Diabetes care supported by connected health
•Download as PPT, PDF•
2 likes•384 views
Using tools like personal health records, self-care for long-term conditions like diabetes can sustained, better supported and there are more opportunities to add value whilst reducing wastes.
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Diabetes care supported by connected health
Similar to Diabetes care supported by connected health (20)
Recently uploaded
Recently uploaded (20)
Diabetes care supported by connected health
- 2. Monday is T1SWAS clinic Everyday is T1SWAS Day Dr Pete Davies Janet Kinson Diabetes Centre, Sandwell Hospital, SWBH NHS Trust
- 3. What is this Tiswas you speak of… Bwian?
- 4. 2014: It’s time for Type 1 diabetes Outcome: Birth of T1SWAS, T1 SWBHT Advice & Support • 10+ years of transformation – “Right Care, Right Here” – Type 2 diabetes care closer to home • Helped to create time/space to develop type 1 diabetes care – BUT ask people with diabetes – ‘Voice of the customer’ • Planned continuous improvement methodology Survey autumn 2014
- 5. Cycle 1: Autumn 2014: Voice of the customer We asked PWD type 1: • What are their specific needs? • Which new elements could add value? • Which features must we retain? • Imagine… “no holds barred!” PWD type 1 told us: • Access needs improving – Greater flexibility in the timing and frequency of support – Faster access to support & advice • “Mind the gap” – Peer support – Emotional support – Psychological support • Tools that allow closer communication – Open to Skype, sms-support, secure messaging, etc. 36 online & 17 paper form responses analysed
- 6. Patients get to spend an average of three hours per year with a professional… …if they are lucky!
- 7. The average person with diabetes: spends three hours each year with a professional The remaining 8,757 hours, they care for themselves. 3 8,760 = 0.03 %
- 8. Spring 2015, T1SWAS launch: supported by PHR "Patients Know Best™" PlanPlan DoDoStudyStudy ActAct ““Voice of customer”Voice of customer” surveysurvey Improve accessImprove access Greater breadthGreater breadth Technology enabledTechnology enabled PKB “the vehicle”PKB “the vehicle” Carry out the planCarry out the plan Determine whatDetermine what changes need to bechanges need to be mademade What was learnedWhat was learned �
- 9. PHR/PKB at my Trust • Pricing model a barrier to extended use* • Behçet service Specialist Commissioning fund surplus used to add diabetes/endocrinology** 2013 2014 2015 2016 2017+…... Immunology* choose PKB Behçet service* join in, ££ Desire to scale- up PKB** Evidence of meaningful use Cerner Patient Portal: HealtheLife
- 10. Why use PKB? • Expediency! It was available • Someone else was paying! • Tried & tested • Rich variety of functions • Functions include – Secure messaging – Laboratory test result Integration – Care planning – Library for links & documents – Skype consultations integrated – Tracking of biomedical measurements… etc.
- 11. Implementing Patients Know Best • Each person invited face-face in consultation – 1 minute sign-up – PKB leaflets to take away, for the curious – Clinic letter sent by secure message within 3 business days • Team members trained & added, patient-by-patient PlanPlan DoDoStudyStudy ActAct ““Voice of customer”Voice of customer” surveysurvey Improve accessImprove access Greater breadthGreater breadth TechnologyTechnology enabledenabled Implement PKBImplement PKB Offer to PWDOffer to PWD Engage theEngage the teamteam trainingtraining DetermineDetermine what changeswhat changes need to beneed to be mademade What wasWhat was learnedlearned People with diabetes Diabetes nurses Dietitian Doctors Emotional support team Peer support team
- 12. Evaluation Sept 2015 •In use 5 months •~200 patients using PKB • 50:50 type 1 diabetes & endocrine •N = 30 (15% response rate)Numbersofpatients/HL7messagesexchanged Cycle 2 of continuous Improvement Evaluating PKB
- 13. Evaluation of PKB: September 2015 Use of PKB by people with type 1 diabetes: I do not own the record I feel I own the record
- 14. The potential that people with type 1 diabetes see for PKB
- 15. Evaluation of PKB: September 2015 Time & cost saving Impact of PKB as perceived by people with type 1 diabetes: Can help support a business case justification to adopt PHR
- 16. Impact of PKB on doctor/nurse-patient relationship perceived by people with type 1 diabetes Can help support a values-based justification to adopt PHR
- 17. People with diabetes said… “Using the messaging service put my mind at rest” “I received a reply much faster than I would have expected through more traditional means.” “It’s useful that correspondence is saved for me to look back over, so I can process the information at a pace that suits me” “PKB helped me to construct a more considered and detailed question than I would have managed verbally whilst feeling unwell and confused” “I feel safe in the knowledge that I have expert advice at the click of a button. Excellent.” “I like to use this PKB because I don't have to keep going to appointments and it saves me a lot of time” “PKB has enabled me to have discussions with my consultant and the team - for which I am incredibly grateful.” “I find it very reassuring that you are able to contact your consultant very quickly and resolve any concerns or fears you might have” “I think this is really useful when you are worried or concerned” “I have found PKB invaluable, I needed guidance with an issue & the doctor was able to help, advise and guide me through my treatment via the messaging service.”
- 18. Diabetes UK annual professional conference March 2016 Runner-up DUK Education and Self-care award
- 19. Further evaluation: February 2016 •In use 10 months •346 patients using PKB •New focus is • Value-added • PKBs capacity to eliminate ‘wastes’Numbersofpatients/HL7messagesexchanged Spring 2016: Cycle 3 of continuous Improvement
- 20. PKB use adds value & can eliminate ‘wastes’ Commonest wastes are ‘waiting for things’ & ‘duplication’ Greatly Improved Not changed
- 21. Add value such as •Great to have advice from my nurse, dietitian and consultant on hand in one place •Online processes are faster and more convenient •When I ask a question, I get a speedy response that puts my mind at rest •It shows me that the whole team is working together to solve my problem •Greater understanding of test results Eliminate waste such as •No more appointment reminder letters •Specialists and GPs no longer request same tests •I used to have to leave telephone messages and not know when my call will be returned any more •No more unnecessary clinic visits •My query used to be handled by several people before it got to my nurse, now it's immediate People with diabetes said…
- 22. Latest Use Statistics: >400 patients, >1100 HL7, >3000 secure messages
- 23. PKB Overall • Functions ++ • Ease of use & liked by patients • No need for training • Flexible modes of connection, e.g. sec. message/Skype • Achieved meaningful use • Potential to promote team working • Potential to work across whole system pathways • Not all find it easy • Disadvantages the ‘digital poor’? • LTC care+, but no good in episodic (acute) care • Use by professionals patchy • Lack of work credit & JP time • Sign-up task rests with senior nurses & docs • Poor analytics • Not integrated into workflow
- 24. Tools for diabetes #ConnectedHealth HbA1c Results to Patients+ https://vimeo.com/91089977 ‘Florence’ Simple Telehealth* http://bit.ly/1OtehBC Skype Consultations** https://youtu.be/e6JSVVtBkto Cerner Patient Portal*** http://bit.ly/24TpVKb 2013 2014 2015 2016 2017+…... ‘Florence’ Simple Telehealth* Skype Consultations** PHR with secure messaging, PKB Evidence of meaningful use Cerner Patient Portal*** HealtheLife 2011-12 HbA1c Results to Patients+
- 25. “Make like an electron” So… everyday can be a T1SWAS Day
- 26. Tools for diabetes #ConnectedHealth • Can help sustain supported LTC self-care • Can be deployed effectively • Offer great opportunities to add value to diabetes care • Break down traditional boundaries in care • Help build closer relationships between people with diabetes and their healthcare team “Healthcare is a relationship based on trust” Using #ConnectedHealth “at first it improves your relationship. Later on it improves the person’s health”
- 27. Thank you!
Editor's Notes
- The situation– Our organisation hs been working through major transformation helping to create care closer to home for over 10 years The move to support people with type two diabetes within primary care also had the effect of creating space and time to develop a specific type one diabetes service In autumn 2014 we engaged people with type 1 diabetes to try to design a service that could meet their wider needs using a survey and focus groups
- Throughout the process we asked people to Think widely about their needs, going beyond traditional boundaries to imagine what could best add value for them Feedback suggested we should concentrate on -making access to the specialist team faster and more flexible; -to address gaps in care especially Peer support and emotional and psychological support too. -There was a clear appetite amongst patients for technology enabled care, at that time our team was using Skype and simple telehealth.
- The service was launched around a year ago, badged as the “type one diabetes Sandwell and West Birmingham advice and support Service”, or T1SWAS for short We were fortunate, in that the trust was already using a well-regarded web-based patient health record called patients know best and wished to test out its capabilities on a larger scale. So PKB was the chosen vehicle to offer a variety of functions including -Secure messaging between patients and their diabetes team [unlike email, secure messaging offers patient context] -Sharing of laboratory blood test results -virtual consultations using Skype -the optional ability for patients to track BP, weight, steps & activity, as well as glucose readings etc.
- Patients were invited at the time of that consultation, it takes only one minute to sign up, if patients were unsure they could take away a leaflet & sign up later. PKB records was usually populated with the clinic letter, sent within three business days. Other team members came on board as patients under their care signed up to PKB. Using patients know best allowed us to readily extend the multidisciplinary team Beyond traditional boundaries to include colleagues working for Sandwell Esteem, who provide emotional and psychological support and who have also established successful peer support groups linked to our service
- After the service has been running for sometime we planned an evaluation by questionnaire. By this time 221 patients had signed up and were using patients know best, Half with type one diabetes, Half with endocrinology problems. 30 people completed the survey giving response rate of over 15%.
- Describe what the survey responses to tell us about use of PKB core functions Describe what the survey responses to tell us about potential for greater/ extended PKB use & functions
- Describe what the survey responses to tell us about impact of PKB core functions (especially on patience time and costs) Describe what the survey responses to tell us about potential impact for greater/ extended PKB use & functions (especially on patience time and costs)
- … just to highlight some of the feedback Information that can be processed in a more personalised way Ready access to expert advice Improved speed to resolve concerns and fears, time-saving In short, feedback that suggests the professional-patient relationship has been greatly enhanced
- From the feedback received, our next steps plan to focus on a Deeper dive into how we can make care more personalised to add value and eliminate wastes in care. We anticipate that that will lead to many changes to the structure and working practices in the outpatient clinic and the wider support to the T1SWAS Service
- The ‘electron’ of professional care is seen to be made up of many leptons- emotional support team, peer support mechanisms, etc. The electron can be where it needs to be, all because of connected health…
- In summary Mr Chairman, web-based personal health records are available Can be deployed across diabetes teams Can add greater value to diabetes care Can help breakdown traditional boundaries and extent the scope of the multidisciplinary team Have great value in building closer relationships between people with diabetes and their healthcare team This is one example of great potential of connected health–if you believe that healthcare is a relationship based on trust, using connected health tools you will find this quote is a truism: at first the relationship improves after which patient's health does too