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The Role of Telehealth in Emerging Models of Care


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Ross McKenna
Portfolio Manager, Health System Infrastructure
Information Strategy and Architecture
National Health Board Business Unit
Ministry of Health

Published in: Health & Medicine
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The Role of Telehealth in Emerging Models of Care

  1. 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. 2. Telehealth - Emerging models of care…. PSYCHIATRIC HELP 5c MODERN METHODS
  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 </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. 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 </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 ( </li></ul></ul></ul>
  14. 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. 15. QUESTIONS? Web references Presentations from the supported self management seminars held in June 2009: 2007 Synergia Self Care Literature Review Link to Genetic and Bioinformatics resources: NZ Government Broadband Initiatives – MED site