David international telehealth case studies

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David international telehealth case studies

  1. 1. International Telehealth Case Studies… and what we’ve learned from them. David Chang Tunstall Healthcare Feb. 2010 1
  2. 2. Tunstall Healthcare Group at a glance • World’s leading telecare and telehealth provider • Global company headquartered in the UK • Operating since 1957, celebrated 50 years anniversary in 2007. • Full suite of telecare and telehealth solutions and systems including integration of hardware, software, service, support and 24/7 personal response • Operates in over 30 countries worldwide. • 4.8m users around the world, of which Tunstall has 2.5m (more than 52% market share) • 1,150 employees worldwide • 5% of revenue invested in R&D pa © 2009 Tunstall Healthcare 2
  3. 3. The Continua Health Alliance • Tunstall is a founding member • 200 member companies • Global standards • Interoperability focus • Collaborative product development © 2009 Tunstall Healthcare 3
  4. 4. Telehealth definition • Telehealth is the remote monitoring of patient vital signs by a clinician, nurse or doctor • Enables the collection and transmission of a patients’ vital signs to a clinical information system • Health care provider can review data to make informed decisions • Serves as communicator between the care provider and the patient • Assists the patient in their own healthcare management © 2009 Tunstall Healthcare 4
  5. 5. Telehealth versus Telecare Intel Health Guide or RTX solution Complex case management Complex intensive care case management and Increasing capacity Chronic Disease/Condition Genesis or RTX Solution: Management Single condition, usually less complex case management, can be both a step Beneficiaries of down or step up approach to telehealth telehealth technology monitoring for patients Telecare Solutions: Prevention, Self-Care & Broader implementation criteria, larger self management and scale patient usage. supported self care community care and condition engagement. Ideal for broadening the pyramid base and preventing escalation up the pyramid Self Care Professional care © 2009 Tunstall Healthcare 5
  6. 6. How telehealth monitoring works Data transmitted to Telehealth Patient Providing Management clinical reports System to health professionals Exceeded limits send an alert and agreed protocol put into action Patient measures vital signs at home © 2009 Tunstall Healthcare 6
  7. 7. Vital signs which can be monitored Vital sign devices: Other functions: • Blood pressure • Disease specific Intelligent health • Pulse questions • Weight • Patient reminders • Blood oxygen saturation • Self care advice • Blood Glucose • Medication prompts • PT/INR (Blood clotting) • Temperature • Spirometry / Peak flow • ECG © 2009 Tunstall Healthcare 7
  8. 8. Telehealth suitability • Suitable for: • Require assistance: – CHF – Patients with cognitive – Hypertension impairments such as – dementia, – Stroke cerebral palsy, downs syndrome, – Other vascular disease schizophrenia – Kidney disease – High anxiety levels – COPD – Technical phobias – Asthma – Some physical disabilities – Diabetes – Parkinson's disease – Post hospitalization support and – Rheumatoid arthritis monitoring – Multiple sclerosis – Cancer support, post cancer – Children treatment monitoring Consider your patient’s needs, their skills and abilities before prescribing Telehealth © 2009 Tunstall Healthcare 8
  9. 9. Telehealth drivers… growing prevalence of long-term conditions Chronic Health Conditions • Globally over 860M people with a chronic disease* • 75-85% of healthcare expenditure is related to chronic disease* • 40% of people over 65 have a chronic disease, set to double over 10 yrs • Without action, an estimated 388M people will die from chronic diseases in the next 10 years Telehealth solutions support both social care and healthcare needs 2003 WHO report, FT 4th August 2006 Ldam.org * World Health Organisation © 2009 Tunstall Healthcare 9
  10. 10. Tunstall UK Telehealth over 60 projects • Sheffield PCT (COPD) • Quality Healthcare at Home • Camden PCT (COPD) • Housing 21 • Leeds PCT (COPD) • Milton Keynes Community Alarm Centre • Weavervale Housing Trust (MC/CM/DN) • Knowsley County Council • Nottingham City PCT (CM) • Blackpool Care Line (CM/DN) • Carlisle (S21) • Greenwich Care Line (COPD) • Wolverhampton (HF) • Ulster Community Hospital (Diabetes) • Wirral (CHF) • South Gloucestershire PCT (CHF) • Torfaen LHB (COPD) • Swindon PCT (COPD) • Pembrokeshire LHB (LTC) • Rotherham PCT (COPD/CHF) • Northumberland PCT (COPD) • ChesterCare Alarm Centre • Wandsworth PCT (HF) • Guildford Council (S21) • Doncaster PCT (COPD) • West Lothian Council • Hull PCT (CHF) • Medway PCT • Newport Monitoring Centre • Northern Health Board- NI • East Riding County Council • Western Health Board – NI • Denbighshire Health Board • Southern Health Board – NI • Conway health board • Fold Housing Association • Birmingham North and East PCT • South West Essex PCT (COPD) • Conway LHB • Gloucestershire PCT • Northamptonshire PCT © 2009 Tunstall Healthcare 10 • Bexley County Council
  11. 11. COPD Case study: Sheffield PCT THE CHALLENGE • Sheffield’s local population has a high prevalence of COPD • Three times higher than the national average • 2,000 COPD related hospital admissions a year THE SOLUTION Telehealth units were rolled out to 30 high-risk patients for a duration of five months. © 2009 Tunstall Healthcare 11
  12. 12. COPD Case Study: Sheffield Outcomes THE OUTCOME • COPD hospital admissions decreased by 50%. • Saved £30,000 to £40,000, • PCT could then justify to purchase 15 more monitors. • Based on a cost of £2,000 per admission; – by reducing 50 admissions a month – PCT savings equate to £1,200,000 per year. • Home visits were reduced by 80%, – cutting travel costs and – allowing healthcare staff to prioritise their workload – increasing productivity and case management © 2009 Tunstall Healthcare 12
  13. 13. COPD Case Study: Sheffield Outcomes • For patients – Increase in patient confidence and ability to cope – Enhanced understanding of condition – Reduced anxiety and increase in security and peace of mind • For the PCT – Reduction in demand on unscheduled care – Reduction in admissions to hospital – Reduction in demand on primary care – Increase in capacity for case managers © 2009 Tunstall Healthcare 13
  14. 14. Mainstreaming Case Study: Nottingham PCT • Initial telehealth pilot 9 months • Reductions seen in : – Hospital admissions and Emergency Department presenations – GP Events – Community Matron visits • Post pilot evaluation determined way forward for mainstreaming telehealth © 2009 Tunstall Healthcare 14
  15. 15. Mainstreaming Case Study: Nottingham PCT • 2009 implemented mainstream Telecare and Telehealth program • 300 telehealth monitors measuring: – COPD – CHF – Diabetes • Phased implementation plan over 12 months – 2/3rd Long term monitoring – 1/3rd short term monitoring (800 patients per year) • Multi-user monitors based in wards and also in a local prison • Commissioning targets for telehealth referrals • University evaluation © 2009 Tunstall Healthcare 15
  16. 16. CHF Case Study: Orchard Medical Centre Background • Medical Centre based in Bristol • Services 13,500 patients • 100 patients with CHF Pilot telehealth Program • Commenced 2007 • 7 telehealth units • Focus on CHF patients particularly those discharging from hospital • Joint venture with NHS South Gloucestershire and South Gloucestershire Council community care & housing department and Takeda UK Ltd © 2009 Tunstall Healthcare 16
  17. 17. CHF Case Study: Orchard Medical Centre Summary Results • Patients & clinicians found system easy to use • Medication changes and monitoring easier • Medication compliance increased • Trends noticed more easily • Early intervention facilitated • Patients have increased confidence in managing condition • Patients reported increased reassurance and quality of life • Hospital admissions appear to have decreased from some patients • Full evaluation is pending © 2009 Tunstall Healthcare 17
  18. 18. User Case Study: Orchard Medical Centre • Patient Name: Margaret • Age: 60 years • Condition: CHF • Issues: Medication non-compliance, frequent presentations to A&E • Results: Improved medication compliance, no admissions for 18 months “The equipment has made me more positive, it reduces anxiety, and therefore I need less doctor and hospital visits. I would feel lost with out it now.” © 2009 Tunstall Healthcare 18
  19. 19. Australian statistics • 77% of Australians have a long term condition* • 71,000 people are severely disabled by bronchitis/emphysema • 3.7M people have cardiovascular disease+ • An estimated 106,000 new cases of cancer are diagnosed each year** • 11.3% of all deaths in Australia are due to, or associated with, kidney failure^ • Over 850,000 Australians have been diagnosed with diabetes. The same number again may have it but not know it.^^ *ABS 2006, + AIHW 2004-2005 Key facts about cardiovascular disease in Australia, ** Cancer Council Australia, ^Kidney Health Australia, ^^Diabetes Australia © 2009 Tunstall Healthcare 19
  20. 20. Tunstall’s first Australian Telehealth project • Operated by Ipswich Community Aid (ICA) • Aim is to investigate the effects and benefits of daily monitoring on individual’s with chronic disease • Each participant using the system for a period relevant to their condition and needs • The project will focus on four different patient groups: 1. Cardiac, 2. Respiratory, 3. Endocrine, 4. Other • Project commenced 4th Feb • Project length 18 months • For more information contact Erik Jansink at Ipswich Community Aid (icaiinc@bigpond.net.au) • www.tlcproject.com.au © 2009 Tunstall Healthcare 20
  21. 21. Remote Area Monitoring in Tasmania • Central Highlands Health • Services a wild and remote region of Tasmania • 1 patient over 3 hours driving distance from nearest clinic • Identified 5 patients with chronic conditions who regularly present to Hobart Hospital • Implemented a telehealth program to support remote living patients • Primary aim is to reduce presentations to hospital • Secondary aim: proactive management and improvement of patients condition © 2009 Tunstall Healthcare 21
  22. 22. Transition Care Pilot • Federal government funded pilot • Community care provider: Baptist Community Care • Evaluation by: Southern Cross University • Pilot objective: to evaluate the use of telecare and/or telehealth within a transition care program (hospital to the home) • Length of pilot: 12 months + 6 months evaluation • 80 places, on a 10-12 week transition care program • In total over 200 participants located in Western Sydney and country areas © 2009 Tunstall Healthcare 22
  23. 23. Transition Care Pilot - Participants • Randomized control study with five groups: 1. Control group 2. Group with Telehealth for duration of transition care intervention (12 weeks) 3. Group with Telehealth for duration of transition care intervention and an additional 12 weeks of monitoring 4. Group with Telehealth and Telecare for duration of transition care intervention 5. Group with Telehealth and Telecare for duration of transition care intervention with an additional 12 weeks of monitoring © 2009 Tunstall Healthcare 23
  24. 24. Transition Care Pilot - Evaluation • Four principle sources of research data 1. Service entry data about the participants including demographics and clinical indicators. 2. Pre- and post-service survey using the Depression, Anxiety, Stress Scale (DASS) 3. The BCS Data Monitoring Centre 4. Pre- and post-service survey to identify existing patterns of service usage, such as GP usage, HACC services, hospitalisation © 2009 Tunstall Healthcare 24
  25. 25. How to setup a Telehealth program 1. Establish goals and outcomes 2. Identify how Telehealth can integrate in to your organisation 3. Review available Telehealth systems 4. Identify a funding source 5. Develop a business proposal including an outline of a project plan 6. Setup a project team © 2009 Tunstall Healthcare 25
  26. 26. Developing a Telehealth program budget Consider and identify costs: • Human resources • Equipment • Software • Telecommunications • Training • Research • Contingency © 2009 Tunstall Healthcare 26
  27. 27. Telehealth pilot’s are all about collaboration Sponsor Patient Healthcare Tunstall provider © 2009 Tunstall Healthcare 27
  28. 28. Pilot Programme Sponsor’s Role • Project sponsor and direction • Pilot funding • Defining outcomes/KPIs • Ethics approval • Evaluation of pilot • Contract development with healthcare provide • Member of project steering committee © 2009 Tunstall Healthcare 28
  29. 29. Pilot Programme Healthcare Provider’s role • Project Management • Patient assessment and eligibility for pilot • Develop patient care plans • Telehealth monitoring • Equipment installation • Patient training • Second level training of care professionals • Equipment maintenance and infection control • First level technical support • Program reporting © 2009 Tunstall Healthcare 29
  30. 30. Pilot Programme Tunstall’s Role (Supplier) • Project Management Support • Source and supply Telehealth equipment • Set up patient management database • Establish data communications • Provide a train the trainer program: – software – equipment – installation – maintenance – support materials • Help desk technical support © 2009 Tunstall Healthcare 30
  31. 31. Pilot programme implementation planning • Experienced project manager to be appointed and steering committee formed • Scope, objectives and deliverables defined and agreed • Project plan developed • Stakeholder engagement • Risk management plan • Staged implementation approach: – Pre implementation planning – Commencement – Testing – Full Implementation roll out – Program completion – Evaluation © 2009 Tunstall Healthcare 31
  32. 32. Pilot programme expected outcomes 1. Reduced care costs • Less hospital admissions and reduced time in hospital • Less use of ambulance service • Reduced travel costs for community carers 2. Efficient utilisation of human resources • Deliver more effective care to more people 3. Increased participation of the patient, family and carers in their own health care • Improved medication compliance • Increased sense of involvement and responsibility • Reduced episodes © 2009 Tunstall Healthcare 32
  33. 33. Characteristics of Good Telehealth Projects • Communication bringing social care and health together • Forward thinking clinicians - willing to try new approaches to care – service redesign • Clinicians who allow patients who are borderline to participate • Well designed policy, procedure and care pathways – But don’t reinvent the wheel! • Senior management support with clear telehealth vision and operational support • Key partnerships with all stakeholders (multi partnership working) i.e. IT, GP’s, Consultants, Community based staff, Social Services etc • Focus on training and support for telehealth projects – 10% Technology – 90% people The equipment is only as good as the individuals that are using it! © 2009 Tunstall Healthcare 33
  34. 34. Way Forward • Form your Steering Committee • Start with ‘clear objectives’ – Patient centric – Clinical outcomes – Economical benefits – Social welfare benefits • Planning and preparation is essential • Buy-in from all stakeholders • Proven technology – including robust equipment and reliable software • Start out small 30-50 then scale up • At least 12 months of data is required • Measureable outcomes with quantifiable and qualitative data © 2009 Tunstall Healthcare 34
  35. 35. Why? Provide a foundation to effect support and funding for large scale implementation Move healthcare systems from: Find and Fix to Predict and Prevent © 2009 Tunstall Healthcare 35
  36. 36. For more information: Taiwan: www.tunstall.com.tw/home UK::www.tunstall.co.uk/ AU: www.tunstallhealthcare.com.au. LEGAL NOTICE: The information contained in this document is PROPRIETARY and CONFIDENTIAL to Tunstall Australasia Pty Ltd and has been developed by Tunstall solely for the purposes set forth herein. By accepting this document, the recipient agrees to keep confidential the information contained herein. This document is being generated solely as a basis to obtain information and facilitate further discussions, and is not binding on Tunstall in any way. No representations are made as to the accuracy and completeness of this Information. The requirements and specifications are subject to change in Tunstall’s sole discretion. Nothing contained herein shall be construed as granting any license or right to use any of the information contained herein for any purpose other than for the purposes set forth herein. Distribution or reproduction of this document or the information that it contains in its entirety or any portion hereof, by any means, electronic, mechanical, or otherwise, for any use or purpose not expressly permitted by Tunstall is strictly prohibited. © 2009 Tunstall Healthcare 36

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