Alex Tarling User experience consultant:  [email_address] WCIT 2010 The Lothian Telehealth Trial RESEARCHERS: JENNY URE, G...
Lothian Telehealth Trial <ul><li>What is Telehealth? </li></ul><ul><ul><li>‘ Telemetric supported self-monitoring of long-...
Lothian Telehealth Trial <ul><li>‘ TeleScot’ program: 4  Randomised  Controlled Trials for Telehealth covering Chronic Obs...
The Telehealth Context of Care $10,000 $1,000 $100 $10 $1 Quality of Life Cost of Care / Day Independent, Healthy Living C...
Workflow model for the COPD trial Patient and family at home Physiotherapy team contacts patient: videoconference or home ...
Patients complete daily ‘health sessions’: <ul><li>Symptom questionnaire with 8 questions: </li></ul><ul><ul><li>“ I am mo...
Evaluation focus on the patient and clinician experience <ul><li>Usability, acceptability and desirability of the system :...
Patient experience findings… <ul><li>Patients overwhelmingly positive about their experiences: </li></ul><ul><ul><li>“ I’v...
Clinical outcomes from the first phase of the trial <ul><li>Perception of a moderate increase in clinical workload in prim...
Second phase delivered by the Community Respiratory Team: <ul><li>Community focus: delivering a service into patients home...
In summary <ul><li>What we have seen in the Lothian trial: </li></ul><ul><ul><li>Patients like Telehealth! </li></ul></ul>...
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Evaluation of patient and clinician experience in the Lothian Telehealth trial.

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Evaluation of patient and clinician experience in the Lothian Telehealth trial. Presentation delivered at the World Congress for IT conference, Amsterdam, June 2010.

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  • PHS 30/30/30 Presentation for US RSLT-A-0312, Rev 1.0 Approval Candidate Effective: Pending Approval of 55 On the Continuum of Care, people want to stay at home as long as possible. The home typically provides the highest quality of life, and the lowest cost of care. This chart represents the continuum of care expressed in dollars versus quality of life. The bottom right quadrant of the graph represents the acute care setting. Patient is in the hospital or a specialty clinic. The cost of that care is very high. New models of care are focusing on “staying left” or “shifting left” to the upper left quadrant of the graph. We all can agree that everyone would prefer to “Stay Left” on this chart. Not only is it better for people, but it also reduces the cost of care. Anything that care givers can do to help patients “shift left” not only improves the patient’s quality of life, but also reduces the cost of care.
  • The first phase of the trial delivered a service using a monitoring centre to perform an initial triage on patients readings every day. Community focus: delivering services in patients homes
  • From the patients perspective – this is quite different to other changes in clinical practice – this is technology and equipment that goes into the home It requires a different level of acceptance, particularly where you want to achieve long-term use. There are also impact for the patients families – what is like to live with this stuff in your home? Importance of this approach is that it allows you to explore and identify changes and challenges to working practice You have then the potential to support innovation in service design from a ‘bottom-up’ perspective – that of the front-line clinician
  • So there is a shift in the balance of how care is delivered.
  • Deploying mobile working tech alongside telehealth. Ground-up innovation! Patient empowerment and self-management are often cited as one of the opportunities of Tele-health. The team is a strong educational role helping patients self-manage their conditions
  • workload in primary care is not reduced by the systems but it may reduce workload in secondary care
  • Evaluation of patient and clinician experience in the Lothian Telehealth trial.

    1. 1. Alex Tarling User experience consultant: [email_address] WCIT 2010 The Lothian Telehealth Trial RESEARCHERS: JENNY URE, GILLIAN KYDD, ALEX TARLING LEAD INVESTIGATORS: BRIAN MCKINSTRY, JANET HANLEY, CLAUDIA PAGLIARI, HILARY PINNOCK, AZIZ SHEIKH, WILLIAM MACNEE UNIVERSITY OF EDINBURGH E-HEALTH RESEARCH GROUP INTRODUCTION 15 MINUTES
    2. 2. Lothian Telehealth Trial <ul><li>What is Telehealth? </li></ul><ul><ul><li>‘ Telemetric supported self-monitoring of long-term conditions’ (as applied by the TeleScot programme). </li></ul></ul><ul><ul><li>In other words… patients have a technology solution at home that supports them in monitoring their health status, and shares data with their clinicians. </li></ul></ul>
    3. 3. Lothian Telehealth Trial <ul><li>‘ TeleScot’ program: 4 Randomised Controlled Trials for Telehealth covering Chronic Obstructive Pulmonary Disease (COPD), Hypertension, Stroke/High Blood Pressure, Diabetes, plus a pilot trial for Congestive Heart Failure (CHF). </li></ul><ul><li>COPD project explores whether Telehealth monitoring affects hospital admissions or quality of life for people with moderate or severe COPD. </li></ul><ul><li>120 Telehealth units deployed to date in the COPD and CHF projects, and growing: </li></ul><ul><ul><li>74 COPD patients (working towards 300 participants, 150 to have Telehealth equipment). </li></ul></ul><ul><ul><li>46 CHF patients. </li></ul></ul>
    4. 4. The Telehealth Context of Care $10,000 $1,000 $100 $10 $1 Quality of Life Cost of Care / Day Independent, Healthy Living Community Clinic Chronic Disease Management Doctor’s Office Home Care Assisted Living Skilled Nursing Facility Residential Care Specialty Clinic Community Hospital Emergency Department Acute Care ICU
    5. 5. Workflow model for the COPD trial Patient and family at home Physiotherapy team contacts patient: videoconference or home visit as appropriate Patient’s daily readings and symptom scores sent to remote server Daily monitoring provided directly by Community Respiratory Team 1 3 2 E-Health Support Technical support issues Technical support issues Community Respiratory Physiotherapist
    6. 6. Patients complete daily ‘health sessions’: <ul><li>Symptom questionnaire with 8 questions: </li></ul><ul><ul><li>“ I am more breathless than usual” </li></ul></ul><ul><ul><li>“ My sputum has increased in colour” </li></ul></ul><ul><ul><li>“ My sputum has increased in amount”, etc </li></ul></ul><ul><ul><li>Answers are scored, scores above certain threshold trigger a clinical response </li></ul></ul><ul><li>Physiological measures on a daily/weekly basis or as needed: </li></ul><ul><ul><li>Pulse Oximeter (Pulse, SpO2), Peak Flow Meter (FEV1), Weight Scales. </li></ul></ul>Intel ® Health Guide Vital signs Peripherals
    7. 7. Evaluation focus on the patient and clinician experience <ul><li>Usability, acceptability and desirability of the system : </li></ul><ul><ul><li>For patients and their families, friends, carers and visitors - what does it mean to live with this technology in the home? </li></ul></ul><ul><ul><li>Initial perceptions and early adoption experiences. Ongoing motivation and compliance. </li></ul></ul><ul><ul><li>For care professionals: challenges to work practice, relationship with patients, and with other clinicians. </li></ul></ul>
    8. 8. Patient experience findings… <ul><li>Patients overwhelmingly positive about their experiences: </li></ul><ul><ul><li>“ I’ve never felt so well looked after in my life, I think it’s a godsend like.” (patient) </li></ul></ul><ul><ul><li>“ You've no idea the sense of security … this is a hundred per cent right for me.” (patient) </li></ul></ul><ul><ul><li>“ That machine can tell Alec he’s ill even before he knows it himself.” (spouse of patient) </li></ul></ul><ul><li>Initial learning experiences very smooth for most patients. </li></ul><ul><ul><li>Patients found the equipment easy to use, accomplishing daily care plans quickly and consistently from day 1. </li></ul></ul><ul><li>Extremely high rates of compliance, maintained over time: </li></ul><ul><ul><li>Overall utilisation = 89%, compliance with care plans = 99% </li></ul></ul>
    9. 9. Clinical outcomes from the first phase of the trial <ul><li>Perception of a moderate increase in clinical workload in primary care: </li></ul><ul><ul><li>Large increase in patient contacts, but mostly by phone </li></ul></ul><ul><ul><li>Doubling of prescriptions of antibiotics. </li></ul></ul><ul><ul><li>Doubling of the number of times the record is opened. </li></ul></ul><ul><ul><li>However, this probably reflects previously undiagnosed exacerbations. </li></ul></ul><ul><li>Hospital admission rates were perceived as lower and more appropriate than before, and GPs also perceived the quality of care, and the rate of deterioration as slower in these patients. </li></ul><ul><ul><li>“ Mr. B. was admitted to hospital 3 times in the 12 months prior to starting with us on home tele-monitoring. Since then he hasn’t had a single admission, not even through the winter months. ” </li></ul></ul>
    10. 10. Second phase delivered by the Community Respiratory Team: <ul><li>Community focus: delivering a service into patients homes. </li></ul><ul><li>Building on Telehealth and mobile working to innovate new work practice: </li></ul><ul><ul><li>“ By using telehealth with our patients we have more time to see the acutely unwell patients. Those routine visits, those follow-ups you do ‘just in case’, aren’t required.” </li></ul></ul><ul><ul><li>“ I used to see 8 or 9 patients a day at home; with telehealth I can monitor and see up to 35 patients on a good day.” </li></ul></ul><ul><li>Supporting patient self-management : </li></ul><ul><ul><li>“ Using telehealth encourages patients to accept responsibility for their condition. They are more aware of their symptoms and because of that, they participate in anticipatory care more effectively.” </li></ul></ul>
    11. 11. In summary <ul><li>What we have seen in the Lothian trial: </li></ul><ul><ul><li>Patients like Telehealth! </li></ul></ul><ul><ul><li>Telehealth systems encourages evidence based practice and quality care (although may not save time/resources in primary care). </li></ul></ul><ul><ul><li>Frontline clinical professionals incorporating Telehealth into their workflow, targeting resources and care more effectively to their acutely unwell patients. </li></ul></ul>

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