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© 2007 Tunstall Group Ltd 1 Telehealth, its uses in COPD, the Sheffield experience Sue Thackray - Deputy Head of Development Nursing Sheffield Primary Care Trust Dawn Weston - Lead Development Nurse Respiratory Conditions Sheffield Primary Care Trust Mike Worden – Telehealth consultant
© 2007 Tunstall Group Ltd 2 Terminology Telehealth is an umbrella term used to describe the delivery of health related services and information via telecommunications technologies As simple as two health professionals discussing a case over the telephone, or as sophisticated as using satellite technology to broadcast a consultation between providers at facilities in two countries. 3 main types of telehealth technology –Store and forward telehealth (digital images, video, audio and clinical data are captured and stored) –Real time telehealth (telecommunications link between the involved parties allows a real-time interaction) –Remote Monitoring Telehealth (sensors are used to capture and transmit biometric data, real time or store and forward)
© 2007 Tunstall Group Ltd 3 Telehealth for Sheffield Focus: Tunstall telehealth technology focuses on consistent, reliable, and accurate remote monitoring of a patient’s vital signs through the use of simple easy to use equipment that professionals can customise to each patient, enabling day to day individual care according to need. The most popular (number of monitors in daily use) telehealth monitor in the UK and the World
© 2007 Tunstall Group Ltd 4 Sheffield design for telehealth Genesis monitors Patient homes Clinicians based in the Community Free phone telephone number Respiratory team Northern General
© 2007 Tunstall Group Ltd 5 Heart Rate Blood Pressure Weight Oxygen Saturation (Sp O2) Temperature Prothrombin time Peak flow (FEV-1) Electrocardiogram (ECG) Blood Glucose Customisable subjective questions most suitable to the individual in care i.e. Have you used your oxygen in the last 24 hours? A large number of vital signs can be remotely monitored
© 2007 Tunstall Group Ltd 6 Monitor Functionality Up to 4 programmed sessions per day for patients Any number of manual tests real time monitoring function Once prompted a patient has 30 minutes to engage the monitor giving the patient time to settle before collecting vitals Remote programming ability – flexibility to the patients routine Multi user ability Languages include: English, French, French Canadian, Spanish, Italian, German, Polish, Russian, Armenian, Portuguese, Hindi and Welsh
© 2007 Tunstall Group Ltd 7 Sheffield design for telehealth Genesis monitors Patient homes Clinicians based in the Community Free phone telephone number Respiratory team Northern General
© 2007 Tunstall Group Ltd 8 Triage software
© 2007 Tunstall Group Ltd 9 Full patient history
© 2007 Tunstall Group Ltd 10 1 to 90 day graphic and tabular trend Reports Fax, email, print to clinical staff
© 2007 Tunstall Group Ltd 11 Liase with clinical staff and distribute relevant data 2 Agree SLA’s and key stakeholders 1 Discharge patient remove equipment and clean 2 Define policy and procedure 1 Trouble shoot 2 Patient recruitment, Referral process & consent 2 Admit patient 2 Home assessment & installs 2 Daily triage,notifying staff of medical exceptions 2 Define roles & responsibilities 1 Project Cycle Primary Care Secondary care Social Services/monitoring centre Carers Evaluation 1 & 2 Review & options for mainstream 1 Key 1 = telehealth steering group responsibilities 2 = implementation group responsibilities
© 2007 Tunstall Group Ltd 12 COPD and telehealth - Service Redesign Shift in focus to Primary Care - a Transition from ‘hospital care’ to ‘out-of-hospital care’ –Bringing care closer to home –Delivering more services in the community and specifically moving them out of hospital –Innovation and potentially promoting a new service for PBC –Increasing diversity of Primary Care provision –Potential to better manage a patients condition from home Admission avoidance –Frequent flyers –Re-admissions & admission prevention –Supported early discharge –Promoting self-care –Efficiency gains D39, Chronic Obstructive Pulmonary Disease or Bronchitis w cc (with complication) £2360 per episode D40, Chronic Obstructive Pulmonary Disease or Bronchitis w/o cc (without complication) £1752 per episode Opportunity to Unbundle PbR tariff –The service supports directly the Government agenda to unbundle the Payment by Results (PbR) Tariff
© 2007 Tunstall Group Ltd 13 Frees up hospital beds 18 weeks target Closer management of chronic disease Prevent Emergency Admissions Patient at home where they prefer to be COST AVOIDANCE Reassurance and confidence INDEPENDENCE & DIGNITY DISEASE & CASE MANAGEMENT! Quick intervention if condition deteriorates Opportunity to unbundle PbR tariff Reduce total referrals into the Acute Sector Earlier diagnosis and treatment Choice and control Reduce risk of MRSA and Clostridium difficile (c-diff) Maximise efficient use of the primary care budget
© 2007 Tunstall Group Ltd 14 What will make a pilot a success? n Innovative PBC Group & PCT n Pioneering approach to LTC management n Partnership approach across all Healthcare professionals n Drive, determination, focus and commitment to make it happen n Enthusiasm from all n Patients come “First” n About patient centred care and not the equipment
© 2007 Tunstall Group Ltd 15 Objectives for the presentation Where are we now – Innovation in practice How we got there – Sharing experience Where are we going – The future
© 2007 Tunstall Group Ltd 16 Introduction - the Sheffield focus Here to day to discuss our pilot of telehealth and how it has become part of our innovative working practice in COPD Sheffield Focus -Industrial legacy -High prevalence of COPD 3% overall - key target areas 6 –7% -Annual rate of COPD unscheduled care admissions 2,000 -Average unscheduled care admissions for COPD 166 per month Recent developments to build a network of respiratory knowledge in the community to create accessible and responsive services Delivery of care through segmented targeted approach Evidence based care
© 2007 Tunstall Group Ltd 17 COPD Unscheduled care admissions to secondary care Source Sheffield PCT 2007
© 2007 Tunstall Group Ltd 18 What we found in our pilot of telehealth Sheffield PCT ran a 6 month pilot of telehealth: –Completed Mar 07 –Key findings published in HSJ (online) –80% reduction in home visiting –50% of patients would have been readmitted without the support provided by remote monitoring – telehealth = Significant cost savings
© 2007 Tunstall Group Ltd 19 Where are we now – innovation in practice Partnership working between Sheffield Primary Care Respiratory Team and the Northern General Hospital NHS Trust Sheffield COPD team Led by Sheffield Primary Care Public Health Directorate Nurse led Developing roles across communities of practice district nurses, new respiratory community nurses – hospital and home
© 2007 Tunstall Group Ltd 20 Key benefits we found to the organisation Reduction in unscheduled care admissions to STH Reduction in number of home visits Early identification of patients at risk of hospital admission Reduction in travel costs per month Prioritisation of clinicians work schedules System can be used across hospital and community interface Ability for early diagnosis – e.g. hypoxia, rapid heart failure access into support services – e.g. hypoxia patients for oxygen assessment
© 2007 Tunstall Group Ltd 21 Benefits to the patient Choice for the patient hospital or home Tool for self care – Expert patient Reduction in anxiety and increase in confidence for the patient and carer’s – unexpected benefits! Well received by patients No cost for the patient
© 2007 Tunstall Group Ltd 22 What did we learn Easy to use and install Increase job satisfaction, reduced stress levels Confidence growing in remote monitoring Developing triage skills Over coming barriers to change More confidence in dealing with the more complex patient
© 2007 Tunstall Group Ltd 23 How we implemented and developed telehealth Initial trial –pilot of the technology –How it worked for us locally –Identified our target area of patients –Clear patient selection criteria –Identified champion clinicians –Developed strong clinical commitment –Started small to grow big Clear plan of where we wanted to go with telehealth –Integration into community COPD pathway –Demonstrate cost benefits –Strong relationships between primary and Secondary care Competence frameworks –Official training to support the use of the technology, some staff initially hesitant
© 2007 Tunstall Group Ltd 24 Fully integrated into the community Monitoring as integral part of the COPD care pathway Implemented across all long term conditions Communication with GP practices and other systems e.g. System one (TPP), out of hour services Evaluation via Sheffield University and Sheffield PCT commencing December 2007 key pilot evaluation to support a larger RCT research study The Future The future
© 2007 Tunstall Group Ltd 25 The Sheffield Team Ruth Marrison Sheffield Teaching Hospitals COPD Co-ordinator Cheryl Oates COPD Nurse Specialist COPD Team Sheffield Teaching Hospitals Rosemary Lawson Head of Service Redesign Formerly Sheffield PCT Dawn Weston Lead Development Nurse Respiratory Care Sheffield PCT Sue Thackray Deputy Head of Development Nursing Sheffield PCT Lis Reid Head of Developmental Nursing Sheffield PCT Nicky Kenyon Head of Clinical Care Pathways Sheffield PCT IT Departments Sheffield Teaching Hospitals & Sheffield PCT John Skinner Audit and Evaluation Department Sheffield PCT Mike Worden Telehealth Consultant Tunstall
© 2007 Tunstall Group Ltd 26 “The definition of insanity is doing the same thing over and over again and expecting a different result.” ~ Albert EinsteinAlbert Einstein
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