Good morning everyone. I would like to help set the scene for the presentations to follow by offering some suggested common terminology, talking about the New Zealand context for Telehealth and outlining the potential opportunities, providing some information on current relevant initiatives, discussing a couple of emerging Telehealth care models. And summarising some actions going forward.
Telehealth, Telecare and Telemedicine are terms that are often used interchangeably,. Given the wide range of definitions used to describe technology enabled health care I though it would be useful to simplify the debate and this presentation by offering some common definitions. While there are a wide range of definitions, some common themes are apparent across UK US and Australian usage. These align reasonably well to the definitions for Health, medicine and care. The term Telehealth is most often used in the context of an overarching term for all forms of technology enabled health care provided at a distance. Telemedicine involves the application and practise of medicine, generally between health professionals and for diagnoses and referral – subsets are specific medical disciplines such as Teleradiology and teledermatology. Areas that are becoming increasingly accepted as part of mainstream care models – evidenced by decreasing use of the “tele” prefix in areas such as paediatrics. Telecare now has wide usage and formal acceptance in the UK as the provision of care to end users in the home setting and is evolving to mean services that allow aging and chronically ill people to stay out of institutional care. The spin off benefit is greater independence and it is this area where the benefits of person cantered Telehealth – where people are participants rather than simply receivers of care – is increasingly recognised as providing the potential for major improvements in health system productivity. both Telecare and Telehealth offer significant potential to address many of the current pressures on the health system and I’d like to spend a few moments discussing these 2 areas today.
It is no surprise to anyone here that we are about to experience a significant increase in demand for health care. “ Between 2006 and 2036 the proportion of New Zealand’s population aged 65 or over as a proportion of the working-age population is expected to rise from 18 to 40%,” The number of people over Chronic conditions are estimated to account for 70 percent of health funding and 80 percent of all deaths in New Zealand and health workforce numbers per person are expected to decrease over next 20 years Not a system. Department of labour p rojections show that the number of paid caregivers required in New Zealand will rise almost three-fold from 17,900 in 2006 to 48,000 in 2036. There is likely to be a significant time lag between the economy returning to growth and fuller employment and the Government's deficit being reduced by increased tax revenues. In other words, next year's budget will be even tighter. The Government is borrowing $250m a week for the next 4 years. So we have to get maximum value out of every health dollar. We also have a health environment where there is an increasing range of medicines and interventions available - they all cost money so how do we decide where to focus any technology investment.
Evidence from overseas experience suggests that Telehealth offers scope to support long term condition self-management and to provide scope to better use health resources. In terms of telemedicine this has potential to provide more efficient and effective treatment and diagnostic services Keeping people out of hospital/aged care by allowing them to be treated in primary care and stay at home Enabling more effective use of increasingly stretched resources though education, support and removing the barrier of distance. Telecare proves the capability for people to stay out of hospital by being in a position to confidently care for themselves without leaving the home. The Scottish Government has been running a Telecare Development Programme that has shown some success in these areas and they believe these benefits can be significantly improved by moving to a mainstream “third generation” Telecare service. However, evidence also shows that this is very difficult to achieve if you are employing models of care where the person is viewed as a recipient rather that a participate in the care process. Moving to this kind of person-centred, co production health care model is no small thing and will require new ways of working and interaction for all involved. However, there are a couple of initiatives in terms of the establishment of IFHCs and Connected health that can support this transition to mainstream “3 rd generation” services. EU 2009 has reinforced requirement for Interoperability Standards Mandate M403 on adoption of standards to support Health record sharing as an enabler for a more patient centred health system/s Connected Health is a programme of work focussed on enabling safe sharing of health information and will support the system interoperability needed for Telehealth to gain wide adoption.
First Generation medic alert type services – as in common use in NZ today – react to user generated need Second – Kent, England example were 12 types of passive devise were used in 3 trials beginning in 2004 – movement sensors, call buttons, smoke flood and fall detectors – bed, chair and exit (house) sensors At the end of 2006, 320 people using Telecare services through the pilots – main measured benefits were psychological – helping them be confident they could safely remain in the home. 3 rd Generation In the Netherlands, - with 2.4 million people over 65! The Koala project provides video phones to 600 users with clinic conditions, diabetes and heart conditions and use TV remotes to set up calls to remote nursing centers who can see the patients care record and remote devise monitoring details
As Telecare has evolved from simply reactive response services there is increasing research and support for care models that enable “participatory” medicine – or “patient centred collaborative care, This focuses not on treating people that are ill, but fostering and supporting people who could be healthier if it were simpler to care for themselves. Telecare can assist in helping people with understanding there own condition through monitoring and alerts as well as medication management and guiding them on treatments and prevention. In the pacific and New Zealand context this approach also fits well with the concepts of family well being in providing individuals with support for self care.
The Better, Sooner, More Convenient, primary Care plan also provides an opportunity for programmes that move care from the hospital to primary care and, potentially, into the home. The EOI process will, based on the successful submissions in the first wave create more than 32 new community based IFHCs and whänau ora centres that can provide the capability to run home based Telecare models. They are intended to be technology hubs and if the business cases can show benefits in terms of reduced load on hospital services they could result in a significant growth in the number of telecare models in place. Person centred services as part of integrated preventative and chronic care management programmes that result in quantifiable benefits – e.g. reduced admissions and bed days Some potential use cases Health Education, Rehabilitation Intermediate care Hospice/palliative care Home safety and activity detection – e.g. falls Assistive technologies, Self care Monitoring, health condition and device performance Note – Evidence that increasing sophistication and cost does not always equate to better health outcomes Expected benefits of UFB for Health are in deployment of: Video based services Greater sharing of electronic health information – improved access and workflow Integrated Family Health Centres Diagnostic Imaging Telecare – home based Shared systems and applications
In August 09 Cabinet agreed that: to take advantage of the governments $1.5 Billion UFB investments for Health, MoH will work on behalf on clinicians and consumers to help ensure that: the priorities for the health sector are understood and that services are, as much as possible, able to be implemented in areas of high need “ use of Faster Broadband and the potential for technology enabled improvements in healthcare are a part of new Integrated Family Health Centre proposals ” While this will not directly enable Telehealth initiatives, it should remove barriers in areas where lack of any level of broadband is limiting the deployment of Telemedicine or Telecare. Also, the general wider availability of broadband over the years of the deployment will support more availability of services such as those based on video.
Given all this potential for Telehealth, I’d like to paint a bit of a picture of a possible future based around a few models of care that are emerging due to the massive changes in availability and accessibility of health care information, technology development and increasing ability to analyse and synthesise data.
Health Social Networking sites are providing people with the opportunity to be supported in the self care efforts – through access to health information, easy access to medical advise and support, a community of caring supporters and even the opportunity to participate in clinical trials. As an example, this site now has the largest available set of information on a particular health condition. However, there are still significant potential issues in terms of ownership and privacy of information.
The range of test information available today also has potential to support self care and home based telemedicine. Here is an example of a set of tests ordered from direct labs. Entelos partners with pharmaceutical and biotechnology organizations to develop new treatments for disease and reduce the time and cost needed to develop them. Entelos develops dynamic large-scale computer models of human disease. integrating data (e.g., genomic, proteomic, physiologic, environmental) in the context of a disease or therapeutic area, focusing on understanding and determining clinical responses to potential treatment Consider how these models plus personal health tracking devices might start to converge and enable person centre, participatory Telecare based models to evolve that can keep people healthier and out of hospital.
I hope you agree that there is opportunity to make use of Telehealth to drive positive health system change. The challenge will be to do this in such a way that it results in real quantifiable benefits in terms of keeping people independent and health. The more significant opportunity seems to be in terms of enabling them to practise supported self care in the home. We do have some changes that should support these types in approaches in terms of changes to primary care the Connected Health programme and wider broadband availability over time .Capitalise on existing Telehealth initiatives (E.g ASSET and West Coast) Assess the need for central policy on; applicability, assessment and safety aspects of Telecare Move to a shared health record approach that will allow for integration and interoperability with personal health records. Thank you for your time and any questions?
1. The Role of Telehealth in Emerging Models of Care - moving from information exchange to person-centred, technology-enabled care Ross McKenna Portfolio Manager, Health System Infrastructure Information Strategy and Architecture National Health Board Business Unit Ministry of Health HINZ Telehealth Seminar 2009
2. Telehealth - Emerging models of care…. PSYCHIATRIC HELP 5c MODERN METHODS
3. Summary <ul><li>Definitions of Telehealth </li></ul><ul><li>The potential of Telehealth in the New Zealand Health system </li></ul><ul><li>Moving from recipient to participant </li></ul><ul><ul><li>Health Social Networking </li></ul></ul><ul><ul><li>Consumer Personalised Medicine </li></ul></ul><ul><ul><li>Going forward </li></ul></ul>
4. Recommended definitions Telehealth Provision of heath care and information at a distance using Information and Communications Technology Telemedicine Application of clinical medicine at at a distance using Information and Communications Technology Telecare Provision of health care and support using Information and Communication Technology to empower people to remain independent in their own homes
5. Health system pressures <ul><li>Aging population </li></ul><ul><li>Chronic disease </li></ul><ul><li>Economic pressures </li></ul><ul><li>Workforce </li></ul><ul><li>New technologies and medicines </li></ul>How can Telehealth help?
6. Telehealth – enabling health system change Workforce effectiveness Personalised care Preventative Care Resource effectiveness Connected Health – networks, architecture, standards Integrated Family Health Centres TELEMEDICINE TELECARE Chronic conditions Education Self management Family/whänau support Remote consultations Video conferencing Peer review/support Shared systems Home Based
7. Telecare – evolution from recipient to participant <ul><li>First Generation </li></ul><ul><ul><li>User activated alarms </li></ul></ul><ul><ul><li>Call centre organises a response </li></ul></ul><ul><ul><li>POTS based dial up service </li></ul></ul><ul><li>Second Generation </li></ul><ul><ul><li>Sensors monitor home – smoke, flood, power </li></ul></ul><ul><ul><li>Sensors monitor vital signs, physiological measures </li></ul></ul><ul><ul><li>Store and forward </li></ul></ul><ul><ul><li>POTS, ADSL based </li></ul></ul><ul><li>Third Generation </li></ul><ul><ul><li>Interactive services, part of integrated care </li></ul></ul><ul><ul><li>Includes Video services – family, care giver support, doctor or specialist consultations </li></ul></ul><ul><ul><li>Education, self management </li></ul></ul><ul><ul><li>Broadband, Internet enabled – home PC, mobile, wireless </li></ul></ul>Three “generations” based on– Telecare in Scotland, Benchmarking the Present, Embracing the Future , February 2008 REACTIVE PREDICTIVE PREVENTITIVE
8. Models of care – moving from recipient to participant (technology enabled) MODEL R(ecipient) MODEL P(articipant) CSIP, UK Department of Health “Supporting Long-term Conditions and Disease Management through Telecare and Telehealth: evidence and challenges, January 2008 Preparing for Success: Readiness Models for Rural Telehealth Jnl Postgrad Med December 2005 Journal of Participatory Medicine Provider delivered at the hospital Illness and treatment Site of care focused Episodic care Workforce constrained Solitary decision making – referral based Efficiency Decentralised, independent Person & whänau involved in the community/home – provider as colleague/advisor Wellness and informed/responsible/participating/empowered Continuum of care – home and mobility Disease prevention and management Demand managed Patient involved, collaborative, evidence based decisions – co-diagnosis, co-care Efficiency and Effectiveness Coordinated, specialised care
9. Moving care closer to home SECONDARY PRIMARY COMMUNITY Early detection Education Community Medicine Alerts Education Self care Feedback loop Monitoring Electronic consultations Support – care giver/family/whänau Home-based Telecare IFHC Home assessments Electronic consultations Sharing health records Billing/payments Monitoring – 24/7 Support/advice Education <ul><li>Consults </li></ul><ul><li>Tests </li></ul><ul><li>Referral & discharge </li></ul><ul><li>Share health records </li></ul>Hospital/DHB Peer review Consult Train Share systems & health records Diagnostic Imaging Videoconferencing Other provider sites
10. Broadband <ul><li>Linked to the Primary Care Implementation Plan – IFHCs. </li></ul><ul><ul><li>IFHCs supporting the community – enabling services such as: videoconferencing, diagnostic imaging and home based Telecare </li></ul></ul><ul><ul><li>EOI selection process informing the roll-out of Broadband </li></ul></ul><ul><ul><li>Key steps: </li></ul></ul><ul><ul><li>November 2009, EOIs selected to proceed to business case </li></ul></ul><ul><ul><li>December 2009, proposals from potential LFC co-investors. </li></ul></ul><ul><ul><ul><li>Indicate the regions likely to receive the first phase of funding from this initiative. </li></ul></ul></ul><ul><ul><ul><li>Ministry of Health will advice on the requirements identified from EOI process to align, where possible, any plans for fibre deployment. </li></ul></ul></ul><ul><ul><li>Early 2010, identify rural schools and hospitals/health sites outside the 75 percent coverage are able to be connected. </li></ul></ul>
11. Emerging Telecare models – enabling self care <ul><li>Increasing Internet access, connectivity and information availability </li></ul><ul><li>Developments in care and monitoring devices </li></ul><ul><li>Cost and availability of analysis and computing power </li></ul><ul><li>Some examples of emerging person-centred models </li></ul><ul><ul><li>Health social networking </li></ul></ul><ul><ul><li>Consumer personalised medicine </li></ul></ul><ul><ul><li>Self tracking and management </li></ul></ul>
12. Health Social Networking <ul><li>Information and research sharing </li></ul><ul><li>Keep updated on latest developments/treatments </li></ul><ul><li>Learn and try new approaches – participate in clinical trials </li></ul><ul><li>Physician Q&A – free or fee </li></ul><ul><li>Social connection and emotional support – “I am not alone” </li></ul><ul><li>Track health progress </li></ul><ul><li>Source of condition data </li></ul><ul><li>E.G Patientslikeme.com </li></ul><ul><ul><li>45,000 members, 10% per month growth </li></ul></ul><ul><ul><li>Free to join </li></ul></ul><ul><ul><li>16 conditions </li></ul></ul><ul><ul><li>Largest dataset on ALS </li></ul></ul><ul><ul><li>(Amyotrophic Lateral Sclerosis) </li></ul></ul><ul><ul><li>Sells data to drug and medical companies </li></ul></ul>
13. Consumer personalised medicine <ul><li>Using individual biological characteristics to tailor therapies and remedies </li></ul><ul><li>Combines genetic, blood, biomarker, environment, lifestyle data </li></ul><ul><ul><li>Personalised genomic information </li></ul></ul><ul><ul><li>Biomarker/blood testing – blood count, thyroid, lipid, liver, kidneys, diabetes, etc (see www.directlabs.com) </li></ul></ul><ul><ul><li>Environment testing – pollutants, pesticides, etc. Blood or hair testing </li></ul></ul><ul><ul><li>Predictive bio stimulation – project a “virtual” patient (e.g. Entelos) </li></ul></ul><ul><li>Quantified self-tracking </li></ul><ul><ul><li>Implanted and external devices monitor health metrics </li></ul></ul><ul><ul><li>Current web based services require external input </li></ul></ul><ul><ul><li>Wearable devices </li></ul></ul><ul><ul><ul><li>Energy expenditure, sleep measurement ( www.fitbit.com) </li></ul></ul></ul>
14. Going forward… <ul><li>Recognise the opportunities to drive positive change through new models of technology enabled care – Telemedicine and Telecare </li></ul><ul><li>Focus on Telecare services development – person centred, home based </li></ul><ul><li>Supporting changes </li></ul><ul><ul><li>Establishment of IFHC as “technology hubs” and wider broadband deployment </li></ul></ul><ul><ul><li>Continue development of Connected Health </li></ul></ul><ul><ul><li>Supporting information and policy </li></ul></ul>
15. QUESTIONS? Web references Presentations from the supported self management seminars held in June 2009: http://www.moh.govt.nz/moh.nsf/indexmh/longtermconditions-masterclasses 2007 Synergia Self Care Literature Review http://www.synergia.co.nz/assets/file/Role%20of%20information%20in%20self-care%20July%202007.pdf Link to Genetic and Bioinformatics resources: http://www.ornl.gov/sci/techresources/Human_Genome/posters/chromosome/tools.shtml NZ Government Broadband Initiatives – MED site http://www.med.govt.nz/templates/StandardSummary____40551.aspx