Telehealth: The Cornwall Experience
Dave Tyas
Telehealth and Service Improvement Manager
What am I going to talk about today?
• Telehealth in Cornwall – current position
• How we got there – the process, the structure and the challenges
• Patient and Clinical Experience
• Next Steps in Cornwall
Telehealth – a work in progress……
•
Started in 2009 as part of WSD
•
Mainstreamed in April 2010 with recurrent funding
Now
•
1000 people installed
•
650 actively being monitored
•
Conditions covered: Diabetes, CHF, COPD, Stroke, Falls Risk, UTI
•
Referrals from Acute, Community and Primary Care
Future
•
Expand service to over 1000 active users by end of the financial year
•
Individual systems in peoples homes and multi-user systems for residential /
nursing care
•
Develop the service with other conditions / circumstances
How we got there……. WSD Timeline
2008
• Formation of the WSD project team including management, clinicians,
programme support staff and field teams
• Engagement with GP’s to sign up practices (45 signed up)
• Procurement of Telehealth equipment from Tunstall
2009
• Commenced installations (Feb)
• Refined processes and established team
• Data collection for evaluation
2010
• Completed WSD installations
• Service mainstreamed and opened up to other conditions
How we got there…….Team Structure
Central service monitoring 80% of the patients:
• Service operations lead
• Senior Telehealth Nurse
• 3.5 x Telehealth Nurses
• 3 x Patient Support Operators
• 2 x Engineers
• 2 x Assistant Practitioners
=12 FTE
20% monitoring covered by community matrons and specialist nurse teams
What were the challenges?
• Clinical buy in – lots of evidence but not robust enough hence the need for
WSD
• Patient Logistics – installing in the whole county from a central location under
tight time pressures
• Data Collection – vast amounts of data needed for national evaluation
• Lack of a clearly communicated evaluation approach
• Local Evaluation – unable to complete as may impact national trial results
• Split monitoring – tieing together community monitoring and central team
• Patients using the equipment correctly
Overcoming the challenges
• Clinical buy in – used the evidence available and payments per patient for involvement
• Patient Logistics – having the right number of resources, giving flexible installation slots
and grouping appointments by location
• Data Collection – have a central database that collects all the information. Have
dedicated staff with regular tasks to update the information. Being clear on what is needed
and why
• Lack of a clearly communicated evaluation approach – making sure everyone
understands the requirements and
• Local Evaluation – still completed and used for internal monitoring only
• Split monitoring – building effective working relationships so that information is shared
freely (still not fully resolved)
• Patients using the equipment correctly – robust training, phone support and follow up
What worked for us
• Central Team focused on the service
• Separate service which can then develop across locality boundaries
• Detailed processes for decision making and clarity
• Dedicated project management to get the service launched
• Support from different levels in the organisation
• Early communication and regular contact detailing progress
• Freephone patient support during the working week
• Continuity of staff
• Ensuring part of LTC QIPP Plans
• Close working relationships with suppliers
Patient Profiles & Equipment
Profiles
• COPD plus at least 1 non-elective admission or
intermediate care response in previous 12mths
• Heart Failure plus at least 1 non-elective
admission or intermediate care response in
previous 12 mths
• Diabetes plus at least 1 non-elective admission
or intermediate care response in previous 12
mths
• Stroke via Stroke Clinic – confirmed TIA or
Stroke – monitoring ongoing hypertension and
response to treatment
• Falls – with CHF and potential hypovolaemia –
monitoring fluid retention / loss and response to
treatment
• UTI – more than two UTI’s with admissions in
the last 12mths
Equipment
• Monitor + BP, Pulse Ox
• Monitor + BP, Weight Scales
• Monitor + BP, Glucometer
• Monitor + BP
• Monitor + BP, Weight Scales
• Monitor + Urine Analyser
Monitoring Process
• Non-transmissions and technical issues monitored by PSO
• Clinical monitoring completed 9-5 – focus on developing
trends
• Intervention ranges from telephone triage to emergency
referral
• Education and support is provided as part of day to day
contact
• Onus is on the patient to act the majority of the time –
clinical feedback / info provided to primary/secondary care
clinicians
Who benefits from Telehealth?
3 types of people:
1. Not interested in home monitoring – reliant on utilising
care when they become ill / symptomatic
2. Interested in home monitoring but need the constant
support of a clinician
3. Interested in home monitoring and utilising the information
to Self Care!
Focus on types 2 and 3 but consider how to convert type 1!
Clinical Experience
Positive for some, mixed for others:
Plus points
•Impact on capacity – it has the potential to save visits in remote locations
•Supports clinical care and management – getting to know patients biometrics
which often signify and exacerbation.
•Enhances patient independence and empowerment – empowers patients and
helps to get them motivated about managing their own conditions with visual
evidence
Requirements
•Only works if the patient is engaged and wants to manage their own condition
•Care management systems need to adapt to imbed the technology – clinicians
need to commit to making it work
•Technology on its own will not have the necessary impact
Clinical engagement will only be effective with the required evidence!
Case Study 1 – Eddie’s story
It will be too
complicated to
use
I don’t
understand
what the
readings
mean
Reality
• The equipment is
simple to use
• I can relate the readings
to how I feel and know
when I should and
shouldn’t do things
• It has enabled me to
visit family and walk into
town
“I wouldn’t be without it”
Taking the
readings will
limit my
freedom
Case Study 2 – Changing Perception
66 yr old male – COPD
Keyworker – Julie Coles RSN – feedback as follows:Problems:
Early detection of exacerbation a problem
Person not wanting home oxygen
Action taken:
Short Burst Oxygen Therapy instigated
Early detection of exacerbation – antibiotic therapy
Outcome:
Has successfully reduced admissions
Person more aware of early signs of exacerbation
Case Study 3 – Branching out and working
with carers
•
•
78 year old user suffering from Dementia with husband as carer – had emergency
meds in the home
User symptomatic of UTI detected by follow up to question set - complained around
lunchtime that she was experiencing a burning sensation and a strong urine odour
Husband decided to test her urine and then called the results into the Telehealth nurse
team
The results came back as positive for early onset of UTI
The husband started his wife on emergency meds
He expressed his relief that he could now do something about it - his comments were
that if he tried to make an appointment with his GP he would be unlikely to get one until
Monday and that this would be too late. In addition taking a urine sample now would
not then be processed until after the weekend
Follow up with user – symptoms eased over the weekend following intake of meds
•
Previous experience from discussion with carer – would have resulted in admission
•
•
•
•
•
Benefits to Patients
•
•
•
Visual impact of seeing biometrics – giving up smoking, losing weight
Early diagnosis of problems – irregular heart beat, postural blood pressure drop, high
blood pressure
Diagnosis of serious illness – diabetic ketoacidosis, low blood oxygen levels
Overall, quality of life effects have been amazing!
•
“It gives me peace of mind to know my daily readings. If they vary significantly it gives
an opportunity to review recent lifestyle changes and consider their effect”
•
“To start with I wasn’t sure about the equipment and couldn’t see how it could help me
now I wouldn’t want to be without it – it’s a good lifeline”
•
“I now have a better idea of when to adjust and increase my medication to combat
symptoms. Before Telehealth I tended to leave it too late thinking I would get better and
sometimes I would be taken to hospital”
The collective view – not just individuals…..
•
Survey May 2011 – 500 Cornwall Telehealth users
• 54% response rate
• 90% users got some benefit from utilising Telehealth
• 89% felt that the equipment was easy to use
• 78% felt that the equipment helped them to manage their condition and
that they got a benefit from clinical monitoring
Keywords: “Anxiety reduction, independence, security”
Next Steps in Cornwall
• Expansion of service throughout community, acute and
primary care
• 12mth trial of RISC tool for Telehealth patient selection
• Installation of multi-user Telehealth systems in care
homes and remote locations (Isles of Scilly)
• Investigation into early discharge and step down from
acute care at home
• Referrals from health and social care hubs
Any Questions?