Transcript Telecare & commissioning

Integration/Interoperability
of Telecare & Telehealth
user requirements, outcome-driven
system development & service
redesign
Hydra/REACTION/InCasa
Russell Jones, Malcolm Clarke & Jo Fursse
Pharma Times – 2/10/12
User/Client requirement
• Support
– Clinical advice
– Measurements
– Education and additional information
• Device
– Accessible and easy to use for all
– Unobtrusive
• Feedback
– Tailored to personal need
• Access determined by patient/client
Pharma Times – Oct 2012
Commissioner requirement
• Reducing bed numbers
• Concentration of specialised services
• Affordable health services
– Integrated services
• Stratagem for
– Care of elderly
– Increase in long term conditions
– Expectation and relative reduction of resource
Pharma Times – Oct 2012
Professional requirement
• Clinically valuable
– Convincing evidence of improved clinical
outcomes and improved quality of life for
patients/clients
• Cost effective and affordable
• Achievable changes in delivery of care
• New patient/client pathways become the
norm
Pharma Times - 2012
Deduced
• Monitoring is a tool and only as good as the
service
• Many trials bring service where there was little
or no service
• Service development – nurses learn
• Applied to small number of worst case
patients
• Current systems expensive, bulky,
cumbersome, limited functionality
Pharma Times - 2012
How is it done?
• Use the standards
o IEEE 11073, IHE, Continua Alliance
• Redesign the concept
o Consider what the patient wants
o Get rid of the computer
o Exploit the changing infrastructure
Pharma Times - 2012
New approaches to a solution
HYDRA - Technology Strategy Board
Telehealth and
telecare
Pharma Times – Oct 2012
Embedded
communications
Completing the loop - CARL
REACTION - EU
Pharma Times – Oct 2012
REACTION monitoring protocol
Start
Review Visit 1
Step 1
Patient invited to attend Diabetes
Review and given information
about monitoring
Begin Monitoring
with Reaction
Platform
Review Visit 2
Assessme
nt
Intervention
Stop Monitoring
Pharma Times – Oct 2012
REACTION monitoring protocol
Start
Step 2
Usual review visit 1 protocol
followed
Review Visit 1
Patient Gives Consent to
Monitoring
Begin Monitoring
with Reaction
Platform
Patient is provided with monitoring
equipment for 2 weeks and either:
Review Visit 2
•
•
Provided monitoring
equipment every 24
weeks
Pharma Times – Oct 2012
Asked to monitor for 2 week
Assessme
nt
Intervention
Stop Monitoring
URL
Tablet
•
•
•
•
Physiological Measurements
Activity
Diet
Medication Compliance
REACTION monitoring protocol
Start
Review Visit 1
Step 3 – Review Visit 2
Begin Monitoring
with Reaction
Platform
Step 3 – Review Visit 2
Assessment made on monitoring data plus
clinic data.
Review Visit 2
If intervention is required patient continues
to be monitored until management is
deemed acceptable.
If intervention is not required patient returns
monitoring equipment.
Assessment
Estimated - 60% Require
No Intervention
Intervention
Pharma Times 2012
Stop Monitoring
REACTION monitoring protocol
Start
Review Visit 1
Begin Monitoring
with Reaction
Platform
Step 3 – Review Visit 2
Step 3 – Review Visit 2
Assessment made on monitoring data plus
clinic data.
Review Visit 2
Estimated
30% Require Some Short
Term Intervention
• Education
• Diet
• Activity
• Reinforcement
Pharma Times – Oct 2012
If intervention is required patient continues
to be monitored until management is
deemed acceptable.
If intervention is not required patient returns
monitoring equipment.
Assessment
Intervention
Stop Monitoring
REACTION monitoring protocol
Start
Step 3 – Review Visit 2
Review Visit 1
Step 3 – Review Visit 2
Assessment made on monitoring data plus
clinic data.
Begin Monitoring
with Reaction
Platform
If intervention is required patient continues
to be monitored until management is
deemed acceptable.
If intervention is not required patient returns
monitoring equipment.
Review Visit 2
Estimated - 10% Require
Intensive Intervention
Assessment
Intervention
Pharma Times – Oct 2012
Stop Monitoring
Suite of tools to fit patient
requirement
Internet – wired / wireless
Mobile
PC
Tablet
Pharma Times – Oct 2012
G.P.R.S
1° care clinical portal
• Manage incoming
data from monitoring
devices and patient
portal
• Display data in a
meaningful and useful
way in order to aid
clinical decision making
• Enable exporting of
data into Electronic
Patient Record
Pharma Times – Oct 2012
Patient portal
• View Physiological
Measurements
• Manually enter Physiological
Measurements
• Questionnaire / Feedback
– Diet
– Activity
• Enter and view Diary
– Carbs
• View Medication Compliance
– Insulin Diary
– Med Compliance question
Pharma Times – Oct 2012
Interaction
Pharma Times –Oct 2012
Patient feedback
Trend Data
Graphical Data
Insulin Diary
Pharma Times – Oct 2012
Patient portal
– review patient feedback
• View Physiological
Measurements
• View Questionnaire results
– Diet
– Activity
• View Diary Results
– Carbs
• View Medication
Compliance
– Insulin Diary
– Med Compliance question
Pharma Times – Oct 2012
InCasa -Frail elderly
• Co-morbidity
monitoring
–
–
–
–
BP
Heart failure
Glucose
Falls
• Activity monitoring
– Bed and chair
– Movement
Pharma times – Oct 2012
• 40% of over 65 yrs
fall each year
• 40% of trauma
admissions are due to
falls
• Few falls are reported
• Most to primary care
• No frailty register
Sensors available
Device
Manufacturer
Model BT
Model ZigBee
Blood pressure
A&D
UA-767PBT-C
UA-767PZ-C
Weighing scale
A&D
UC-321PBT-C
UC-321PZ-C
Pulse oximeter
Nonin
9560BT
IPOD
Glucose meter
Lifescan
One Touch Ultra 2 / Docking station
Medication dispenser
Pivotell
Carousel Mk 3
Bed/chair sensor
Tynetec
ZTX450
Motion sensor
Optex
EX-35R
Smoke alarm
Tunstall
VDS3000NS
Home gateway
Acute Technology
HMPG
Pharma Times – Oct 2012
Habits monitoring
RSM – Sep ‘10
Clinical Monitoring
RSM – Sep ‘10
05
/07
/20
07
12
/07
/20
07
19
/07
/20
07
26
/07
/20
07
02
/08
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07
09
/08
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07
16
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07
23
/08
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07
30
/08
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07
06
/09
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13
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20
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27
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04
/10
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07
11
/10
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18
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25
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01
/11
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07
08
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07
15
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07
22
/11
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07
29
/11
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07
06
/12
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07
13
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07
Values
Monitoring trends
WSP CHF/DB2 - ID 1020
180
160
140
120
100
RSM – Sep ‘10
Pulse
80
Sp02
Weight
60
40
20
0
Date
Reviewing and sharing data
Linked to EPR
220
210
200
190
180
170
160
150
140
130
120
110
100
90
80
70
60
50
40
04/04/2007
Pharma Times – Oct 2012
11/04/2007
18/04/2007
25/04/2007
02/05/2007
09/05/2007
16/05/2007
Service restructured
RSM – Sep ‘10
Gains
•
•
•
•
Generic platform
Adaptable and flexible
Standards adopted
Integrated/Shared usage – health and
social care
• Cheap
• Unobtrusive
• Appropriate placing of sensors
Pharma Times – Oct 2012
A business case
• Plug in gateway
= £100
= £1,000
• Installation and training • Installation and
training
= £500
= £0
• Re-use factor = 5
• Cost per patient
installed
= £1,500
• Cost per patient = £20
• Telehealth console
Pharma Times – Oct 2012