over 80 years, means the NHS is currently facing its most challenging period of development since its inception. Financial and resource constraints are making it increasingly difficult to treat the elderly and long-term ill within the traditionally secondary care based model.
The reality of this oncoming tidal wave of an increasingly aged population, combined with the very real threat of NHS funding cuts, mandates a change in the way healthcare services are delivered across the UK. Current traditional pathways of care are likely to be overwhelmed. Redesign to improve efficiency and implement innovative, effective pathways of care is urgently required to maintain care and support for the elderly, many of which suffer from chronic conditions.
The upshot is the NHS must focus on achieving healthcare delivery and value for money by shifting the emphasis on care from hospitals to community-based care. Patients with chronic conditions require increased support to help them manage their conditions at home or close to home. If more efficient ways of managing long-term conditions are not put into practice, the NHS is in danger of being engulfed by the wave.
It is widely acknowledged that advances in modern technology have had, and continue to have, an enormous impact on the quality, delivery and efficiency of public healthcare services. Telehealth home monitoring systems, supplied across Scotland by a variety of providers including Tunstall Healthcare, offer a potential solution.
Telehealth enables patients to stay at home, helps prevent avoidable admissions, supports early discharge and improves quality of life for patients. This benefits patients from a clinical point of view and helps alleviate the organisational burden on the NHS.
One of the key advantages of telehealth is the potential to deliver high quality healthcare to patients in, or close to, their own homes, reducing the need for travel to hospitals to receive care and treatment. This is relevant for all elderly patients and particularly for those living in rural and remote areas of Scotland.
Telehealth in Scotland
In 2006, the Scottish Centre for Telehealth (SCT) was established to support and guide the development of telehealth for clinical, managerial and educational purposes across Scotland. This involves working across boundaries, with industry, academia, local authorities, NHS Boards etc, to develop models for redesigning care.
The Centre’s role is to provide support and advice to NHS Boards and help evaluate and implement the benefits of new technologies, with the aim of making Scotland a recognised global leader in telehealth.
The geographical spread of Scotland with its widely distributed population has always made the delivery of healthcare challenging, but telehealth technology has made this task easier. Its value in assisting clinicians to manage patient’s long-term conditions, as well as saving on secondary care costs to the NHS, has long been recognised and has been demonstrated through numerous pilots and projects carried out across the country.
The SCT identified the potential use of telehealth in the management of Chronic Obstructive Pulmonary Disease (COPD) in Scotland as a priority area of work and commissioned a report to: 1) review key reported studies, 2) detail the COPD telehealth projects known to be ongoing both in Scotland and elsewhere, 3) introduce, examine and propose options for the use of telehealth nationally to manage people with COPD in Scotland.
In 2009, an evidence session held by the Scottish Parliament’s Health and Sports Committee with the SCT reported that excellent work was being undertaken across Scotland on telehealth development. Telehealth systems had been widely used in Aberdeenshire and The Highlands, with one project leading to a 100% reduction in emergency admissions for patients with chronic cardiac conditions.
However, concerns were raised that progress with widespread implementation was not occurring at a rapid enough rate. Nearly all the applications reported had been on a small scale and a lack of large-scale evidence meant reliable measurement of the potential benefits was unavailable.
There was varying feedback on the benefits of telehealth and, whilst some pilots may say that telehealth has been 100% successful, others have indicated that workload was increased by its use.
However, despite the lack of widespread usage and quantifiable results, the majority of applications report discernable benefits in various areas, including patient and carer satisfaction and secondary care admission reduction. To truly observe, derive and measure mass scale benefits from telehealth requires its usage to transform from pilot studies to mainstream usage.
A national agenda
To drive this agenda, the SCT is planning to establish a national home telemonitoring service for COPD patients to monitor and record the effects of telehealth on a wider scale.
Initially, existing telehealth users from a number of different areas across Scotland will be recruited to pool together data to give a better picture of its current effectiveness.
Parallel to this, the first phase of a national telemonitoring service will be constructed consisting of four health boards reflecting urban, rural, semi-rural and island areas of Scotland.
Once established, if this platform proves to be effective, the remaining health boards will have the opportunity to join the service, creating a truly nationalised service.
Obstacles and vision
It is not enough just to plan the widespread uptake of telehealth. An important element of progressing the telehealth agenda in Scotland centres around overcoming obstacles to telehealth implementation, which currently exist within the NHS.
Examples of barriers to implementation include cultural resistance and fear of change, lack of training amongst clinicians and health professionals in telehealth technology, protection of vested interests amongst certain health professionals and a narrow focus on traditional ways of delivering healthcare.
Many clinicians are unaware of the non-clinical benefits of telehealth, such as cost savings, and so are not incentivised to change the way they work. Awareness of the tangible benefits to patients, healthcare professionals and the organisation in general must be raised to encourage integration of telehealth into their working practice. Clinicians must be convinced and confident that telehealth is best practice in their sphere of influence.
A major factor slowing progress is the lack of clinical confidence in telehealth. Many clinicians raise concerns that patients may feel that the level and quality of care they receive via telehealth will be inferior to the care they receive face-to-face.
In fact, the vast majority of patients, who have participated in telehealth, have proven to be enthusiastic and satisfaction is very high. One tactic to drive the agenda forward will be to recruit patient groups to present their positive feedback to clinicians.
It is not solely clinicians who need to be convinced. Organisational confidence to buy in to telehealth is required for telehealth to go mainstream. A significant driver here is the economic climate.
To engage health boards and other bodies, business planning must be undertaken clearly demonstrating the potential long-term, clinical, organisational and cost benefits resulting from mainstreaming telehealth across Scotland.
Driving the agenda
What drivers may push the telehealth agenda forward? Two factors highlighted by the SCT are:
• Incentivising health boards and clinicians to adopt telehealth
• Ensuring telehealth is mainstreamed into the education and training of all health care professionals.
The approach adopted by the Government to encourage health boards to use telehealth systems has, to date, been largely unsuccessful. There is ongoing frustration at the continued failure of telehealth projects to achieve the critical mass required to become mainstream options for the delivery of care by health boards.
Whilst, many boards have undertaken effective pilot projects, there has been no real incentive to ensure telehealth development overcomes the cultural resistance which has prevented its widespread use.
In light of this, a two-year strategy has been developed by the Joint Improvement Team, in association with the SCT, which outlines the first phase of an approach to develop and deliver telehealthcare education and training opportunities in Scotland.
Stakeholders, who have been identified as potentially benefitting from telehealthcare training include; senior strategic and operational managers, GPs, nursing professionals, social workers, allied health professionals, equipment installers, home carers and service users.
The strategy will involve a two-pronged approach:
• The inclusion of training in telehealthcare in the core curriculum of the emerging telehealthcare workforce
• The development of accessible, Scottish Qualifications Authority (SQA) accredited training and CPD opportunities for staff already working within telehealthcare services
As telehealthcare education and training is new ground, robust review and feedback mechanisms will be employed during this two-year strategy to enable the approach to be adjusted and refined as necessary.
The power to make a difference
Scotland has the potential to be a world leader in telehealth. A major problem for the SCT in driving forward the telehealth agenda has been the advisory nature of its original remit. A review by the Scottish Government of the SCT undertaken in 2009 identified it being hosted by a regional health board, rather than being part of a nationwide NHS body, as possibly creating a perception that telehealth is only relevant to remote and rural health services. This may have limited the SCT’s credibility in encouraging clinicians and health boards to take up telehealth as a mainstream delivery tool.
A recommendation from the review was that the SCT integrate with Scotland’s answer to NHS Direct, NHS 24. This integration occurred in April 2010 and will provide the national platform required to ensure telehealth is given the focus it deserves within health board planning, and should lead to more innovative solutions to redesign healthcare in Scotland.
During the 20th century, the biggest challenge facing the healthcare industry was whatto use to diagnose, treat and cure ill health; this resulted in the discovery of medicines such as Penicillin and imaging techniques such as MRI.
The challenge we face in the 21st century is not what we use to deliver healthcare, but how we deliver it equitably, and advances in communications technology have presented us with a solution.
Telehealth technology has a vital role to play in revolutionising healthcare in Scotland, and it is this point that needs to be driven home. The question is how will the NHS in Scotland harness this technology to deliver efficient and sustainable services for patients?
The healthcare environment is ripe for Scotland to move forward and become world leaders in mainstream telehealth deployment. The continued failure of the NHS in Scotland to capitalise on successful telehealth pilot projects has been very disappointing. However, if the measures outlined here are successful, then Scotland could become the first country to establish national-scale telehealth services.
Scotland has the opportunity to lead the way and we need to grasp this opportunity as the silver tsunami is coming, and healthcare, like it or not, is changing. In the words of the great singer song-writer Bob Dylan, “You better start swimming or you’ll sink like a stone. Because the times they are changing.”
Targeted Mobile Wireless Technology to Achieve Maximum Healthcare Outcomes
in Remote Care Monitoring
DALLAS, Jan. 5, 2011 Patients suffering from diabetes, hypertension, heart disease and other chronic conditions may soon be able to enjoy the benefits of improved health information transfer. Using wireless technologies, AT&T and MedApps, a recognized leader in the development of wireless mobile remote patient monitoring solutions, announced today the inclusion of MedApps in AT&T’s ForHealth portfolio of mHealth, cloud-based, and telehealth products and solutions.
The ForHealth product ecosystem is intended to streamline healthcare data flow and care delivery and contribute to improved disease management, particularly for those with chronic conditions. Along with other key providers and their products, the inclusion of MedApps’ CloudCare(TM) product line will broaden the mHealth solution suite offered by AT&T, enhancing AT&T’s abilities to offer turnkey solutions for the healthcare industry.
“MedApps’ focus on cloud computing and open platform architecture, allowing connection of multiple clinical devices to a single plug-and-play hub, is highly aligned with AT&T’s vision,” said Randall Porter, assistant vice president, AT&T ForHealth Solutions. “It will help AT&T offer mHealth solutions that are user agnostic and universally accessible, despite carrier, device type and operating-system. AT&T is excited to work with MedApps to provide a comprehensive remote care monitoring solution suite to our healthcare customers.”
AT&T will provide 3G connectivity to the MedApps solution suite, and will also be co-selling MedApps’ remote care monitoring hub and enterprise back-end solutions, bundling MedApps with existing AT&T remote care applications, clinical peripherals and devices.
The MedApps solution suite begins with HealthPAL, a dedicated portable device that uses a combination of embedded cellular and Bluetooth technologies to automatically transmit readings from retail monitors like glucose meters, blood pressure monitors, scales, and pulse oximeters directly to a patient’s electronic medical record (EMR), providing caregivers with ready access to the latest patient data for monitoring and review. For patients with chronic conditions, such as diabetes, fast access to the most current biometric data can improve patient compliance, help stabilize patients and drive down the cost of crisis care. HealthPAL provides a hands-off telehealth solution that is easy to operate for users of all ages and technological skill levels.
On the caregiver side, MedApps offers the HealthCOM portal, a web-based application that allows healthcare professionals to remotely review and manage the data collected by HealthPAL, and provides integration with other enterprise EMRs. HealthCOM is accessible from any place with Internet connectivity. The entire MedApps infrastructure is tied together by its patent-pending CloudCare(TM) platform.
“In looking at healthcare, and disease management, it is important to remember that different subsets of the population have much different rates of utilization of healthcare resources,” said Kent Dicks, CEO of MedApps. “Each of these groups also has different demographical characteristics that affect its use of technology – and one solution does not fit all. Therefore, multiple solutions are needed to engage different populations in order to achieve the best compliance and adherence rate possible. This is an essential and highly attainable way to reduce healthcare costs immediately.”