1. Developing Patient based Telehealth services Dr Nicholas Robinson MA MRCGP Clinical Director Long Term Conditions

2. Why Telehealth? Demographic problems Patient numbers growing Elderly Long term conditions (15m) Carer numbers falling Single households Older carers with elderly relatives Fewer NHS professionals Pensions / NHS changes

3. Matching care to user needs The Pyramid of Doom POPULATION WIDE PREVENTION Level 3 Level 2 Level 1 Highly complex (5%) High risk (15%) Low risk (80%) Disease Management Case Management Supported Self Care NHS Wellness

4. Level 3 Level 2 Level 1 The general public: Smoking Drinking Eating Sedentary Bad habits Mental health NHS Health Risks Program

5. What do patients want? 1 Care close to them (at home) Feeling secure and safe Feeling they have someone they can contact Feeling someone is watching over them Understanding medications – new/changed/why/side fx/need for repeats what to do if something goes wrong.

6. What do patients want? 2 At Home Regular contact with NHS services Support /education Enhanced understanding of diseases Ditto drugs (and improved compliance) Supported self-care

7. How can we improve Patients experiences? Part of improved service offering From admission to discharge to life in the community Planning starting at admission Problems / suitability defined for follow-up service Need for 30 day support (Home testing / monitoring) Need for longer term support (Telehealth service) Tailoring device to patient

8. Proactive calling Vital signs monitoring Patient reminders Social alarms Homecare monitoring Environmental controls Dementia monitoring Care information Supported discharge Lifestyle monitoring What is telehealth? Telecare Telehealth Telemedicine eHealth Assistive Technology

9. What do Telehealth services offer currently? 7000 patients monitored daily (1.2m for Telecare) Focus on COPD / CCF Current WSD pilot results pending (RCT for 6000 patients) Developing 30 day discharge agenda Challenges Not acute service (5 days / 8-6pm) 7 day installation delay Excluded patients (20%) Fixed installation for stationary patients! Limited clinical engagement

10. What is needed for widespread take-up of services? Patient engagement not about cost-saving may be only option Clinician engagement Not about cost-saving Allows focused services based on current needs Commissioner engagement Evidence Value for money

11. Elderly living independently Home Automation Security Wireless Network Lights Doors windows Motion / Activity Bed Drawers Kitchen Bathroom Glucose Sensor Scales Blood- pressure Cuff Cholesterol Monitor Medication Tracking Pulse Oximeter Separate Health & Social Care Systems Family, friends and volunteers Care Response Service, Warden etcEmergency Servicese.g. Text alertsCommunity Alarm Centre Social Worker Step by Step Development? Home Hub Appliance Coordination Required eSAP NHS Direct Healthcare Professionals WWW Telehealth Care Record NHS Care Record

12. Tailoring of service to patient needs Suitable patients Numbers / cost Suitable patient contact channel Web / phone / text based service interaction? 24/7/365 call-centre support Phone-based service (30 day discharge) Evolution to Telehealth monitoring if suitable Suitable device Fixed hub / Mobile device / Tablets Telehealth TTA?? £500 to call ambulance £50 to visit your GP £20 to call NHS Direct £1daily for Telehealth £0.13 to assess digitally

13. Different Types of Health Hubs

14. What is monitored? Patients health, symptoms, well-being Metrics Weight BP PO2 Temperature Glucose Linked by wire / Bluetooth / Patient entry

15. What do patients say? N Yorks PCT Questionnaire 4/11

16. Where are we going? Urgent Care matrix NHSD / 111 / OOH / Urgent GP / WICs Large scale telehealth services Working with Bosch, Docobo & Honeywell Need data exchange to prevent duplication and improve effectiveness and timeliness of care Consider needs / expectations of patients for care channels now and in future Web / Voice / face to face

17. The future? The Present!