Telehealth Whole System Demonstrator (WSD) report – implications for the future of healthcare

Ivan McConnell gives his view on the implications of the Telehealth Whole Systems Demonstrator report for the future of healthcare.

Telehealth Whole System Demonstrator (WSD) report – implications for the future of healthcare

George MacGinnis gives his view on the implications of the Telehealth Whole Systems Demonstrator report for the future of healthcare

Published on Thursday 13 October 2011 00:01

A £5 MILLION telehealth system with the potential to save around £1,000 per patient per year has been largely ignored by NHS boards, the public spending watchdog has warned.

Telehealth is designed to provide remote electronic healthcare, particularly for hard-to-reach areas. But Audit Scotland’s review found that the system is generally not considered an option when NHS boards are planning or redesigning services.

An estimated £4.7m has been allocated to telehealth initiatives since 2006. Economic modelling work suggests the home monitoring of patients with chronic obstructive pulmonary disease could save NHS boards around £1,000 a year for each patient.

However, Audit Scotland found limited coverage in local delivery plans and only half refer to telehealth specifically.

Over a third of the medical directors interviewed did not know if the Scottish Centre for Telehealth (SCT), established in 2006 to support NHS boards to develop telehealth, was performing its core functions well.

Half of medical directors felt that the integration of SCT and NHS24 had no impact on the delivery of telehealth within the board.

Auditor General for Scotland, Robert Black said: “The NHS in Scotland is facing serious pressures from the ageing population and increasing numbers of people with long-term health conditions such as diabetes and respiratory illnesses.

“Telehealth could help to provide a range of services efficiently and effectively.”

Health secretary Nicola Sturgeon said: “Telehealth has a pivotal role to play in delivering efficient and effective care to people of all ages across our country.”

The Royal College of Nursing Scotland backed the auditor’s call. Director Theresa Fyffe said: “Investment has been inconsistent and a survey of our members last year, found that less than 20 per cent use telehealth.”

Read the article on Scotsman.com

After the success of the P4 Digital Healthcare convention in 2010, Highlands and Islands Enterprise offers the opportunity to further explore the rapidly evolving field of P4 digital healthcare.

The term ‘P4′ is being adopted in the life sciences and digital healthcare sectors to describe the changing healthcare landscape as it becomes more Predictive, Preventative, Personalised and Participatory.

P4 Digital: The future of healthcare conference, taking place at the Centre for Health Science in Inverness, will be held on 10 and 11 May 2011.  The theme of the event will be ‘exploring and connecting’.

Conference agenda

• Day 1, 10th May 2011
• 12.00pm – 1.00pm registration and lunch
• 1.00pm – 1.10pm introduction and welcome
• 1.10pm – 1.30pm scene setting – Dr Steven Dodsworth, Highlands and Islands Enterprise
• 1.30pm – 2.10pm P4 Digital and m-health – Sarah Sanders, Vodafone
• 2.10pm – 2.50pm P4 Digital, sensors and devices – Steve Setford, LifeScan
• 2.50pm – 3.50pm coffee and exhibition
• 3.50pm – 4.30pm P4 Digital and the web – Dame Wendy Hall, Web Science Trust*
• 4.30pm – 5.00pm Moray, a living laboratory – Moray Community Health and Social Care Partnership
• 5.00pm – 5.10pm closing remarks

* Remote connection

• Day 2, 11th May 2011
• 8.45am – 9.15am registration and coffee
• 9.15am – 9.30am opening remarks
• 9.30am – 10.10am P4 Digital and the NHS – George Crooks, NHS 24
• 10.10am – 10.50am P4 and consumer health psychology – Vivien Swanson, University of Stirling
• 10.50am – 11.30am coffee and exhibition
• 11.30am – 12.20pm P4 and design innovation – Irene McAra-McWilliam, Glasgow School of Art
• 12.20pm – 1.00pm P4 Digital in practice
• 1.00pm – 1.10pm closing remarks
• Lunch and networking
  

Delegate sign-up -  please complete our online form here to sign up for this event.

Exhibition space will be available on a first come, first served basis. A donation is requested from exhibitors to cover hospitality costs. For more information please contact dyan.berry@hient.co.uk

We can keep you up to date with news about P4 digital, if you would like to sign up for the mailing list please send your details todyan.berry@hient.co.uk

Information on last year’s event can be located is available from the list ofprevious conferences.

Ten million pounds is to be invested over four years to improve care by growing the Scottish telehealthcare sector.

The project – jointly announced today by the Scottish Government and the Technology Strategy Board – will show how new technologies and innovative services can help improve the quality of life of, and support independent living for, older people and people living with long-term conditions.

The demonstration programme will involve at least 10,000 older people and people with disabilities.

In the first joint project between the Technology Strategy Board and the Scottish Government, the Scottish Assisted Living Demonstrator agreement was signed today by Health Secretary Nicola Sturgeon and Iain Gray, Chief Executive of the Technology Strategy Board.

Ms Sturgeon said:

“Supporting people to live independently at home is a key priority for the Scottish Government. It is what older people have consistently said they want and we know it is generally better for people’s health to remain at home wherever that’s possible.

“Over the last four years, Scotland has made significant progress on developing and expanding new technologies to help people do just that – providing effective care and reassurance to many older people.

“Today’s announcement demonstrates our commitment to build on this progress and to expand even further the role technology plays in supporting twenty-first century healthcare.

“The experiences from the Scottish Assisted Living Demonstrator will also be used to inform and provide invaluable opportunities for Scottish businesses in support of economic growth.”

Iain Gray said:

“I am delighted that the Technology Strategy Board and the Scottish Government are to work together to establish an Assisted Living Demonstrator in Scotland. Scotland is a leader in the introduction of innovative technologies and services to enable independent living for older adults and people living with long-term conditions.

“This demonstrator programme, which will involve at least 10,000 users in Scotland, will be the first step towards the aspiration of providing assisted living services for millions of people across the UK.”

The key objective behind the demonstrator is to help break the barrier between new healthcare technology and the implementation and use of the technology in the public sector, such as NHSScotland, the private sector, for example in housing and in the insurance sector and the third sector, including by charities and social enterprises. Other key agencies involved in the development of the demonstrator are NHS 24, Highlands & Island Enterprise and Scottish Enterprise.

The demonstrator will also show how cost savings could be made alongside the provision of improved health benefits for both public and private provision, while opening new markets in social innovation, service innovation and wellness.

The Scottish Assisted Living Demonstrator is likely to be the first of a number that will be established across the UK by the Technology Strategy Board under a programme named DALLAS – Demonstrators of Assisted Living Lifestyles at Scale.

Further details of the Scottish Assisted Living Demonstrator programme, including the geographic focus, will be agreed in discussions between the Scottish Government, its agencies and the Technology Strategy Board.

The Technology Strategy Board is a business-led government body which works to create economic growth by ensuring that the UK is a global leader in innovation. Sponsored by the Department for Business, Innovation and Skills (BIS), the Technology Strategy Board brings together business, research and the public sector, supporting and accelerating the development of innovative products and services to meet market needs, tackle major societal challenges and help build the future economy.

The demonstrator programme sponsors, and anticipated funding contributions, are: Technology Strategy Board (£5m), Scottish Government (£3.9m), Highlands & Islands Enterprise (£0.8m) and Scottish Enterprise (£0.3m). NHS 24 will be the delivery arm for Scottish Ministers and the Scottish Government’s Health & Social Care Directorate.

Further details of the programme will be developed and established by the Scottish Government, its agencies and the Technology Strategy Board over the next year, as preparations are advanced for implementation of the Scottish Assisted Living Demonstrator from April 2012.

This programme is being run through the Technology Strategy Board’s Assisted Living Innovation Platform (ALIP), which is responding to the challenge of the demographic shift – in essence promoting independence by making technology better, cheaper and more desirable. The ALIP aims to significantly advance the technology to meet the demand for independent living from the expected increase in the numbers of people suffering from long term conditions and age-related disability. By 2021 half of the UK’s adult population will be over 50 and by 2025 almost 1.5 million people will be living with an age-related disability.

By David Doherty

At the Healthcare Innovation Expo in London I met with Dr Richard Pope, Consultant Diabetologist, who is reporting some great success with the use of Video Conferencing with home based patients:

Key take aways of the talk:

• There are currently 150 home based patients being telemonitored. Set against registry data service is saving ~0.1 all cause admissions, per patient, per month
• Between July 2009 and December 2010 it has saved 202 all-cause admissions
• Based on these reduced admissions alone it’s saved >£93k in 18 months
• 5 year programme is running across 20 prisons delivering A&E urgent care service + 21 outpatient specialities offering elective services via telemedicine

Patients Perspective:

“…There is no expensive journey to and from hospital. No re-organising of work commitments to then spend time sitting around in waiting rooms… simply a live link up where I can talk freely and we can swap ideas as to how to improve my life…“

Consultants opinion on the value of video connectivity:

“…First of all it allows you to deal with comorbidities much more straightforwardly, we’re doing what we’re doing in clinic but we just happen to be remote from the patient. And the visual dimension gives you a lot more confidence in your decision making. So you’ve got a data stream coming in oxygen saturations are low and you’re going to admit somebody because thye’ve dipped but you can actually see them in their own house and they’re not breathless and you just make decisions that you make day in day out and I also think there is an ability to engage in a different way with the family so i’ll give you an example, I was doing a call to a guy with diabetes at home and he’s telling me how he’s sticking rigidly to his diet and then i hear a shout from the kitchen “oh no you’re not you lying bugger!” and his wife comes around the corner joins in the call and we have a much more engaging conversation. So obviously he’s given permission to have his wife in the room so confidentiality isn’t an issue in this case but there are lots of examples like that were another patient who was hospital phobic and wouldn’t come to clinic, and her (blood sugar) control was awful and she felt really bad about herself. But she engaged through this modality in a way that allowed her to have really quite complex clinical discussions, six or seven sessions later and her HbA1c levels are back down and have stayed down. so i think it allows you to do what you do day in day out but actually do it in a much more efficient way“

Read the full article on 3GDoctor

• Remote capture of health information from the home can save NHS millions and improve quality of life for people with long-term chronic conditions, says new report “Healthcare without walls – a framework for delivering telehealth at scale.”
• Urgent government action needed to put in place a national strategy.

The explosive growth in the number of people with long term conditions (LTCs), such as diabetes, heart disease and lung disease, could overwhelm NHS resources, according to a new report to be published on 24th November. The report by the think tank 2020health.org warns that the current NHS approach to delivering care to people with LTCs is unsustainable both in terms of cost and quality, and in no one’s best interests – least of all the patients and their carers.

The report will be launched by former Health Secretary Rt Hon Stephen Dorrell MP, chairman of the Commons health select committee, at 6 pm on Wednesday November 24 at St Stephen’s Club, Westminster, London.

The scale of the problem is immense, according to the report:

• A rise of 23 percent in LTC patients will occur over the next 25 years
• LTC patients account for 31 percent of the population, 52 percent of all GP appointments and 65 percent of all outpatient appointments
• Three out of every five people aged over 60 in England have a LTC and it is not just the elderly who are suffering from chronic disease. Many of the young obese could develop diabetes, heart disease and arthritis among other things in their 30’s.

The report demands urgent Ministerial support to facilitate the use of the remote capture and relay of health information from the home for clinical review and early intervention. Julia Manning, Director of 2020health.org, says:

“Properly implemented this is a prescription for the next generation and would easily save the NHS up to £1 billion.

“If things are left as they are now, however, the pressure that the LTCs put on the NHS and social care could overwhelm it. Doing nothing is not an option. Government needs to grasp this nettle and make enabling telehealth a national priority now.

“If we get this right now, we can improve the quality and affordability of patient care for the next generation.

“Implemented effectively, the remote capture of information from patient in the home, distance learning and consultations can all improve the patient’s care and quality of life by reducing the need for appointments and emergency admissions to hospital. It also means nurses’ and GPs’ time can be focused on genuine needs instead of taking routine measurements.”

With no complex technology, the telehealth care devices are installed in the patient’s home and typically connect to their telephone line or broadband service so that the data collected can be sent to a central monitoring centre.

The patient uses the system and accompanying device (e.g. digital thermometer, weighing scales, blood pressure cuff, pulse reader) to take readings such as blood pressure or oxygen levels which are sent automatically. If the readings show any signs of the patient’s condition deteriorating, a doctor or nurse is alerted to contact the patient.

Based on a thorough analysis of the relevant evidence, John Cruickshank, the report’s author and independent health IT expert, calls on the Government to recognise the key specific recommendations so the NHS can best exploit the transformational potential of telehealth:

The key recommendations are:

1. Amend tariffs/incentive schemes to recognise and reward telehealth- and teleconsultation-enabled services on a consistent basis across the NHS
2. Create improved public awareness around telehealth and its ability to enable better self-care – leading to systemic improvements across health and social care.
3. Establish a national framework of support and expertise in telehealth to share best practice

2020health calls on the Government to act on the recognition that face-to-face services are under significant pressure – even before taking into account the financial challenges of the years ahead –and is reason enough to promote less resource intensive ways of delivering high quality evidence-based chronic disease management.

This follows a Department of Health acknowledgement in 2009 that “Transforming the care and lives of those with long term conditions and delivering truly integrated, efficient and people-centred community services has the potential to improve the quality of millions of people’s lives.”

The last government sponsored three large “whole system demonstrators” with a view to gathering robust evidence and learning lessons for implementing telehealth at scale.
And in many ways the latest health White Paper creates the environment in which the demand for telehealth-enabled services can be fostered. Yet there is a prevailing view that initiatives such as this can be left to the market to sort out and action is limited, according to the 2020Health.org report.

“While there are over 100 telehealth projects around the NHS, there are estimated to be less than 10,000 patient units deployed. The majority of these projects are small-scale, many are known not to be well integrated into healthcare systems. The need to build on successful pilots to create scaled up projects is crucial,” Mr Cruickshank says.

“To enable these ‘tele’ technologies to make a dramatic impact in terms of patients’ quality of life, and the NHS’s capacity to cope with the ever-increasing numbers of cases and in the associated economic costs, the government must adopt a firm strategic leadership for telehealth at scale,” he adds.

“With our national finances now severely constrained and for the foreseeable future, the current, largely reactive approach to chronic condition management is unsustainable. Telehealth should sit as a part of a nationally recommended suite of enablers that if integrated through local business change and service delivery, will underpin the transformation outlined in the NHS White Paper.”

Examples:
From over-the-phone patient consultations and coaching to:

• real-time audiovisual conferencing system that allows specialists in stroke care to remotely assess patients and to view their CT brain scan images
• simple video conferencing between at home patient and case manager
• through-the-TV technology to send messages and reminders or have a consultation
• text messaging: medication reminders; appointment reminders; blood monitoring reminders; physical health monitoring; behavioural change; social inclusion; ‘feel good’ messages
• in-home vital signs data collection of blood pressure, blood glucose, oxygen levels, weight or body images and transfer to professional for evaluation or automatic assessment
• in-bed sensors that detect changes in pulse and breathing
• implants such as pacemakers and insulin pumps from which readings can be collected remotely

Resulting in:
Reduced service utilisation costs including primary care attendance, A&E attendances, outpatient attendances and acute admissions, improved quality of life for patients and carers.

The report was supported by the following eight organisations – Accenture, BT, isoft, Medtronic, Pfizer Health Solutions, Tunstall, TPP and Vodafone.

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.

Expected Benefits

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).

Read more: http://www.ihealthbeat.org/articles/2011/1/11/family-caregivers-say-health-it-tools-can-provide-key-benefits.aspx#ixzz1B0aoBG8P