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Developing Patient based Telehealth services
Dr Nicholas Robinson MA MRCGPClinical Director Long Term Conditions
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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
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Matching care to user needs The Pyramid of Doom
POPULATION WIDE PREVENTION
Level 3
Level 2
Level 1
Highly complex(5%)
High risk(15%)
Low risk(80%)
DiseaseManagement
CaseManagement
Supported Self Care
NHS Wellness
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Level 3
Level 2
Level 1The general public:
•Smoking
•Drinking
•Eating
•Sedentary
•Bad habits
•Mental health
NHS Health
Risks
Program
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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.
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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
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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
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Proactive calling
Vital signs monitoring
Patient reminders
Social alarms
Homecare monitoring
Environmental controls
Dementia monitoring
Care information
Supported discharge
Lifestylemonitoring
What is telehealth?
Telecare
Telehealth
TelemedicineeHealth
Assistive Technology
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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
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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
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Elderlyliving independently
Home AutomationSecurity Wireless Network• Lights• Doors windows• Motion / Activity• Bed• Drawers• Kitchen• Bathroom
GlucoseSensor
Scales
Blood-pressure
Cuff
Cholesterol Monitor
MedicationTracking
Pulse Oximeter
Separate Health & Social Care Systems
Social Worker
Step by Step Development?
Home HubAppliance Coordination
Required
eSAP
NHS Direct
Healthcare Professionals
WWWTelehealth Care
Record
NHS Care Record
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Tailoring of service to patient needs
Suitable patients
Numbers / cost
Suitable patient contact channel
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??
£500 to call ambulance£50 to visit your GP
£20 to call NHS Direct£1daily for Telehealth
£0.13 to assess digitally
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Different Types of Health Hubs
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What is monitored?
Patients health, symptoms , well-being
Metrics
Weight
BP
PO2
Temperature
Glucose
Linked by wire / Bluetooth / Patient entry
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What do patients say?
N Yorks PCT Questionnaire 4/11
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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
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The future?
The Present!