Whole System Demonstrator & Telehealth in Practice

Dave TyasService Improvement Manager – Self Care and Long Term Conditions (Telehealth Lead)

The Future ?

"Just think of what a world it would be if we could measure the

characteristics of your body when you get sick and transmit those directly

to a doctor or a computer. You could get diagnosed and cured instantly

and wirelessly."

• In 2008 Cornwall were successful in bidding for Department of Health funding to become one of three demonstrator sites.

• The Whole System Demonstrator trial is a two year research project that aims to find out if using new technology can help people keep well at home

• Largest trial of Assistive Technology of its kind globally

• Three sites: Kent, Newham and Cornwall involving 6000 people

Background

Evaluation

• National Evaluation – 12mth study• We will know to what extent the WSD model of care:

• promotes individuals long term well-being and independence • improves individuals and their carer’s quality of life• improves the working lives of staff• is more cost effective• is more clinically effective• provides an evidence base for future care and technology models

• Local Evaluation• Community Matron impact• Patient Experience• Non-WSD participants

Telehealth

Patients take their own biometric readings (blood pressure, weight temperature, blood glucose and pulse oximetry) and answer questions in the comfort of their own home on a daily basis.

These results are fed back to the Community Matron or Specialist Nurse electronically to monitor their condition.

Telecare

Patients will have a range of active and passive sensors along with devices in their homes such as bed occupancy, falls sensors and medication reminders. Any alarms that are triggered by these devices are fed back to Carrick Lifeline for further action.

The Technology

Evaluation

• National Evaluation – 12mth study• We will know to what extent the WSD model of care:

• promotes individuals long term well-being and independence • improves individuals and their carer’s quality of life• improves the working lives of staff• is more cost effective• is more clinically effective• provides an evidence base for future care and technology models

• Local Evaluation• Community Matron impact• Patient Experience• Non-WSD participants

Day to Day Life of Patient using Telehealth

2. The patients “keyworker” (Community Matron or Specialist Nurse) logs on to check the patients

readings on the online monitoring tool.

4. If readings are normal the keyworker acknowledges the reading on the online monitoring tool and continues to monitor patient and look for trends as the patient transmits

their results daily.

1. Patient completes their daily “scheduled session” taking their biometric readings and answering any questions.

3. If patients readings are outside the parameters set by thekeyworkers, further action will be taken e.g. get them to

retest or phone or visit the patient.

Challenges : Clinical

Initial concerns around time

IT issues

Impact on patients – managing equipment, reinforcing the sick role, raising anxiety

Impact on workload – GPs

“I don’t have time to get into the office

never mind monitor patients daily….”

“The IT system will be difficult to use and I

am not very IT literate….”

“Patients will become fixed on their

readings and anxious about them….”

“Patients will be ringing me every time their

blood pressure rises by a tiny amount….”

Clinical Experience

Impact on capacity

Supports clinical care and management

Enhances patient independence and empowerment

“I get to know patterns with patient’s biometrics which often signify an exacerbation. It backs up phone triage with objective information.”

“Empowers the patients.Helps to get them motivated about managing their own conditions with visual evidence.”

“Saves visits especially out in the 'sticks‘”

Challenges : Patient

It will be too complicated to

use

I don’t understand

what the readings mean

Taking the readings will

limit my freedom

Reality

• The equipment is simple to use• I can relate the readings to how I feel and know when I should and shouldn’t do things• It has enabled me to visit family and walk into town

“I wouldn’t be without it”

Benefits to Patients

• Visual impact of seeing biometrics – giving up smoking, losing weight

• Early diagnosis of problems – irregular heart beat, postural blood pressure drop, high blood pressure

• Diagnosis of serious illness – diabetic ketoacidosis, low blood oxygen levels

Overall, quality of life effects have been amazing!

Telehealth in Practice – where are we?

• Whole System Demonstrator Trial

• 780 patients installed in Cornwall (1000+ by End 2010)

• 660 active participants

• Heart Failure, COPD and Diabetes

• Mainstream Service from April 2010

• Accepting referrals from all practices

• Trialing Telehealth in other conditions and areas : Falls prevention

and UTI

• Consider its use in 3 areas: Diagnosis, Management & Prevention

Questions & Answers