Transcript Telehealth, its uses in COPD, the Sheffield

Telehealth, its uses in COPD, the
Sheffield experience
Sue Thackray - Deputy Head of Development Nursing Sheffield Primary
Care Trust
Dawn Weston - Lead Development Nurse Respiratory Conditions
Sheffield Primary Care Trust
Mike Worden – Telehealth consultant
© 2007 Tunstall Group Ltd
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Terminology
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Telehealth is an umbrella term used to describe the delivery of health
related services and information via telecommunications technologies
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As simple as two health professionals discussing a case over the telephone,
or as sophisticated as using satellite technology to broadcast a consultation
between providers at facilities in two countries.
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3 main types of telehealth technology
– Store and forward telehealth (digital images, video, audio and clinical
data are captured and stored)
– Real time telehealth (telecommunications link between the involved
parties allows a real-time interaction)
– Remote Monitoring Telehealth (sensors are used to capture and
transmit biometric data, real time or store and forward)
© 2007 Tunstall Group Ltd
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Telehealth for Sheffield
Focus:
Tunstall telehealth technology focuses on consistent, reliable, and accurate
remote monitoring of a patient’s vital signs through the use of simple easy to
use equipment that professionals can customise to each patient, enabling day
to day individual care according to need.
The most popular (number of monitors in daily use) telehealth monitor in the
UK and the World
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Sheffield design for telehealth
Genesis monitors
Patient homes
Respiratory team
Northern General
Free phone
telephone number
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Clinicians based
in the Community
A large number of vital signs
can be remotely monitored
• Heart Rate
• Blood Pressure
• Weight
• Oxygen Saturation (Sp O2)
• Temperature
• Prothrombin time
• Peak flow (FEV-1)
• Electrocardiogram (ECG)
• Blood Glucose
• Customisable subjective questions most
suitable to the individual in care i.e. Have
you used your oxygen in the last 24 hours?
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Monitor Functionality
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Up to 4 programmed sessions per day for patients
Any number of manual tests
real time monitoring function
Once prompted a patient has 30 minutes to engage the
monitor giving the patient time to settle before collecting
vitals
• Remote programming ability – flexibility to the patients
routine
• Multi user ability
• Languages include: English, French, French Canadian,
Spanish, Italian, German, Polish, Russian, Armenian,
Portuguese, Hindi and Welsh
© 2007 Tunstall Group Ltd
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Sheffield design for telehealth
Genesis monitors
Patient homes
Respiratory team
Northern General
Free phone
telephone number
© 2007 Tunstall Group Ltd
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Clinicians based
in the Community
Triage software
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Full patient history
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1 to 90 day graphic
and tabular trend
Reports
Fax, email, print to
clinical staff
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Project Cycle
Agree SLA’s
and key
stakeholders
Define roles
& responsibilities
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Define
policy and
procedure
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Patient
recruitment,
Referral process
& consent
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Primary Care
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Review &
options for mainstream
1
Secondary care
Carers
Evaluation
1&2
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Admit
patient
Discharge patient
remove equipment
and clean
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Social Services/monitoring centre
Daily
triage,notifying
staff of medical
exceptions
Trouble
shoot
2
Liase with clinical
staff and distribute
relevant data
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2
© 2007 Tunstall Group Ltd
Home
assessment &
installs
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Key
1 = telehealth steering group
responsibilities
2 = implementation group
responsibilities
COPD and telehealth - Service
Redesign
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Shift in focus to Primary Care - a Transition from ‘hospital care’ to ‘out-of-hospital care’
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Bringing care closer to home
Delivering more services in the community and specifically moving them out of hospital
Innovation and potentially promoting a new service for PBC
Increasing diversity of Primary Care provision
Potential to better manage a patients condition from home
Admission avoidance
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Frequent flyers
Re-admissions & admission prevention
Supported early discharge
Promoting self-care
Efficiency gains
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D39, Chronic Obstructive Pulmonary Disease or Bronchitis w cc (with complication) £2360 per
episode
D40, Chronic Obstructive Pulmonary Disease or Bronchitis w/o cc (without complication) £1752 per
episode
Opportunity to Unbundle PbR tariff
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The service supports directly the Government agenda to unbundle the Payment by Results (PbR)
Tariff
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Choice and control
Reduce risk of MRSA and
Clostridium difficile (c-diff)
Maximise efficient use
of the primary care budget
Patient at home
where they prefer to be
Earlier diagnosis
and treatment
Frees up hospital beds
18 weeks target
Reassurance and
confidence
Prevent Emergency
Admissions
Opportunity to unbundle
PbR tariff
Quick intervention
if condition deteriorates
Closer management
of chronic disease
Reduce total referrals
into the Acute Sector
INDEPENDENCE &
DIGNITY
DISEASE & CASE
MANAGEMENT!
COST AVOIDANCE
© 2007 Tunstall Group Ltd
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What will make a pilot a success?
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Innovative PBC Group & PCT
Pioneering approach to LTC
management
Partnership approach across all
Healthcare professionals
Drive, determination, focus and
commitment to make it happen
Enthusiasm from all
Patients come “First”
About patient centred care and
not the equipment
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Objectives for the presentation
• Where are we now – Innovation in practice
• How we got there – Sharing experience
• Where are we going – The future
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Introduction - the Sheffield focus
• Here to day to discuss our pilot of telehealth and how it has become part of
our innovative working practice in COPD
• Sheffield Focus
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Industrial legacy
High prevalence of COPD 3% overall - key target areas 6 –7%
Annual rate of COPD unscheduled care admissions 2,000
Average unscheduled care admissions for COPD 166 per month
• Recent developments to build a network of respiratory knowledge in the
community to create accessible and responsive services
• Delivery of care through segmented targeted approach
• Evidence based care
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COPD Unscheduled care admissions to
secondary care Source Sheffield PCT 2007
March
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2006/07
February
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January
2004/05Month2005/06
December
November
October
September
August
July
June
May
300
250
200
150
100
50
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April
Number of patients
Number of COPD admissions
What we found in our pilot of
telehealth
Sheffield PCT ran a 6 month pilot of telehealth:
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Completed Mar 07
Key findings published in HSJ (online)
80% reduction in home visiting
50% of patients would have been readmitted without
the support provided by remote monitoring –
telehealth
= Significant cost savings
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Where are we now – innovation in practice
• Partnership working between Sheffield Primary Care
Respiratory Team and the Northern General Hospital NHS
Trust Sheffield COPD team
• Led by Sheffield Primary Care Public Health Directorate
• Nurse led
• Developing roles across communities of practice district
nurses, new respiratory community nurses – hospital and
home
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Key benefits we found to the organisation
• Reduction in unscheduled care admissions to STH
• Reduction in number of home visits
• Early identification of patients at risk of hospital admission
• Reduction in travel costs per month
• Prioritisation of clinicians work schedules
• System can be used across hospital and community interface
• Ability for early diagnosis – e.g. hypoxia, rapid heart failure
access into support services – e.g. hypoxia patients for oxygen
assessment
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Benefits to the patient
• Choice for the patient hospital or home
• Tool for self care – Expert patient
• Reduction in anxiety and increase in confidence for the
patient and carer’s – unexpected benefits!
• Well received by patients
• No cost for the patient
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What did we learn
• Easy to use and install
• Increase job satisfaction, reduced stress
levels
• Confidence growing in remote monitoring
• Developing triage skills
• Over coming barriers to change
• More confidence in dealing with the more
complex patient
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How we implemented and developed
telehealth
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Initial trial
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pilot of the technology
How it worked for us locally
Identified our target area of patients
Clear patient selection criteria
Identified champion clinicians
Developed strong clinical commitment
Started small to grow big
Clear plan of where we wanted to go with telehealth
– Integration into community COPD pathway
– Demonstrate cost benefits
– Strong relationships between primary and Secondary care
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Competence frameworks
– Official training to support the use of the technology, some staff initially
hesitant
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The future
The Future
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Fully integrated into the community
Monitoring as integral part of the COPD care pathway
Implemented across all long term conditions
Communication with GP practices and other systems
e.g. System one (TPP), out of hour services
• Evaluation via Sheffield University and Sheffield PCT
commencing December 2007 key pilot evaluation to
support a larger RCT research study
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The Sheffield Team
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Ruth Marrison Sheffield Teaching Hospitals COPD Co-ordinator
Cheryl Oates COPD Nurse Specialist COPD Team Sheffield Teaching
Hospitals
Rosemary Lawson Head of Service Redesign Formerly Sheffield PCT
Dawn Weston Lead Development Nurse Respiratory Care Sheffield PCT
Sue Thackray Deputy Head of Development Nursing Sheffield PCT
Lis Reid Head of Developmental Nursing Sheffield PCT
Nicky Kenyon Head of Clinical Care Pathways Sheffield PCT
IT Departments Sheffield Teaching Hospitals & Sheffield PCT
John Skinner Audit and Evaluation Department Sheffield PCT
Mike Worden Telehealth Consultant Tunstall
© 2007 Tunstall Group Ltd
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“The definition of insanity is
doing the same thing over and
over again and expecting a
different result.”
~ Albert Einstein
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