simple telehealth overview v3 - nhs networks · 2012-10-21 · simple’telehealth’...
TRANSCRIPT
Simple Telehealth
NHS Stoke-‐on-‐Trent
July 2010 – Phil O’Connell
Version 1.0 draB 09.1
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content
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03. Background
06. Overview
11. PaKent
15. Provider
21. Commissioner
23. Financial
25. Technology
29. InnovaKon
31. Q & A
BACKGROUND
“We need to deliver real efficiency savings and quality improvements whilst enabling be:er and faster pa<ent outcomes on a massive scale and at a low cost.” Terry Hawkins, Programme Director-‐PersonalisaKon NHS Stoke-‐on-‐Trent Jan 2009
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“We want health and social care services to be available to everyone one on an equal basis. We want then to be locally responsive, high quality and inclusive, especially in area of social depriva<on. This is a mission that lies at the heart of the Na<onal Health Service. But achieving our goal is not always easy. It requires crea<ve thinking and new forms of delivery.” Department of Health – June 2009
background With Telehealth manufacturers targe<ng the complex and supported care segments of the market to sell their ever more sophis<cated and costly products, the ques<on was asked...
Complex • There are plenty of Telehealth soluKons
targeted at this level ranging from in-‐home video consultaKons through to whole home management and monitoring systems.
Supported care • This is the main baVleground for
Telehealth companies, promising large savings from various types of avoidance.
• Benefits for supported care use are very difficult to isolate as Telehealth plays only a small part in the paKents care plan. However, for certain cohorts there can be significant benefits of being involved.
• Costs for this type of Telehealth can be high and we should ask the quesKon, would we have been beVer off buying more clinicians in place of Telehealth kit?
Self management • In Telehealth terms, there is liVle (if
anything) in this space that can provide personalised assistance for paKents, without regular clinician interacKon.
Healthy populaDon • There are no personalised Telehealth
soluKons in this segment.
NHS Telehealth needs 1. Reduce Telehealth costs to allow mass
deployment where there is a proven ROI. 2. Migrate paKents from supported care to
self management. 3. Enable more self management across a
wide range of condiKons. 4. Prevent “at risk” cohorts in the healthy
populaKon from needing care.
“What would happen if the Telehealth agenda was driven by real and prac<cal
NHS needs and not by the need of manufacturers to sell their products ?”
It may not be in the commercial interests of Telehealth manufacturers, to move the market in the direcKon of NHS Telehealth needs as the higher the markets success, the lower the profits.
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Healthypopula,on
Self‐managementofa
longtermcondi,on
Supportedcare
Complex
background Is there a way to address NHS Telehealth needs when there is li:le commercial incen<ve ?
Yes there is…….. and we’ve found it.
Dividing lines • There is a clear delineaKon at the boVom
of today’s Telehealth market where; – need for clinician support reduces – high frequency quesKon sets are not
required – complex systems do not show a reasonable
ROI • At the top and boVom of the pyramid,
there is either no need for Telehealth or the needs are too complex.
• This leaves a large secKon of the populaKon that may benefit from some type of simple and affordable, assisted or self directed care.
Responsibility • The NHS assumes responsibility for the
care of its paKents. However some cohorts would like to take more responsibility themselves and when given
the means to help themselves, the NHS economy, paKent saKsfacKon and outcomes can all benefit.
Concept • In Jan 09 an innovaKve Telehealth
concept was born, building on proven techniques, technology and clinical protocols to address the unmet NHS Telehealth needs of:
– reduce today’s Telehealth costs – migraKon to self management – wider scope of condiKons – prevenKon in the healthy populaKon • The concept enables and assists paKents
to take responsibility for appropriate and targeted parts of their own health management and well being.
• The concept is routed in behavioural change, compliance improvement, monitoring and feedback.
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Mapped NHS Telehealth need to the Kaiser Permanente levels.
Healthypopula,on
Self‐managementofa
longtermcondi,on
Supportedcare
ComplexNHS unmet need
Today’s systems
OVERVIEW What is Simple Telehealth and why is it different ?
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overview
What is “Simple Telehealth” ? Quite “simply”, a toolset and methodology designed by NHS Professionals for the NHS as a soluKon to unmet Telehealth need. The soluKon is driven out of genuine clinical and commissioner input and as a key principle, always considers the use of good old fashioned basic and proven building blocks ahead of any other methods. Ownership of Simple Telehealth is kept within the NHS and is provided as a not for profit service to parKcipaKng NHS Trusts. Simple Telehealth is also protected by patents, ensuring conKnued NHS benefit. Simple Telehealth (STH) is a mulK-‐faceted system that addresses all of highlighted unmet NHS Telehealth needs. The whole system is complimentary to today’s commercial Telehealth offerings but it answers quesKons that others simply can not.
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affordable prevenKon
Lifestyle Structured educaKon Screening compliance PreventaKve compliance
excepKonally wide scope
MulKple readings and alerts One off procedures or repeated acKons limitless range of condiKons
self care without complexity & startup costs
Does not require clinician reacKon to readings Direct feedback to paKents Very simple and easy to use
reduce cost & release savings
At least 80% less cost compared to others
Measureable direct savings and high ROI
Ultra low cost for mass deployment
overview
What is “Simple Telehealth” ? Building Blocks STH builds on a number of proven methods and technologies to deliver a holisKc service. There have been numerous successful pilots of the component techniques and technology used in STH, each demonstraKng improved outcomes, however very few have made it to full producKon due to cost and reliability issues. STH is the first of its kind to combine all aspects into one soluKon and to overcome the cost and reliability issues. If it is so good why is no-‐one else doing it? They are ! However these are in isolated condiKon specific or technology driven applicaKons. There is a global push toward mobile health care, parKcularly in the U.S.A supported by and sponsored by the Bill Gates FoundaKon, U.S. Food and Drug AdministraKon and U.S. Agency for Healthcare, Research & Quality. We are seeing more and more sophisKcated applicaKons for smart phones with services for wellbeing and supported care and at the same Kme a number of outbound (one way) texKng services are be developed and hailed as leading edge health tools. STH is years ahead of any other offering and promises much more.
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How does it work with paDents ? STH uses the mobile phone texKng service “SMS” to communicate with paKents, thereby providing virtually equal access to all. No smart phone needed ! “Text messages are personal, can be referenced for long periods of <me, and are already part of people's daily cell phone rou<ne, said Heather Cole-‐Lewis, researcher at Yale University who has studied the effec<veness of tex<ng for health purposes. They can serve as automated reminders or as direct links between pa<ents and their health care providers. Tex8ng conveys "the idea that someone is interested in your health and you're not alone on this ba?le," Cole-‐Lewis said. Her March 2010 study in Epidemiologic Reviews, which included diabetes management and smoking cessessa<on programs in its analysis, found strong evidence for texKng as a behavioral change tool.” Elizabeth Landau, CNN May 21st 2010
There have been hundreds of studies across the world supporKng the use of SMS to improve health outcomes. However, STH goes much further than any previous system, assisKng with the management of mulKple condiKons across differing combinaKons of healthcare teams with automated data collecKon & analysis, immediate response & alerts, advice and behaviour changing protocols.
overview
What can “Simple Telehealth” do ? Building a Protocol STH allows the automaKc execuKon of varying combinaKons of easily understood & simple workflow acKons to achieve specific and targeted health goals at a Kme and place of the paKents choosing. The system is intuiKve and very easy to use yet complies with InformaKon governance and security. There are literally thousands of possible combinaKons of acKons and health applicaKons however here are three real life scenarios either already trialled with paKents during technical tesKng phases or about to be.
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3. Community Matron Service. CM’s, & G.P. share paKent data. For: B.P., O2, Pulse, Temperature. Use: Step down/in place of RTX system Cost: <20% of complex system
1. MulDple Respiratory Services. CM’s, McMillan nurses, G.P. & UHNS Consultant share paKent data. For: O2 & others Use: Regular obs monitoring, replace nurse visits to assess obs, replace manual data sharing between teams.
2. Expert PaDent Programme. Expert PaKent uses limited version. For: Diabetes behavioural change Use: For low cost use with new diabetes paKents
The ability to use any combinaKon of personalised or templated observaKons, alerKng, prompKng and quesKons at any Kme in any frequency for any duraKon combined with a low cost, personal delivery mechanism and professional data sharing platorm posiKon STH as currently unrivalled.
Pa#ent
STH
G.P.
ConsultantClinician
groupA
Clinician
groupB
Pa#ent
STHNon‐
clinical
Pa#ent
STH
G.P.
Clinician
group
overview
Why is “Simple Telehealth” different ? PaDent choice and shared decision making PaKents really do choose to “opt-‐in” to the service and can also choose to “opt-‐out” of it themselves at any Kme. PaKents use their own mobile phone and shiB responsibility from the care provider to the paKent. PaKents become more involved with and educated about their care creaKng a posiKve feedback loop. (the posiKve feedback loop has been proven in STH trials in Mental Health) With some protocols, paKents can even use their own mobile phone to change the way the service works for them. Simple steps The system enables interacKon with the paKent via simple steps, fiung in with the paKents life style. PaKents are familiar with their mobile phone, are not overwhelmed with new technology and view the system as helpful, thereby reducing the risk factors of paKent non-‐compliance or opKng out. Although STH can be used in a reacKve mode with supported care paKents in a similar manor to other Telehealth systems, the key to success is reducing reliance of paKents on costly reacKve services by “call to acKon” methods, informing the (but not taking responsibility for) paKents decisions about their health care.
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Mass deployment The system can be used on a massive scale, targeted at specific outcomes, at a very low cost. Due to the low cost, each outcome can have its own business case showing the ROI broken down to releasable cash, direct, indirect and strategic benefits. Unlike other Telehealth systems, the majority of uses can be jusKfied on the cash or real direct savings alone. “Simple Telehealth is the only Telehealth system to genuinely offer an ROI in year 1” Technology The system is designed to specifically overcome the cost and reliability issues that have prevented other systems moving from pilot to mainstream. Using the “designed to be simple” principles, STH will operate 24x7x365 with 99.99% availability, no maintenance outages and is scalable to handle massive throughput with liVle if any degradaKon to the service. In fact, if a plane landed on an STH data centre, the system would just conKnue ! With an “opt-‐in” system, it is essenKal that it is always on, whenever the paKent needs it. STH is built around the needs of the paKent, not the technology company.
PATIENT PERSPECTIVE What does this mean for me ?
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paKent
What does “Simple Telehealth” mean for me ? Introducing Florence STH by default, interacts with paKents via a persona named “Florence” (“Flo”). Messages and advice come from Flo and the paKent sends data back to Flo. All of the messages related to a protocol can be personalised into a vocabulary best suited to the individual. PaKents who previously would have had liVle interacKon on a relaKvely regular basis with their care provider now feel included and supported to help themselves. PaKents who required regular at home assistance now feel freed to get on with their lives. STH paKents are in control: As STH has been designed as an “opt-‐in” service paKents will review the quality and suitability of the service they receive daily. If they disapprove they can immediately “opt-‐out” via their mobile phone.
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Who can see my informaDon PaKents agree to informaKon sharing when they opt-‐in although STH is virtually an anonymous service. All that is needed is the paKents mobile phone number but it is nice to have a name and NHS number as well. No “private” medical informaKon is stored and only clinician groups the paKent approves of can access the informaKon. The paKent is noKfied if anyone else tries to access their informaKon and they can choose to block access if they do not wish to share their informaKon further.
“Hi, I'm Florence your local NHS self care service. I need to confirm you want to join in. Get started by replying "YES". Don't reply if you didn't ask to join.”
“YES” “Hi, it's Florence. Thanks for joining. I'm here to help you manage your own health be:er. At <mes I'll send advice for you to act on. To help you I may also share informa<on with your healthcare team. You can opt out now or leave any<me by replying with STOP.”
paKent
(A) Mental Health ReseVlement Issue: ChaoKc lifestyle paKent regularly relapsed due to poor medicaKon compliance & DNA’s at professional appointments with various professional teams. Protocol: Morning & evening medicaKon reminders + ad-‐hoc reminders. Result: PaKent takes medicaKon as prescribed and aVends appointments resulKng in significantly beVer health, wellbeing and self-‐confidence. PaKent has recently been away on a holiday without issue, is recovering from the mental health issues and now lives independently, providing a 300-‐1 ROI within two months.
PaDent Comment: “The tex<ng service has altered my life. I feel supported and have been able to take my medicine on <me, even when I was on holiday. I feel be:er and have not had to go back to supported care, I would like to tell everyone about this, it’s great” (B) MedicaDon Reminders Issue: Senior Professional, taking daily medicaKon for which Kming is criKcal. Takes medicaKon at various Kmes when arising in the mornings and someKmes forgets to take due to business and other distracKons. Protocol: Mon-‐Fri 08:00 + Sat-‐Sun 09:00 medicaKon reminders
Result: PaKent prepares medicaKon ready to take prior to prescribed Kme and does not forget. PaDent Comment: “To be honest I was astonished at how Flo changed my medica<on habits, I was scep<cal at first. The <me I used to take my medica<on was a li:le haphazard and I some<mes forgot but now I find myself prepared at the right <me every day. I didn’t even no<ce how or when Flo changed me, one morning my wife pointed out that I had changed my mornings around my medica<on. Brilliant, I would be pleased to write up a case study, be interviewed or take part in a promo<on, other people should be able to benefit from this service.”
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What does “Simple Telehealth” mean for me ?
paKent
(C) Mental Health Behavioural Change Issue: Non-‐compliant paKent does not respond to tradiKonal therapy. Protocol: Mon-‐Sun 11:00 medicaKon reminder + Fri 12:00 reminder to collect medicaKon. Result: Improved compliance and transformaKon of chaoKc lifestyle to a structured and self managed regime resulKng in significantly reduced NHS resource usage and beVer physical health. (D) COPD Daily ObservaDons Issue: PaKent has used Telehealth for over 15 months and speaks highly of it saying it has changed her life. However
the she reports feeling frustrated at being Ked to the machine and guilty that she is prevenKng someone else from using “this expensive equipment” Protocol: Mon-‐Sun 10:00 BP, o2, Pulse, Temperature monitor and alert with daily clinician review. BP + o2 monitors supplied. Result: PaKent uses Flo to text results in and receive instant feedback. PaKent prefers Flo to the complex system although this is pushing Flo to the limit of what it can be cost effecKvely used for and will not suite everyone. This method costs 90% less than the complex system.
PaDent Comment: “Flo is great, I’ve got my freedom back. I’m not <ed to the house, I can take my readings wherever I am, at home, upstairs, my daughters or on holiday. It’s quicker and easier to use than the other system. I always like to take my reading before my meds so that you can tell what’s really happening and with Flo I can take them when I get up, whatever <me it is and I don’t have to wait or exert myself going downstairs. I like the messages Flo sends back telling me if my readings are OK or if I need to call the Matron. I tell everyone about Flo, I feel privileged to be part of this project.”
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What does “Simple Telehealth” mean for me ?
paKent
(E) Unmanaged “Breathe Easy” PaDent Daily ObservaDons Issue: PaKent anxious about breathing difficulKes but not under Community Matron or Respiratory care. The paKent rarely used a mobile phone and had never used SMS text. Protocol: Mon-‐Sun 10:00 o2 & pulse. Pulse oximeter supplied Result: Reduced anxiety regarding breathing, however Flo also indicated that the paKent had tachycardia and advised the paKent to call their G.P. The GP intervened, bringing the paKents pulse back to normal levels. Three years prior, the paKent had undergone major heart surgery and without Flo the paKent was likely to have suffered a major exacerbaKon.
PaDent Comment: “Even though I had never used text before, the system is very easy to use and I don’t have any problems sending my readings in. Flo found I had a heart problem and my GP was able to quickly see me and then check on my progress. I’m far less worried about my condi<on, I am less <red and feel much be:er now because of Flo. (F) “Breathe Easy” COPD Daily ObservaDons Issue: PaKent was on the Community Matron case load however, was very anxious about her condiKon and believed that deterioraKon in her condiKon was not being picked up by the busy clinical
teams. Protocol: Mon-‐Sun 12:00 o2. Pulse oximeter supplied Result: On the second day, the system advised the paKent to call her Community Matron due to low o2 levels. Alerts conKnued over the next few days, prompKng a visit by the Community Matrons who verified that the paKent had hypoxemia and took appropriate acKon. PaDent Comment: “I now feel that I’m not on my own and when I call the Matrons they can see what has really been happening with my readings. Before Flo, it seemed that whenever the nurses took my readings they would be ok and did not reflect how Ill I actually felt.”
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What does “Simple Telehealth” mean for me ?
PROVIDER What does this mean for me?
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provider
What does “Simple Telehealth” mean for me ? Flexibility STH provides a method for providers to engage with paKents in a way and on a scale never before possible for such a small cost. STH can be used across a wide range of condiKons and can be tailored to the needs of both the paKent and clinician to assist with data gathering, Kmely advice or just helping “at risk” paKents to take acKons at appropriate Kmes. Within a pre-‐defined protocol, STH can easily be personalised with just a few clicks and is “just so easy to use”. ProducDvity Providers state that STH will increase their producKvity ( and reduce costs ) for paKents across a range of condiKons. STH enables the re-‐direcKon of resource away from self-‐caring STH paKents toward those who require a clinical intervenKon, not simply hand holding. The ability to automaKcally gather observaKon data for large numbers of paKents in each team with the reassurance that the paKents will be advised to call in should the observaKons meet defined criteria will save a significant amount of Kme and paKent exacerbaKons.
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provider
What does “Simple Telehealth” mean for me ? Control Use of STH is limited within each team to appropriate, pre-‐approved protocols. Clinicians belong to one or more STH clinical groups and can only access protocols approved for that group. Each protocol has its own micro business case thereby assuring focussed and targeted use for the intended purpose. Team working As STH uses the concept of groups, team working is easy. Clinicians have their own “My PaKents” view but can easily access paKent records of other appropriate team members. Data can be shared amongst teams where appropriate thereby allowing observaKons to be shared between a Community Matron and a paKents G.P. ApplicaDons STH can be used across a virtually unlimited range of condiKons, however early applicaKons range from daily observaKons & reminders through to 3 monthly sexual health reminders for “at risk” paKents. Each applicaKon has its own pre-‐approved protocol & supporKng micro-‐business case.
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provider
What the providers say: North Staffs Combined Healthcare NHS Trust. “From a mental health perspec<ve the Simple Telehealth system has a number of applica<ons which will enhance the recovery journey for a wide range of people. Communica<on is crucial in the support of people who have experienced mental difficul<es and are moving towards or returning to independent living. The Simple Telehealth project has already presented opportuni<es to consider rese:lement for people who we would have otherwise an<cipated longer periods of <me in health and social care resources..” Andy Oaks, Head of Service, Mental Health
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“The Simple Telehealth is currently being introduced into care packages of suitable mental health service users within North Staffs Combined Healthcare NHS Trust. This system has been iden<fied as being an extremely effec<ve resource in the management of medica<on compliance and appointment compliance. For example, Miss X has been receiving medica<on reminders for a couple of months – this was introduced as part of her discharge plan from suppor<ve living to independent living and to date Miss X has remained compliant with her medica<on and as a result has sustained stable mental health and well being. Historically Miss X was non compliant resul<ng in staff having to make daily visits to prompt to take medica<on – if this did not happen there would be a significant deteriora<on in mental health and Miss X would require either an admission into hospital or more supported accommoda<on. Miss X has secured a voluntary job this week which is an incredible move forward and demonstrated the stability of her mental health. Furthermore the daily texts have allowed the staff to maximise the efficiency of their <me and thus allowed them to engage in more therapeu<c interven<ons. Miss X has gained more responsibility and independence in managing her own care which has resulted in stable mental health and well being and improved confidence and self esteem.” Donna Cantrell, CPN Care Coordinator, Mental Health
provider
What the providers say: Stoke-‐on-‐Trent Community Health Services “A pa<ent on my caseload has been par<cipa<ng in a trial of simple Telehealth. She reports that from a pa<ents' user perspec<ve it is simple to follow and to input her observa<ons. Addi<onally she prefers the system as she finds the system more user friendly as she is able to take her observa<ons at a <me suitable to her in a loca<on which is suitable to her. From my limited professional experience of u<lising simple Telehealth the database appears simple to use in regards to inpuhng data and observing observa<ons” Jenny Brooker, Community Matron
“I have recently started to use simple telehealth. I used the system to check the observa<ons of a pa<ent on one of my colleagues case loads. Having never used the system before, I found it very easy to use. Simple telehealth is intui<ve and from a clinicians perspec<ve I was able to quickly check the pa<ents observa<ons and send her a message from the same screen. I was surprised at how li:le clinician <me needs to be involved with simple telehealth compared to the other systems we use and I am looking forward to more pa<ents coming onto the system.” Shirley Heath, Community Matron
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“The philosophy of the simple Telehealth tool is to help pa<ents to self-‐manage their long term condi<ons. The aim is to treat pa<ents at level2 of the Kaiser Permanente triangle as we empower individuals to take responsibility for their own health & wellbeing. The ability to use an everyday tool to help pa<ents self manage using a none intrusive tool will help increase the choices available to the pa<ents. The tool will fit into the personalisa<on agenda, increase choice, free capacity [as pa<ents will be managing their condi<ons & a:ending appointments with their GP/PN appropriately], & also empowering people to recognise early changes to their condi<on. The pa<ents for the first phase have been iden<fied via volunteers from Breath Easy, some are not known to the community matron service. By working with these individuals it is envisages that these people will be able to self manage & hopefully reduce hospital admissions via emergency portals.” Tracy Hall, Community Matron/joint clinical champion for COPD
“ ”
provider
General PracDce ” 'I think that we have a great opportunity to trial simple Telehealth in an interac<ve way with various groups of pa<ents; the impact measures should include reduced unnecessary resource use e.g. follow up visits at GP surgeries; improved compliance with medica<on e.g. fewer unplanned pregnancies and be:er BP control; and pa<ent sa<sfac<on with joint management plans.” Dr Ruth Chambers, G.P.
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PracDce Based Commissioning “For the first <me, Simple Telehealth offers a cost effec<ve, easy to implement and universally applicable approach to delivering added value services to pa<ents that contribute directly to reducing demand elsewhere in the system; Simple Telehealth doesn’t require significant new investment from prac<ces or pa<ents and u<lises the skills already evident across primary care while building on the knowledge widely available to (and embedded in) ordinary folk; The technology is tried, tested and trusted and has the capacity to respond to the access needs of individuals (e.g. tex<ng into audio for the blind?) The speed with which Simple Telehealth can respond to local or even prac<ce level health priori<es is limited only by the ability of implementers to spot it’s uses; Simple Tele-‐health is not a passive pa<ent support mechanism, when u<lised as a posi<ve tool it can be a proac<ve driver for focused, personalised and individualised health and well being; and unlike other Telehealth systems Simple Telehealth can be used as a monitoring tool, a pa<ent confidence building tool or as a medium for pa<ent educa<on” Dave Sanzeri, PBC Business Manager
COMMISSIONER What does this mean for me?
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commissioner
What does “Simple Telehealth” mean for me ? ProducDvity increase and cost reducDon With the targeted, InnovaKve use of STH in line with its micro business cases Quality, ProducKvity and PrevenKon can all be increased thereby releasing resource, providing direct cost savings and indirect knock-‐on benefits. STH increases quality, increases the reliability of processes and allows the removal of “non-‐value-‐adding” steps to reduce waste in the system.
“Simple Telehealth is designed to reduce the avoidable use of NHS resources” QuanDfiable Results With each protocol pre-‐approved and mapped out, results can easily be measured and the costs are so low that most protocols can be jusKfied on direct cost savings such as avoided mileage or postage costs alone. Strategic ImplicaDons Business cases for Simple Telehealth are not based on hard to pin down strategic goals, but never the less there are wide ranging cost saving implicaKons for the NHS economy when STH is used as designed on a massive scale.
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What the commissioners say: PCT Commissioning “The use of assis<ve technology has par<cular applica<on for people with long term condi<ons. The technology can be used both for preventa<ve and health improvement ini<a<ves and for suppor<ng be:er compliance with care plans and the monitoring of complex care. It is well established that the burden on health services can be reduced if pa<ents take greater control of their condi<on and do things which reduce symptoms or prevent deteriora<on. The simple Telehealth project is poten<ally able to provide a simple and effec<ve way of achieving this. A key plus from STH is that it is using technology which is very everyday and is extremely convenient i.e. a mobile phone so we think that pa<ents will be more than happy to use it hopefully with significant health benefits!” Jane Tipping, Programme Manager – LTC & End of Life Care
“Simple Telehealth does just what the name suggests, it is simple for pa<ents and clinicians to use and because of its simplicity, has the poten<al for mul<ple wide ranging uses. The project is only just puhng Simple through its paces at the moment but it has already proven that it can free up beds in mental health and is enabling our Community Matrons to realise the benefits of Telehealth from a much wider pa<ent cohort than would otherwise have been the case. Simple Telehealth can quickly enable real direct savings and improve quality and the strategic cost saving implica<ons when rolled out are significant.” Mark Tunstall, Programme Manager
FINANCIAL The business case and methodology
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financial Why should I use Simple Telehealth ? Ultra-‐low cost Simple Telehealth is simply the most cost effecKve Telehealth system available today. Whether used to enable the re-‐deployment of a complex system or just to help a paKent to take their medicaKon there is nothing more effecKve and cost efficient. Capital There is no capital outlay for the use of STH unless you choose to use Blood Pressure monitors or other peripherals. Even the peripherals for use with STH, with the same clinical accuracy as complex devices can be brought at lower cost, keeping capital investment at a minimum. Use it or lose it ? Not with STH! With the high capital costs of complex systems + monthly “connecKon” fees, if you are not using 100% of your equipment from day 1, you are loosing value. You are incurring depreciaKon and monthly fees with the kit sKll in the cupboard. With STH, you can choose to share base operaKonal costs with other Trusts or simply go it alone. This could be done as a region for as liVle as £1,000 per trust! Other costs are all included in the “per SMS” fee, so if you use it more, less or don’t for a while, you sKll only pay for what you use.
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High ROI STH’s methodology provides business cases and protocols that offer quanKtaKve results with higher ROI’s than most other soluKons across the spectrum of condiKons and teams. High ROI’s are available in year 1 and some of the first have worked out with returns of 100’s to 1 within a few weeks. Cash releasing savings With STH it is possible to idenKfy and actually save cash outlow. Where STH’s cases idenKfy a possible cash saving, if the system is not implemented in that area, you are choosing to spend more than you have to. No other system can offer such clear cut savings across such a wide range of applicaKons. What system should I invest in? STH is designed for use in mass prevenKon and does not bring the cost and complexity of other systems. Although designed for different cohorts, when comparing the cost of a complex 20 paKent COPD system for a 2 year project, you could deploy STH for 170 -‐ 280 COPD paKents. STH’s ROI’s can be high, showing between 9-‐1 and 6-‐1 for Community Matron COPD paKents compared to 1-‐1 for the complex system over 2 years and when factoring in Total Cost of Ownership STH costs as liVle as £0.30p per day compared to £4.25p for a complex system.
TECHNOLOGY
What is it and how does it work ? Keep it very simple to use and let the platorm take the strain.
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technology Unparalleled combina<on Keeping it simple STH uses proven technology building blocks for the foundaKon of the system. Combining the paKents own mobile phone, cellular networks , UNIX, MicrosoB, and Intel technologies to build a secure, resilient and “Always On” soluKon. DifferenDators With STH, there is no DR platorm. The system is designed to have extraordinary levels of responsiveness and resilience. STH is built across two secure T4 (the best) dispersed data centres with mulKple levels of physical and soBware resilience and load balancing. If something fails or gets a liVle busy, the rest of the system simply takes over the load with liVle if any disrupKon to full service. Patented Technologies Within the system are a number of NHS patent protected methods and algorithms that make STH unique, enabling it to cope with massive loads and giving it the unique flexibility to provide the NHS with the most cost effecKve Telehealth system available. The simplicity of the interface and ease of use, mask what is a very innovate and sophisKcated technology engine. Interfaces In addiKon to the mobile phone and web browser interfaces, STH also provides interfaces for third party companies to connect, allowing them to seamlessly integrate their own systems to STH. For example, this could be used to make STH data available via EMIS or to directly connect new medical devices.
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STH T4 Data Centre
STH T4 Data Centre
Cellular Network
PaKent
WWW
Clinical Teams
INNOVATION Why is an innovaKon different from other projects ?
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innovaKon What is an innova<on project ? STH -‐ a true innovaDon A “typical” technical NHS project has a solid business case built with evidence and case studies plus a forecast return on investment based on an established product or method. Unlike “typical” NHS projects, STH is a true innovaKon, building on already proven components to make a new system. Whilst there may have been studies and evidence for each of the component parts, with an innovaKon there is no proven evidence for the new system because, well…. it’s new !, it’s a risk ! But one for which the potenKal benefits greatly outweigh any potenKal downside. For those not used to Research and Development, this may be uncomfortable territory. Where innovaKon is commonplace, best pracKce pathways are used to develop “new products”. With guidance provided by MidTECH (WM-‐SHA InnovaKon Unit) STH is on such a path and the early results are very encouraging with significant paKent benefits being accrued on a daily basis, even in the development and tesKng stages. Once the product moves into the commercialisaKon stage, more of the standard NHS methodologies can be applied to the finished product but unKl then, STH will conKnue to rapidly move through its innovaKon pathway on the road to more comfortable and familiar territory. PosiKon July 2010: E/F
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Q & A Frequently Asked QuesKons
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Q & A
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QuesDon Answer
With other systems, there is a large start up cost for equipment, licensing, training and project management. are there similar costs with STH ?
No. There is no capital spend needed to start using STH and it is so easy to use that very liVle is needed in the way of training or project management. If you have decided to use STH to monitor vital signs, then you can purchase the monitoring equipment as and when you need it from any supplier.
Are there any restricKons on what type of monitoring equipment I can use with STH ?
No. There is no specialist or proprietary hardware needed for STH and as long as the equipment displays a measurement, then it can be used for monitoring and alerKng by STH.
Can the paKent use their own monitor or monitors purchased from the high street via a personal health budget ?
Yes. Provided you are saKsfied with the accuracy of the monitor.
What operaKonal costs are there ? OperaKonal costs will vary depending on what you use STH for. However, the cost per message is £ 0.08. You are only charged for what you use, when you use it and the likely costs will be illustrated in a micro business case for each parKcular applicaKon. There is also a small annual cost to maintain the technical infrastructure of £2k per annum. We also ask you to join our NHS community to enable us to conKnue the innovaKve work and share the knowledge and best pracKce throughout the UK; £5,500 per annum.
Does this cost the paKent anything ? No. The short code will be free to text, so the paKent can even use STH via a PAYG phone with no credit ! However, the free to text short-‐code is opKonal and you could use a standard short-‐code where the paKent would be charged their normal network rate to send a text in.
Can the paKent use their own mobile phone ? Yes. All modern mobile phones have the facility to send SMS texts.
Q & A
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QuesDon Answer
How easy is it for the paKent to send readings in ?
From the trials we have done so far, paKents have found it easier than using complex Telehealth equipment. If a paKent already has a mobile, they usually know to send SMS texts and STH has a “natural language parser” which allows the paKent to choose how to send the messages in. A paKent who prefers to use predicKve text might use they key word “oxygen” to send in their SPo2 reading whereas one that prefers not to use predicKve text could use “o2”. Some of the paKents use a mixture.
Which paKent groups would you not use STH for ?
STH is not suitable for paKents with very complex needs or those who are chronically ill and complex Telehealth systems are beVer suited to these needs. STH may also not be suitable on cost grounds for applicaKons that require the paKent to answer large daily quesKon sets, however these should be assessed on a case by case basis.
STH is an “opt-‐in” service, what does this mean ?
It means that the paKent chooses to take part in the service and agrees at sign up that they understand that they are in charge and can opt out at any Kme.
Do my clinicians have to maintain a reacKve service for STH paKents as they do with other Telehealth systems?
The paKent is advised at sign up that STH is an advisory service and this combined with the service being “opt-‐in” means that you do not have to maintain a reacKve service, but the data and alerts are there if you wish to. The paKent will receive advice to call their health care provider if they trigger an alert.
Does STH comply with informaKon governance requirements ?
The service has been assessed as compliant with I.G. requirements by NHS Stoke-‐on-‐Trent as: -‐ the service is “opt-‐in” and the paKent agrees that their informaKon may be shared -‐ the only piece of PID needed is a mobile number, although it helps to have the name and NHS number. -‐ the paKent opt’s in from their mobile phone which idenKfies itself to STH by its SIM. -‐ the paKent chooses to keep or delete STH related texts from their mobile phone. -‐ viewing of paKent data is restricted by clinical group -‐ all acKons on STH are logged in a comprehensive audit trail.
Q & A
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QuesDon Answer
What is STH likely to cost compared to other Telehealth systems ?
Although STH does not directly compete with other systems, a number of ball park comparisons of direct costs are illustrated below. (A) With a complex system, £60,000 may cover the Total Cost of Ownership of daily monitoring
of 20 COPD paKents over 2 years. For the same amount, you could monitor over 170 COPD paKents with STH.
(B) When daily two way interacKon with a paKent is required a complex system should be considered, however if interacKon is either one way (like medicaKon reminders) or is less frequent, there is absolutely no cost comparison to STH.
(C) The costs of monitoring long term blood pressure weekly would be less than £58 over 2 years. Or to put it another way, you could monitor over 50 long term BP paKents over 2 years for the same costs as monitoring 1 COPD paKent with a complex system.
Not everyone has a mobile phone Some people do not have a mobile phone, however this is a very small number. A suitable PAYG mobile can be purchased for less than £10 and we are discussing network sponsorship of mobiles for those paKents. It should also be noted that increasing numbers of paKents are giving up their land lines in favour of mobiles/mobile broadband to save on land line rental charges thereby making complex Telehealth unsuitable.
Some paKents can not use a standard mobile phone.
If they wish to use STH, there are many low cost, specialist mobile phones available to cater for those with addiKonal needs, such big buVons, simple interface or larger screens.
What about paKents who can’t text? During trials a number of paKents have used the system who previously had never texted before or who had low self confidence in texKng. Once shown how to text the readings in, paKents gained confidence over several days and have needed no addiKonal assistance past the first day.
Simple Telehealth
NHS Stoke-‐on-‐Trent
END
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INFORMATION AddiKonal Handouts
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informaKon
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Investment and benefit illustra<on “STH is the only Telehealth system to provide a ROI in year one !”
Years 1
Average cost of 1&2 A&E day admission £1,570
Comm Matron Hourly Cost £30
Base number of Patients on Traditional Telehealth 1
Cost of avoidable supported care bed day £50
Cost of avoidable A&E attendance £109
comparison approximation
Daily
pulse,SPo2Daily SPo2
Weekly
BP
Contraception
reminder
Mental health
med reminders
Costs Traditional STH-A STH-B STH-C STH-D STH-E STH-F
Hardware £1,600 £98 £72 £72 £29 £0 £0
Supplier maintenance charge £0 £0 £0 £0 £0 £0 £0
Communicaitons £240 £131 £102 £73 £15 £1 £58
Installation, maintenance, non-clinical triage £27/month £324 £0 £0 £0 £0 £0 £0
Calibration checks £0 £0 £0 £0 £0 £0 £0
Daily clinical Triage/alert mgmnt (avg
1min/patient)*5days (£30 ?/hour) £130 £0 £0 £0 £0 £0 £0
Total Cost £2,294 £229 £175 £145 £43 £1 £58
Equal investment of: £2,294
Number of patients supported 1 10 13 16 53 2390 39
Benefits for equal investment
Typical benefits claimed (data from current project actuals-
top 5% Community Matron COPD caseload) adjusted
down by n% for suitable cohort 100% 100% 70% 40%
Avoided unplanned COPD hospital admission (1 per
patient/year) £1,570 £15,700 £14,287 £10,048 -
Reduced avoidable CM telephone calls 35% (avg 8 per qtr
* (£30? Hour) * 5 mins £80 £800 £728 £512 -
Reduced CM Visits 5% (avg 2 per qtr * £30? Hour) * 45
mins [incl travel] £180 £1,800 £1,638 £1,152 -
Avoidable A&E attendnace 1 per year - - - - £4,251
Avoided supported care bed days (30 per year) - - - - £58,500
50% Avoided medication visits @ £5 per visit x 2per day - - - - £71,175
Total £1,830 £18,300 £16,653 £11,712 £133,926
Return on Investment N/A 8.0 - 1 7.3 - 1 5.1 - 1 58.4 - 1
Potential Benefit -£464 £16,006 £14,359 £9,418 £131,632
Cost per day/patient (100% deployment) £6.28 £0.63 £0.48 £0.40 £0.119 £0.003 £0.16
REAL cost per day/patient (75% avg deployment) £8.26 £0.72 75%
Daily BP, pulse,SPo2
Like for like STH Only
informaKon
STH Rollout 2010 -‐ 11
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Technical Trials Go live Protocol development & pilots
Mainstream approved protocols
West Mids SHA driven rollout across all PCT’s in region ( SHA fund regional short code and services )
Set up implementaKon channels Generally available
June July August Sept Oct -‐ Mar