Messaging Enabled Care ServicesWashington D.C. Conference 2014

Paul Marriott MA FCIM, TECH Eng. IME

NHS England Northern Senate

Lead Consultant and Advisor of Technology Enhanced Care Services (TECS) to NHS England

Lead professional and advisor in the development and implementation of TECS in the North of England and Clinical Advocate for TECS UK and International NHS England

NHS England TECS - Clinical Advocate 2014 Winner

Marriott.p1@sky.com@VallumPaulM

In performing my role

• I lead Telehealth Programmes TECS (Technology Enhanced Care Services) for the NHS in the North of England

• I work Nationally and Internationally for NHS England promoting and advising on TECS implementation clinically and strategically

• I am a key innovator, leader and problem solver for new innovations within TECS

• I am an author and the inventor of the Multi Matrix Telehealth or (TECS) Model

About us

• NHS England Northern Senate is the largest health region in England

• The area covers boarders with Scotland in the North and Yorkshire and Lancashire in the South

• The region is hugely diverse and is an extreme mixture of industrial, rural, agricultural and cities. The region covers 2 National Parks within the UK

NHS England Northern Senate

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• Life is in three parts. It begins with a trauma (birth) and ends with trauma (death) and in between we face life and wellbeing challenges in multiple ways and of multiple magnitudes.

• Nothing is universal to us all except the beginning and the end of life, therefore the middle section of life has to be met by a diverse Multi Matrix Approach to supporting health and wellbeing.

• The Multi Matrix Model of Technology Enabled Care Services is a concept developed by me in 2011 that seeks to match technology with the whole life perspective of patients.

• It links prevention and lifestyle change to disease development and progression through its stages to end of life and in the most cost and patient effective way.

Multi Matrix Modelof Messaging Enabled Care Services

Prevention is Easier than a Cure

I recently met 8 teams of Oncologists and Radiographers and asked them:

How can NHS England help reduce the number of Tumour and Cancer sufferers you encounter?

The answer was simple and universal REDUCE SMOKING!

Optimum Health

Robust Health

Good Health

Average Health

Signs of Illness

Chronic Illness

Irreversible Illness

PrematureDeath

Wh

ole

Lif

e P

ers

pe

cti

ve

Conception

Death

The Multi Matrix Telehealth Model Seeks to Cross the Whole Life Perspective by Proportionally Matching Telehealth Systems with the Patients Needs, Lifestyles and the Clinicians Medicine.

NHS Florence SMS Simple Telehealth System

SMS

Prompts and adviceGP Practices

Specialist Clinicians

Community and SpecialistNursing

Public Health Smoking Pathway

A Useful Tool That We Have Used SOTW is Quality Function DeploymentWe Now Call it “Health Function Deployment”

The Customer Needs or Wants are Listed on the Left

Needs/Wants are Ranked Numerically in Order of Importance to Customer

How these Needs/Wants can be Delivered are Listed

Scores are Totalled Needs Plus How's and a Ranked Set of Needs and How to Fulfil them Emerges

Condition Clinical Lead

Heart Failure, Angina etc. FT, GP

COPD and Respiratory etc. FT, GP

Hypertension GP

Diabetes FT, GP

Gestational Diabetes FT

Pre Pregnancy HbA1c Family Planning FT

Parkinson’s FT

Rapid Discharge FT

Deprivation Medicine and Social Prescribing GP and 3rd Sector

Acquired Head Injury and Stroke FT, GP

Primary Care Step Up Step Down GP

Care and Nursing Home GP

Weight Management FT, GP, LA & PH

Smoking Cessation LA & PH

Remote Wound Dressing Monitoring FT

Community Matron Case Load FT

Alcohol Induced Morbidity FT

FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health

Some of the Current Florence Pathways in the

Northern Senate (there are now over 80)

Messaging Enabled Care Services are the Most Adaptable, Usable Form of Telehealth Care Provision I know

LET ME SHOW YOU SOME EXAMPLES OF WHAT WE HAVE DONE SO FAR

Remote Wound Management Over Wide Geographical Areas

As an Example Addiction Medicine Pathway

GP

Recovering Substance User

3rd Sector Volunteer Patient Buddy

NHS Florence System

None Medical Control Centre

Carer Pathway Local Authority Social Care and Primary Care

GP

SMS TelehealthPatient and Carer

HQ 9 or Questionnaire

Telecare Control Room

Social Care/Housing

The Application of a Message Enabled Care Monitoring and Support Service in Pain Management (Example Pain Diary)

Typical Pain Management Diary

Date After Block

Good Relief of Leg Pain

Partial and Satisfactory Relief of Leg Pain

Partial but Unsatisfactory Relief of Leg Pain

No Relief of Leg Pain

Same Day √

Day 1 √

Day 2 √

Day 3 √

Day 4 √

Day 5 √

Day 6 √

1 2 3 4

Intervention

The outcomes for those patients referred for Telehealth in South Tyneside have demonstrated significant reductions in access to health care in the three months following the use of Telehealth. The Key Outcomes are as follows:

53% reduction in attendance at A&E

55% reduction in Emergency Medical Admissions

14% reduction in access to Urgent Care Service

No patient having more than one hospital admission

71% reduction in costs associated with A&E attendance and Emergency Medical Admissions.

Telehealth Reported Outcomes South Tyneside Hospital COPD and Heart Failure Patients

Patient Case Studies

• Heart Failure patient is admitted for the fitting of an assist device. Operation has to be postponed as the patient fluid levels are too high. Because Telehealth is on the ward and the patient can use it he is discharged from acute HF bed at a saving of £2,000 per day. The patient is then monitored from home by Cardiology Team whilst medicating with diuretics. Six days in an acute bed are avoided.

• COPD patient “Flo has made my life easier. if I have a very poor day when I cannot manage to mobilise, I can take my readings from my bedroom unlike other systems I have used. Also on better days I can take Flo with me. It’s a nurse in my pocket.”

• TB Medication Reminder. TB sufferers have to take medication regularly and clinical staff have to verify that patients have complied with the drug regime for a 6 month period. An enclave of TB patients with whom it is difficult to engage have been given Flo to manage their medication reminders. The patients have largely chaotic lifestyles and mostly don’t respond to clinicians who attempt to contact them. The Flo system has proved successful in that patients willingly comply with the SMS reminders and valuable clinical time has been saved along with a robust audit trail of drug compliance.

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Key PointsNHS England Northern Senate

• Messaging Enabled Care Services is the most adaptable, usable form of Telehealth Care Provision I have encountered. Even disparate patients respond to SMS contact.

• When used in a Multi Matrix way Messaging Enabled Care Services can work across the whole life perspective from Conception to End of Life and from prevention of illness to chronic disease management.

• We in NHS England Northern Senate have developed over 80 pathways and this is only scratching the surface of what this technology can do we believe.

• Our Work So Far in the Community has Shown Telehealth Can Produce53% reduction in attendance at A&E55% reduction in Emergency Medical Admissions14% reduction in access to Urgent Care ServiceNo patient having more than 1 hospital admission71% reduction in costs associated with A&E attendance and Medical Admissions