As you are well aware, the healthcare environment and society as a whole have increasing pressures to deliver high quality outcomes, while our population, workforce age, costs, expectations and range of therapies keeps increasing also. However, this is in the backdrop of minimal additional funding. For example, ambulance services have seen a year-on-year increase of 4.4% utilisation over the last five years, but have seen no new funding to support this. We know this is not sustainable, therefore other approaches are necessary to help address this.
The knowledge system framework is designed from research of best practices, and our own experiences to provide a holistic approach to managing key dependencies for telehealth services.The framework, while it is originally developed for managing complex care patients, can be applied to any groups that demonstrate effective improvement in service care or aimed to avoid costly recurrent admissions.
The framework comprises of 10 domain interdependicies that needs to be considered to support the providers, the patients, their families, primary care community based teams and general practice teams. These interdependencies can be applied to most services for telehealth.
Knowledge Systems Framework for Sustainable Telehealth Services
Knowledge Systems Framework for Sustainable Telehealth Services Samuel Wong Population Health and Workforce Research Manager
The problem with current telehealthCurrently, many telehealth initiatives areinfluenced by:• Isolated clinical needs that do not integrate well with existing funding models• Vendor marketed product or technology focused• Policy makers wanting a short term solution• Supporting evidence and outcomes not clear
The Healthcare Reality• Growing/Ageing populations and workforce• Higher demands of chronic and complex care patients, including use of new therapies• High societal expectations of health services• Workforce shortages across healthcare sectors• Increased cost of service delivery, cost of living & lifestyles• Year-on-year increases in demands for health services: across pre-hospital, primary, secondary (acute and electives) and community care without any increases in funding
Knowledge Systems managementKNOWLEDGE SYSTEMSFRAMEWORK
The Knowledge Systems TelehealthFrameworkKnowledge systems framework is designed from research of bestpractices and experiences to provide a holistic approach tomanaging key dependencies for telehealth services.The framework will work on selected groups which candemonstrate an effective improvement in service care oravoiding costly recurrent admissions, such as managing complexcare patients.
For example, Patient ProviderTele-monitoring Patient: empoweredSelf Care Effort: convenient to patient Cost maintenance: lowAssisted Health status Patient: supportedhome visits Effort: requires mutual co-ordination Cost maintenance: mildClinic Visits Patient: seeking therapy Effort: set appointments, travel/wait time Cost maintenance: moderateHospital Patient: Treated Effort: Highly inconvenienced Cost maintenance: high $ daily
The Knowledge Systems ApproachThe Tangibles The People and Processes• Monitoring & control • Clinical mandates infrastructure • Staff & qualifications• Hardware set up • Training processes• Reporting infrastructure • Clinical intelligence• Telecommunications • Technical support crew maintenance • Clinical pathways• Funding streams • Support integration• Transition pathways • Continuous improvement and quality
Current initiatives in the sectorCurrent projects aimed to reduce hospitalisations:• Integrated transition of care (Risk score from discharge)• POAC (primary options for acute care)• Extended hours (after hours access for patients)• 20,000 bed days reduction initiatives• Very High Intensity Users (VHIU) programmes
By ComparisonTelehealth: Another way to reducehospitalisation by greater shift towardspatient focused, well supported butindependent enabled self-care
The Interdepencies Monitoring Training Clinical and requirements mandate controlling infrastructure Community- based ground Staff and Telehealth qualifications provider mobile support (Primary Care) clinical staff Support (Primary Care) integration Patient Community General health co- Funding Practice ordinatiors or streams Team non-clinical Whanau/Families Telecommun- support ications (Primary Care) maintenance Hardware/ Reporting Software set Continuous infrastructure up improvement and quality
The Checklist Components Health informatics (Health ICT systems) are a key enabler for the framework
Considerations (of this framework) Infrastructure & People Patient types for managing unplanned Financial admissions Information Systems
Real-Life ExperiencesWHY PROPOSE THIS FRAMEWORK?
ProCare’s Experiences in TelehealthProCare’s HML services - 24/7 Nurse triage service with35 nurses, co-ordinators and support staff• Services 2.4 Million enrolled patients across NZ in 500+ General Practices• Provides after hours nurse triage service for Auckland Regional After Hours• Can be scaled up quickly and efficiently by 20+ ProCare clinical members (Pharmacists, GPs, Nurses, Paramedics) in the case of emergencies• Clinical notes can be linked with ProCare’s 860,000+ enrolled population including complex care patients• Day-to-day operations are telephone-based with video capability possible
The evidence – Case 1 – 2009 H1N1swine flu epidemic - NZ GP flu-line• Primary Care managed telehealth service• Telehealth model with two levels – Public Health Units to Health Services – Health Services to GPs (clinical support)• Operational for six weeks from June-July 2009• Covered all of New Zealand, handled 1130 GP flu enquiriesOutcome: Comprehensive primary care co-ordination andclinical networks across primary/secondary healthcarenationally for all influenza-like illnesses patients
The Evidence – Case 2 – CanterburyEarthquake 2011 Response• Primary Care managed – Three levels• Telehealth models: – Health Management to Health Management – Healthcare advice and services to patient – Health Service to ground team co-ordination Operational for four weeks from start of earthquake to Christchurch Memorial – 16,800 patient and provider calls handled Outcome: Establishing a real-time ICT interface of health service delivery status, healthcare informatics and regional clinical triage with ground team co-ordination
Theory PracticeWhat does this all mean?PRINCIPLES FOR APPLICATION OFTHE MODEL
Teleconsultations Monitoring Training Clinical and requirements mandate controlling infrastructure Staff and qualifications Patient Support integration Lead Clinician Supporting (Primary/ Clinician Secondary/ (Primary/ Community) Secondary/ Funding Community streams Telecommun- ications maintenance Hardware/ Reporting Software set Continuous infrastructure up improvement and quality
Teledermatology Monitoring Training Clinical and requirements mandate controlling infrastructure Staff and Patient qualifications Support integration Specialist provider General Funding Practice streams Team Telecommun- ications maintenance Hardware/ Reporting Software set Continuous infrastructure up improvement and quality
Telemonitoring Monitoring Training Clinical and requirements mandate controlling infrastructure Staff and qualifications Telehealth provider Support (Community/ integration Primary/ Secondary Care) Patient General Funding Practice streams Team Telecommun- ications maintenance Hardware/ Reporting Software set Continuous infrastructure up improvement and quality
Care co-ordination/Clinical networks Monitoring Training Clinical and requirements mandate controlling infrastructure Lead provider Health Service Staff and (Community/ Management qualifications Primary/ organisations Support Secondary Care) integration Patient General Funding Practice Secondary care streams Team services Telecommun- ications maintenance Hardware/ Reporting Software set Continuous infrastructure up improvement and quality
Telehealth Knowledge SystemsFrameworkUnderstanding and planning for the total cost of ownership prior to establishing telehealth services, that will enable sustainable services and value-adding capabilities to intended stakeholders.