Where can Technology Add Value in the Delivery of Cardiac Services Anne Reoch Clinical Lead Cardiac & Stroke NoSPG 25 September 2012

2 NHS 24 is: A statutory national NHS Health Board Provider of national Telehealth services to the population of Scotland SCT - Telehealth merged 2010 JIT - Telecare merged 2011

Definitions? (Telehealth, Telemedicine, Telecare)

Telehealth and Telecare Towards 2020 – (definitions within new strategy) “Telehealth – is the provision of health services at a distance using a range of digital technologies. This includes the capture and relay of physiological measurements from the home for clinical review and early intervention, often in support of self management; and “teleconsultations” where technology such as , telephone, telemetry, video conferencing, digital imaging, web and digital television is used to support consultations between professional to professional, clinicians and patients, or between groups of clinicians.

Telehealth and Telecare Towards 2020 – (definitions within new strategy) “Telecare” –is the provision of care services at a distance using a range of digital technologies. These range from simple personal alarms, devices and sensors in the home, through to more complex technologies such as those which monitor daily activity patterns, enable ‘safer walking’ for people with cognitive impairments, detect falls and epilepsy seizures, facilitate medication prompting, and provide enhanced environmental safety.

Demographic change Currently 10,000 age 100 in UK (2011) 1,000,000 age 100 in UK (2071)

Demographic change 2031 – need for 6,000 new beds (10 new DGHs)

Does everyone need to come to secondary care? How can that be changed - but still provide a quality, safe service for the population?

20:20 Vision ……. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Where can Technology add value ? Transforming cardiology OP pathways? Improve management of HF? Reducing Cardiology DNAs? Providing OOH cover? Improve patient information? Pre/Post surgical assessment ESD

Where can Technology add value ? Transforming cardiology OP pathways – Direct access arrhythmia service – out of 239 patients only 3.8% needed to see the cardiologist

……..Progress in NHS Highland since Primary care and community hospitals contacted Overwhelming support and request for monitors 37 monitors purchased (charity money) Community staff to attend unit for formal training (so that recorders do not sit in box unopened!) Further review planned

Where can Technology add value ? HF Home Monitoring NHS Fife 12 month trial 33 Brittle HF patients Significant > A&E attendance admission bed days 50 from 310 Patients like it

Where can Technology add value ? Providing OOH cover Potential network for general cardiology OOH Barry Vallance keen to explore SEAT aware of need in 2 Boards

Where can Technology add value ? Reducing Cardiology DNAs Using patient reminder services

……..DNA OP service (PRS) Already happening in FV and Western Isles (Grampian join later 2012) Using the ‘Lift’ model - target the 13% most likely to DNA Can achieve 14 % – 18 % reduction in DNA

Where can Technology add value ? Improve patient information over 1.46 million calls per year to unscheduled care service over 1.44 million hits to our websites and

What could be provided regionally? Create Heart Zone Generic film information Generic pre / post operative advise Potential Sign posting locally

Where can Technology add value ? Pre/Post surgical Assessment VC consultation from local hospital to tertiary centre (where possible using existing bookable clinic areas with VC in place)

Where can Technology add value ? ESD Joint health and social care teams Providing joint health and care technology assisted living ‘Telehealth & Telecare Towards 20:20’

Technology crosses boundaries…… internet TV telecare Face 2 Face SMS video mobile

Where can technology provide regional services?

Using familiar technology

keep it simple!