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Ruth Chambers
- 1. Adopting technology enabled care services for delivery of care for people with LTCs Dr Ruth Chambers OBE, Clinical lead for WMAHSN LTC Network; GP; Chair, Stoke-on-Trent CCG
- 3. Care Providers –all settings Public Academia/ education Industry Shared care records LTC Network: new ways of delivery of care Commissioner s: applying intelligenc e
- 4. The Local Digital Roadmap (LDR) Challenge Delivering Sustainability & Transformation Plan (STP) priorities – Demonstrating dependency on data, information and technology – Return on Investment - mapping investment in technology to measurable benefits: health, finance Establishing real partnerships – Between NHS organisations – Between health sectors – Between NHS & other public sector bodies – With patients, carers and the 3rd sector – Industry (including large corporates and SMEs)
- 5. Emerging LDR Themes Infrastructure – Connectivity & bandwidth – Kit • Desktops (Windows XP!) • Mobile devices Rolling out national systems – SCR – ePS – e-Referrals Information sharing – Interoperability & interfaces – Information Governance User focus – Not just professionals! • Patients & carers Making sense of data – Analysis & visualisation
- 6. LTC pathway Patient – self care Evidence base Clinical team Data and measurement Technology Innovation Minimise duplication – shared care plan Workforce training/ upskilling Collaboration around a defined LTC priority – new ways of delivery of care
- 8. 5. Person selects and purchases own technology to support or improve their own health and/or social care and/or lifestyle habits: they may include goal setting, reminders, records of feelings/bodily measurements etc, action plans, information about best practice. They may or may not share their personal information/record keeping generated by the technology (eg health app) with a health/social care professional. 4. Shared delivery by individual professional with patient/carer: TECS initiated & delivered by health /social care professional who updates other health/social care professional(s) or teams involved in the patient’s care (ie giving information rather than interactive decision making between professionals). It might be that a patient requested the inclusion of their personal technology such as an app in their health or social care, that the initiating health/social care professional has adopted; with shared care plan agreed by patient, that optimises patient responsibility for their own care. 3. Shared multidisciplinary protocol with one TECS operator: ≥2 clinicians/ social workers, of different disciplines, in same organisation or setting; sharing (delegated) responsibility for providing TECS directly (≥1 mode of technology) for continuing care of same patient/≥ 1 conditions via agreed care plan. (This might be by the most senior/expert defining patient pathway and endorsing TECS protocol(s) for others to provide with real time support eg advice in person/by email; with shared care plan agreed by patient, that optimises patient responsibility for their own care.) 2. Shared sequential responsibility: ≥2 clinicians/ social workers, in different organisations/settings interface; so one hands over responsibility to the other for providing TECS directly (same mode of technology or different) for continuing care of same patient/same condition via agreed care plan.(This might be by the most senior/expert defining the patient pathway and endorsing the TECS protocol for others to provide with real time support eg advice in person/by email; with shared care plan agreed by patient, that optimises patient responsibility for their own care.) 1.Shared real time responsibility by ≥2 clinicians/ social workers, in different organisations/settings share TECS directly (same mode of technology or connected if different) for delivery of an agreed shared care plan of same patient/ same condition at same treatment phase (clinicians/ social workers have agreed responsibility via shared care plan agreed by patient, that optimises patient responsibility for their own care) Responsibility for delivery of integrated & connected care via technology enabled care services (TECS)
- 9. Stoke-on-Trent CCG Similar CCGs 10+1* (range) NHS England average TECS exemplar you can try 1 Hypertension prevalence1 0.61 0.57-0.63 0.56 Simple Telehealth Flo 2 Stroke & BP not <150/90mmHg1 10.7% 8.5%-10.7% 9.7% Simple Telehealth Flo 3 Asthma prevalence (all ages) 3 6.3% 6.0%-6.8% 5.9% Simple Telehealth Flo 4 Emergency children asthma admissions3 (per 100,000 resident population) 320.8 150.9-399.9 219.1 Simple Telehealth Flo, App, Social Media e.g. Facebook group 5 Emergency adult asthma admissions3 (per 1,000 practice population) 1.62 1.02-1.75 1.09 Skype, Simple Telehealth Flo, App 6 Inpatient spend (respiratory over 75+)2 (per 1,000 population) £221,581 £127,873-£233,569 £167,739 Simple Telehealth Flo, Skype, App 7 Inpatient spend (respiratory under 5s)2 (per 1,000 population) £85,910 £53,065-£85,910 £49,680 Simple Telehealth Flo , Skype 8 COPD QOF prevalence (all ages)3 2.4% 2.1%-3.2% 1.8% Simple Telehealth Flo 9 Emergency COPD admissions3 (per 1,000 practice population) 3.56 2.27-4.72 2.15 Simple Telehealth Flo, Skype, App 10 Excess weight (overweight or obese) in adults1 66.5% 60.2%-69.6% 63.8% Social media e.g. Facebook group, Simple Telehealth Flo 11 Diabetes control (<HbA1c 59)4 61.8% 57.6%-64.5% 59.6% App, Simple Telehealth Flo Sample CCG intelligence pack
- 12. Evolving a particular mode of technology –example Manage Your Health app • Person Driven Design • ‘Patient [Person] focussed apps’ start with people asking the questions • Validated by clinicians and presented in a simple style and language Our aims were to • Persuade not patronise • Motivate not monitor • Content localised to your region • Local support groups • Content that is regularly updated • Match changing guidance • Improve existing information • No personal data monitored or recorded
- 13. Manage Your Health • Available now on: • Uses text/images/videos and avatars to explain how to Manage Your Health • Downloadable and updatable information packs are available for • Asthma • COPD • Diabetes • Lower Back Pain In Development • ADHD • Hypertension & CKD • Atrial Fibrillation & Stroke • Cardiac rehabilitation
- 14. Improves access for patients Focuses appointments Reduces DNAs in hard to reach groups Encourages self care Can reduce admissions
- 15. Skype & remote care – V-Doc
- 16. How Simple Telehealth monitoring works Stage 1: User texts vital signs or self- assessment to Florence Stage 2: Florence compares data to set parameters and texts feedback/advice to user Practitioner can view data, alter parameters and message user
- 17. •Improved clinical outcomes •Quality/savings targets attained •Wealth creation eg patients stay in work •Upskilled patients & workforce •Patients stay independent Technology enabled care underpinning the STP- the future Patient populations Outcomes Current Practice NHS/social care Cluster NHS/social care Cluster NHS /social care Cluster Re-Design Technology enabled care under-pinning service re-design
- 18. Technology Enabled Care Services (TECS) – Local Digital Roadmap Delivering a connected vision raises critical issues: •How to deliver ‘real’ technical inter-operability across STP area? •Can we trust data provided by devices, wearable sensors and apps? •Can we balance privacy & confidentiality with sharing & openness? •How do we evaluate and assure the clinical validity and efficacy of TECS? •Can TECS truly deliver value for money –support QIPP/service redesign? •Are patients who need TECS able to use and access technologies? •What impact will utilising these technologies have on health and social care staff? •What are patients’ & citizens’ needs & preferences for TECS?
- 19. It’s about the basics – keep remembering!! Improving delivery of best practice care for long term conditions should focus on patient empowerment, integration & innovation 19 Best clinical practice & shared management Tech Improved QUALITY of clinical care
- 20. Map focus of evaluation to technology enabled service aims and stakeholder priorities Clinician s I’m stressed...will this ease my workload? Commissione rs Is this more for less? PATIENTS Is this going to be easy to use? Will it help?
- 21. Feedback from Flo telehealth patient Q – How have you been finding Flo? Is it helpful? A- I find Flo very helpful and I have found it to be very reassuring. Q – Do you find Flo easy to use? A- Very easy, it is very simple and to the point. Q – Do you feel any benefits from using Flo? A- I feel more confident, I feel stronger and I feel really good knowing that I can contact somebody at any time. It makes me feel calmer and more able to deal with my condition. Q- Who would you contact if you were feeling unwell, if you did not have Flo to text each day? A – I really not sure, it feels so reassuring to have a point of contact like Flo. I guess I wouldn’t contact anybody until the problem was so bad I’d more than likely be readmitted. Q – How likely would it be that you recommended Flo to another Heart Failure
- 22. Supporting people at home Enhanced support at home Manage Crisis Effectively Speciali st acute input Enhanced support at home Supporting People at Home Manage step down from acute effectively Crisis Acute Trf of care Home Home Support* Support Long term hypertension Smoking Cessation Long term vital signs monitoring Care Homes Pain Mment Medicines Management “Worried Well” INR Weight loss motivational messages Health self assessment Sexual health Unstable Hypertension Newly diagnosed hypertension Medication Reminders for: - Hypertension / Ashma inhaler / pain management Paediatric ashma COPD Diabetes (type1& 2) Heart Failure Palliative care carer support/wellbeing Falls prevention Virtual Wards Intermediate care Step down facilities Unstable vital signs monitoring Medication management As * Pregnancy induced hypertension Gestational diabetes COPD CHD Diabetes physiotherapy Monitoring of pre op patients to reduce cancelled operations Out patient acute specialist follow up DNA management Support early discharge EMAS unstable vital signs monitoring Oncology Neurology Speech therapy Alcohol support Learning disabilities Mental health behaviour Mental Health appt & medication reminders/ supportive messages Daily living/ medication reminders for people with Aspergers/autism Long term hypertension Smoking Cessation Long term vital signs monitoring Care Homes Pain Mment Medicines Management “Worried Well” INR Weight loss motivational messages Health self assessment Sexual health
- 23. How telehealth can support people Level 3: High Complexity Case Management Level 2: High risk Disease/Care Management Level 1: 70-80% of LTC population Self care support/management Low cost, large-scale: ‘Simple Telehealth’
- 24. Wider dissemination Case studies Academic literature Conference posters, presentations or workshops Education events or activities