Transcript Examples of telecare services

Mainstreaming telecare in the UK.
Overcoming the barriers
James Barlow
Innovation Studies Centre
Imperial College London
Southern Institute for Health Informatics Conference
University of Portsmouth
12 June 2003
Agenda
 Background
 Telecare services
 Mainstreaming telecare
 Conclusions
Agenda
 Background
 Telecare services
 Mainstreaming telecare
 Conclusions
Demands on care provision
 Demographic and social change
 Rising cost of care delivery
 Demand for better quality services and
improved access
 Staff shortages
Government aspirations
 The government wishes to see ‘home
telemonitoring’ available in 20% of
homes requiring it by December 2007
and 100% of homes requiring it by
December 2010
Policy context
 Information for Health (NHS Executive, 1998)
 The Royal Commission on Long Term Care (1999)
 Fully Equipped and Fully Equipped 2002 (Audit Commission, 2000,
2002)
 Valuing People: A New Strategy for Learning Disability for the 21st
Century (DOH, 2001)
 Integrating Community Equipment Services (ICES) (DOH, 2001)
 National Service Framework for Older People (DOH, 2001)
 Quality and Choice for Older People’s Housing – A Strategic
Framework (DETR/DoH, 2001)
 The House of Commons Health Committee (2002)
 National strategic programme for IT in the NHS (DOH, 2002)
Industry context
 Telecoms – search for new services
 Smart homes – emerging interest from
some housing providers, consumer
electronics and white goods companies
 Digitalisation allows sensors/devices to be
separated from transmission media so
‘technology silos’ can be broken
 Sensors – developments in size, battery
life, radio frequency
 Within this context new telecare
services are beginning to
emerge …
Agenda
 Background
 Telecare services
 Mainstreaming telecare
 Conclusions
ICT enabled health care innovation
 Innovation in administration and
management (e.g. EPR)
 Innovation in the delivery of care
– Telecare is a ‘B2C’ service – between the
patient / client and the care system
– Telemedicine is a ‘B2B’ service – between
health professionals
Examples- of
telecare
Telecare applications
summary
Telecare service category
Non-customised information – either ‘pushed’
by service provider or ‘pulled’ by customer
Customised information – either ‘pushed’ by
service provider or ‘pulled’ by customer
Making the home environment suitable – inhome safety and security alarms, personal
alarm
Monitoring activities of daily living
Physiological monitoring – vital signs
Information
Risk management
Potential information services
Push
Customised
• Support and advice,
customised to an
individual’s specific needs
• Professionally directed but
not self-navigated, e.g.
quit smoking programme
• General information and
advice provided on an ad
hoc basis
Noncustomised • Not professionally
directed, e.g. pollen count
warnings + reminders to
take anti-histamine
Pull
• Customised advice in direct
response to question from an
individual, triage, access to
self-help groups
• Professionally directed, e.g.
NHS Direct
• General information on health
matters and lifestyle
• May be professionally directed,
e.g. websites for specific
conditions or general
health/lifestyle advice
Progress towards info. services
 40% of respondents (2001 MORI survey)
identified the Internet as their preferred
source of health information:
 500,000+ hits per day on NHS Direct
website; multiple delivery channels
 2%+ of the 1bn+ www documents are
health related (information on specific
conditions and for informal carers)
Examples- of
telecare
Telecare applications
summary
Telecare service category
Non-customised information – either ‘pushed’
by service provider or ‘pulled’ by customer
Customised information – either ‘pushed’ by
service provider or ‘pulled’ by customer
Making the home environment suitable – inhome safety and security alarms, personal
alarm
Monitoring activities of daily living
Physiological monitoring – vital signs
Information
Risk management
Examples of risk mgt. telecare
Service
Examples
Making the home environment suitable –
in-home safety and security alarms,
personal alarm
Bath overflowing, gas left on, door
unlocked, environmental control
Monitoring activities of daily living
Detecting falls, room occupancy, person
identification & location, bed-usage,
memory jogger, medication compliance
Periodic physiological monitoring of vital
signs
Continuous physiological monitoring of
vital signs
Pulse rate and variability, ECG, blood
pressure, basal temperature, blood
velocity, profile, blood oxygen content,
respiration, sweating, pallor, throat
inflammation, heart and breathing
sounds
Not realistic because of response time?
Telecare: schematic model
Sensors: in home, on body
Events
record
EPR
Record event
Response
protocol
Alarm !
Response: home visit,
emergency services,
remote change
Check status: VDI
Contact
centre
Response
service provider:
HCA, neighbour, relative,
ambulance, GP practice
nurse, fire, police
Telecare in the home
‘Thanks to the
smarter home,
a home help is
required only
once a year, to
adjust the
clock’
Progress towards RM services
 c.300 community alarms services serving
1.5m people
 Several telecare demonstration projects,
some intended to develop into
mainstream services, but …
– these amount to <500 users in total excluding ODOP
(West Lothian, 1200 users)
– few seem to be built upon lessons from projects in other
locations
Agenda
 Background
 Telecare services
 Mainstreaming telecare
 Conclusions
Influences on implementation
 Structural and operational complexity
 Distribution of costs and benefits within the
system
 UK health system: policy innovation is faster
than technology innovation, unlike many
other sectors
 Policy tension between modernisation
(telecare) and evidence-based innovation
(RCT as the ‘gold standard’)
Structural & operational complexity
 Large number of stakeholders, incomplete
understanding of care process by staff
 Need to accommodate differing perceptions
of risk and different value systems in different
parts of the care system
 Evolving policy priorities
 (Generally much higher for telecare than
telemedicine)
Columba – simplified pathways
100
referred
patients
(2/week)
Assessment:
30 patients
(0.6/week)
70 patients
(1.4/week)
4 bed
Rehab
Unit
>6 week
stay
24 people
80%
6
people
20%
Own
home:
care
package +
telecare
Residential
homes
76 people
Actual pathway process
Ward MDT
assessment
physio
Home
with
support
No
Dietetics
Referral to
Intermediate
Care Team
Yes
No
mid point review
Podiatry
Mini mental local
services OT
assess
Assess/home visit
Care Manager
requests OT
assessment
Alternative
discharge
package
SALT
Referral made
Does older person
require residential
home?
Accept for
Brockhurst
Care
Manager
to identify
exit route
No
Early discharge
with equipment &
support
Yes
Yes
No
Discharge from
hospital to Brockhurst
Anticipated total length of stay
6 weeks
Yes
Leaflet given re Columba &
Telecare equipment
Inform older
person & family of
details of transfer
Nursing
Patient to remain on Project?
Set final review date
Letter of agreement & consent
signed
continue
Notes to Brockhurst
Final review at 5 weeks
Letter to GP
Identify keyworker for discharge
Identify keyworker
Discharge letter to GP
Care manager to provide
alternative package of
care
Set mid point review
Discharge Home
Brockhurst notes to go
home
Keyworker to visit
weekly (for 4 weeks)
Invite all involved in care, GP,
& family to mid point review
Advise locality care
manager
MDT goal planning & programme setting
Goal planning form
signed by older person
No
Is older person managing?
Yes
Keyworker to complete TOMS
and VAPORS
TOMS & VAPORS completed
Discharge from Columba project
Continue with
programme
Letter to GP
No
Other Therapy/care needs
Keyworker to review patient after 6
months
Yes
Letter to GP
It’s not the technology!
Implications for mainstreaming
 Integration with existing care
services
 Project design
 Procurement
 Supply chain
 Business models
Examples
of telecare
Telecare integration
implications
Category
Information
provision
Risk
management
Service description
Integration implications
Non-customised information –
either ‘pushed’ by service provider
or ‘pulled’ by customer
•Likely to be stand alone,
commercial service
•No integration implications
Customised information – either
‘pushed’ by service provider or
‘pulled’ by customer
•May be stand alone,
commercial service,
•Some services (e.g.
medication reminders) may be
part of mainstream care
delivery & need integration
Making the home environment
suitable – assistive technology, inhome safety and security alarms,
personal alarm
Monitoring activities – ADL,
medication compliance,
wandering
Physiological monitoring – vital
signs
Need for
integration
Lower
•Emergency response service
requires close integration with
existing care services
Higher
Project design implications
 Design must take into account
requirements for future
mainstream service delivery
 Need for early involvement of all
stakeholders in development
phase, especially where
integration needs are high
 Need for clear ownership and
leadership of the project
 Telecare should become a focus
for better integration of existing
services and teams
Procurement implications
 Start at the day to day operational level and
then consider technology requirements
 Mix and match approach – using beneficial
technologies and systems to avoid
technology silos
 Care providers don’t have skills base for
systems integration
 Need for local single point responsibility for
telecare procurement, working with systems
integrators and within national framework
Supply chain implications
 There are several possible ways of
“cutting the stakeholders’ cake” –
different supply chain models …
Sensors: in home, on body
Events
record
EPR
Record event
Response
protocol
Alarm !
Response: home visit,
emergency services,
remote change
Check status: VDI
Contact
centre
Response
service provider:
HCA, neighbour, relative,
ambulance, GP practice
nurse, fire, police
Sensors: in home, on body
Events
record
EPR
Record event
Response
protocol
Alarm !
Response: home visit,
emergency services,
remote change
Check status: VDI
Contact
centre
Response
service provider:
HCA, neighbour, relative,
ambulance, GP practice
nurse, fire, police
Actors in telecare supply chain
Data Providers
Patient
Data &
Protocols
Potential
Provider
GP
Hospital
Records
Community
Nurse
Service Providers
Management
Response
Potential
Provider
Contact Centre
Telecoms
Operator
Healthcare
Provider
NHS/Social
Services
Access Providers
Network
Service
Provision
Potential
Provider
PSTN
Mobile
Broadband
Device Suppliers
Hardware
Potential
Provider
Medical
Equipment
Manufacturer
Community
Alarm
Manufacturer
Electronics
Companies
Business model implications
 Telecare business models remain unclear:
– System procurement, financing and revenue
arrangements (incl. leasing & licensing, subsidies)
– Responsibility for maintenance, continuing support
& upgrading technologies / infrastructure
– Relationships between payers, technology providers,
service providers (care agencies, telecoms, utilities,
media) and customers
– What are the billing arrangements?
Agenda
 Background
 Telecare services
 Implications for mainstreaming telecare
 Conclusions
Conclusions
 The future evolution of the care system needs
to start from existing service delivery and a
recognition of what telecare can achieve
 The purpose and fit of telecare services in the
wider care system should drive its introduction –
not the technology
 This will require a better understanding of
telecare’s impact at the system-wide level and
new approaches to evaluation
Thank you for listening!
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