Overseen by Liverpool Community Health NHS Trust and the North Mersey Health Informatics Service (HIS), the trial is using Philips Motiva technology for the management of COPD, diabetes and heart failure patients.
Results of the three-stage initiative will provide much-needed evidence about the impact such systems can have on key performance indicators such as hospital admissions, length of stay, and potentially financial efficiencies. Sam McPartland, transformational change manager at North Mersey HIS, is managing the project. In an interview with HES, she said: "Liverpool is an area with a high level of deprivation and a high prevalence of COPD and diabetes, so there is potentially a lot of scope if the trial proves successful."
The focus of telehealth should not be on the devices themselves, but it should be seen as an enabler for system change
Phase 1 has been running since April and involves patients with heart failure using Motiva technology to record their pulse rate, blood pressure and weight. These details are then passed to a remote telehealth team which provides a triage service, putting community health matrons in touch with those most in need of help. This first trial will end later this month, before the results are evaluated. In Phase 1b, which is also underway, a pro-active care model is used which first identifies patients with COPD, diabetes and heart failure who are most at risk of hospital admissions.
We are trying out different models and are hoping that, by someone being more educated about their condition, they are less likely to present at A and E and become what are known as 'frequent flyers'
McPartland explained: "The pro-active care model involves patients who have had two or more hospital admissions within 12 months. Rather than going onto a community matron's casebook indefinitely, they are subject to a 12-week health plan, during which they are assessed by health trainers and a care plan is put together by a multi-disciplinary team involving medicines management and community matrons, among others. We thought telehealth would fit into this model, so we have involved these patients in the second stage of the trial."
Phase 2, which will go live in October, will look specifically at using telehealth technologies to support patients with COPD. In phases 1b and 2, the information is fed back to community matrons for triage, rather than a monitoring service.
McPartland said: "We are trying out different models and are hoping that, by someone being more educated about their condition, they are less likely to present at A and E and become what are known as 'frequent flyers'. It is not being seen as a cost-cutting measure, but a way of making the system more efficient and easier. This may also have a knock-on effect whereby things run more smoothly and, as such, financial savings are possible."
What we have found is that supplying the devices is relatively easy, but getting the buy-in from stakeholders, identifying patients, and getting everyone on board is where the real challenge lies
Commenting on the decision to run a restricted POC trial, rather than roll out the technology on a wider scale, she added: "The primary care trust was offered the chance to take part in the trial where they would be given the technology by Philips. In Liverpool we are following the QIPP agenda and telehealth comes into that. It is a possible solution to enable us to manage long-term conditions in a more-effective way. By running a POC trial we can evaluate the exercise and look at lessons learned, how it fits locally, and how staff and patients get on. Early indications are that patients enjoy using it and they do like it and staff have said they like it as well, but we need to properly evaluate the findings before we make a decision on whether telehealth will be rolled out to the wider community."
As part of the trial, a small amount of the technology was provided free of charge by Philips, a practice which is becoming increasingly popular as both industry and the NHS seek further evidence to justify investment in telehealth systems. Malcolm Hart, customer services director for Philips UK, said: "The focus of telehealth should not be on the devices themselves, but it should be seen as an enabler for system change. Telehealth will only work if it is not treated as an add-on cost, but as a replacement cost. If patients go into hospital and do not have a supported discharge, this is very costly to the NHS - at least £250 a day. These 'frequent flyers' make up 70% of the healthcare budget and, with an ageing population, that figure is growing all the time. Clearly that is unsustainable for traditional healthcare systems. The challenge now is to change the way we deliver care, working with patients and their expectations, and a lot of people need to buy into that."
It is not being seen as a cost-cutting measure, but a way of making the system more efficient and easier
Speaking about the Liverpool POC trial, he added: "Liverpool is a pilot, but in reality it is the start of something new. What we have found is that supplying the devices is relatively easy, but getting the buy-in from stakeholders, identifying patients, and getting everyone on board is where the real challenge lies. That's why it is good to start with a small number of people as we are doing in Liverpool."
Using Philips Motiva patients with chronic disease are able to record their vital signs using various devices such as scales and SP02 that are directly connected to Motiva or through imputing data via an easy-to-use remote control. All data is captured on the set-top box shown via a patient-friendly display on their home TV. Additionally, the data is sent via secure broadband to the patient's care provider who can compare the readings to the patient's individual care plan, which lays out ideal targets and ranges. Nurses can then prioritise their workload based on which patients are most in need.
Results from Philips telehealth site in Hull show one community nurse now has more than 160 patients and spends approximately four hours a day collating the information and triaging his caseload. This compares to an average cardiac community nurse, who has a caseload of between 40-50 patients, each needing to be visited regularly.
Hart said: "The technology prioritises using a traffic light system. For example, if Mr Jones is having problems, but Mrs Smith is OK, the nurse can put their energies into helping Mr Jones.
Telehealth is really an enabler to integrated care and one way of making the savings we need to make. It is not just about a few boxes, but a solution to the future management of care
"Also, by presenting the data to patients when they make their recordings, they become much more informed about their own condition and we have found in other trials that as a result they are less likely to depend so heavily on nurses and GPs.
"Telehealth puts the patients right in the middle of the care system. For me, telehealth is really an enabler to integrated care and one way of making the savings we need to make. It is not just about a few boxes, but a solution to the future management of care."