In this industry Q&A, REBECCA LORD, business manager at UK Life Care, part of Honeywell Life Safety Systems, speaks to BBH editor, Jo Makosinski, about the future role for telehealth solutions
As the reforms come into play, we are seeing a concerted effort by the NHS to shift services out of big hospitals and into local communities. In your opinion, what role will telehealth have to play in helping this vision become a reality?
A: With the Government's current vision of merging health and social care in mind, I can foresee an increased role for telehealth.
Many patients who use telehealth systems feel that they are receiving a greater level of care and that someone is looking after them who they can call on if they have a concern.
In many cases, this can help patients be able to self manage more and rely less on social care packages.
Supporting the patient and helping them to understand their illness can help them become more confident in self caring. Crucially, empowering patients and helping them to manage their own conditions while having the re-assurance of being monitored remotely on a regular basis can play a key role in reducing significant health service costs such as emergency admissions and re-admissions.
I also envisage that teleheath will be vital in improving the efficiency of social care services by reducing the demand on personal care by service users who are vulnerable because of their conditions.
Telehealth also has the potential to become a primary method of improving supportive discharge. Providing patients with the appropriate monitoring devices or mobile applications after being discharged from hospital could potentially decrease anxiety, provide patients with reassurance at home, and help educate them on how to manage their own conditions.
Q: How can telehealth technologies help to ease the financial burden on health budgets?
A: Telehealth ensures that patients can be supported in a more cost-effective way. Through the early identification of an impending uplift in a patient's parameters, a clinician can decide the right course of action, from changing medication through to admission to hospital. Many of these decisions can be made over the telephone without the need for a face-to-face meeting. By preventing an emergency admission, the impact on budgets can be significant. However, a planned admission is also a less expensive process and can also help budgets.
Telehealth is not about the equipment; it is about improving the quality of patients’ lives and supporting the clinical teams with their case management and decision-making processes
There is also compelling evidence highlighting a reduction in GP home visits. This is particularly significant for those GPs working in rural areas, helping them ensure they are able to provide care to their patients without having to travel to their homes.
I believe telehealth will play a critical role in delivering on the Quality, Innovation, Productivity and Prevention (QIPP) agenda. Key to this is patient education to prevent the need for medical intervention. Helping a patient understand and react to their own symptoms is a huge benefit.
A recent survey carried out by the Birmingham OwnHealth telehealth programme, which uses Honeywell HomMed technology, demonstrated key savings through a reduction in hospital admissions among patients with long-term conditions, including cardiovascular disease and stroke.
Following the introduction of telehealth monitoring to the homes of 74 people suffering from long-term conditions in NHS Birmingham East and North, savings of £277,187 were achieved through reduced hospital admissions. The number of admissions for the group fell from 175 in the 12 months before monitoring began, to 24 in the 12 months following the introduction of the programme. And the total number of days spent in hospital was reduced by 1,062.
Q: Can telehealth be a substitute for face-to-face healthcare, or should it be deployed as part of a more extensive package of care?
A: There will always be a need for a patient to have facet-to-face contact. However, with the right support and education, telehealth can ensure that this contact is focused on the occasions when it is truly necessary.
Many patients with long-term conditions want to see a clinician because they are nervous and worried about their illness. Through telehealth, patients become more comfortable receiving less face-to-face care from health professionals and more time self-managing their condition from home.
Teleheath will be vital in improving the efficiency of social care services by reducing the demand on personal care by service users who are vulnerable because of their conditions
Users of telehealth soon learn that if there is a medical necessity then a clinician will call them and discuss any issues. This raises their confidence and, in many ways, they feel more cared for as they do not have to wait for a GP appointment or panic and call an ambulance.
Much of the research into telehealth that has been produced shows a significant increase in patient confidence and a reduction in anxiety. This is due to the patient being able to manage their own condition without visiting their GP or nurse, increasing independence, but with the knowledge their condition is also being monitored on a regular basis.
The win for the nursing team is that they too can prioritise their caseload. By using the clinical data that is sent through from their patients they can quickly assess who needs a call or a visit and who is not in need of their valuable time.
Q: Who will benefit most from telehealth?
A: I believe the patient benefits the most, but clinicians also see the rewards of supporting their patients at a closer level and are better able to manage their caseloads more effectively.
Telehealth is not about the equipment; it is about improving the quality of patients’ lives and supporting the clinical teams with their case management and decision-making processes.
Q: How should telehealth technologies be deployed?
A: Firstly, there are a number of companies offering a variety of equipment. When purchasing, clinical teams need to consider the features and benefits of the equipment as well as the support packages they will receive to help them deploy and build a successful programme.
All telehealth programmes vary depending on the localised health economy. Some models have worked better than others, but there is no winning template; it is very much about working in partnership to ensure that all involved are engaged with the process.
We encourage user group meetings so that clinicians from different areas can share best practice and learn from each other’s successes and how they overcame certain challenges.
To ensure that telehealth works effectively there must be a certain amount of joint working between primary and secondary care, community nursing teams and hospital consultants. Historically this has been very disjointed
Q: Telehealth is being considered as one of the key ways to deal with the demand on the health service caused by an ageing population. But can the elderly and infirm really use these technologies in practise?
A: Telehealth will not work for everyone and referrals have to take into account the patients’ individual needs. We have designed our products to cater as much as possible for people with impairments with features including big buttons, simple displays and voice activation for those with sight impairments.
Q: Why have NHS trusts not pushed ahead with this approach in greater numbers?
A: To ensure that telehealth works effectively there must be a certain amount of joint working between primary and secondary care, community nursing teams and hospital consultants. Historically this has been very disjointed.
In order for telehealth to work there needs to be a lot of engagement with a change management process. Professionals and organisations need to be willing to change their established methods of practice and gain confidence in a different approach. I believe that the new structure to the NHS will make telehealth more successful as teams will need to work less in silos with their patient management.
Q: Is there enough of an evidence base that telehealth works to enable trusts to justify its use?
There is a great deal of evidence. However, the criticism that is sometimes used is that the evidence is not your usual randomised control studies. The Whole System Demonstrator site is hoping to finally stop these discussions and at Honeywell we are always happy to send out the evidence that we have collated that shows the cost savings and benefits to the patients from these programmes.
Following the introduction of telehealth monitoring to the homes of 74 people suffering from long-term conditions in NHS Birmingham East and North, savings of £277,187 were achieved through reduced hospital admissions
Q: What are your top 10 tips for trusts looking to deploy telehealth technologies?
A: Our tips are as follows:
- Plan and develop a service model that will ensure your organisation can fully adopt teleheath into care pathways
- Ensure your team is fully educated and trained
- Referral criteria for patients needs to be fit for purpose and patient focused
- Educate and train patients to a level where they feel completely comfortable with the technology
- Start putting evaluation and monitoring processes into your programme from the very beginning
- Ensure you gain full consent from either the patient and/or their next of kin before installing the equipment
- Ensure you have a well-managed and sustainable installation process
- Grow the programme organically, buying the equipment slowly and making sure it is deployed before you buy more
- Share your knowledge within the team. Consider what are the successes and what are the barriers
- Focus on the patient at all times: It's not about the equipment, it is about the results that the equipment brings