Simon-Arnold

Last week Simon Arnold, Tunstall’s Managing Director and Director of TF3 consortium, which comprises Tunstall, Fold and S3 Group, spoke at NICON eHealth conference (#eHealthNI14) about Telemonitoring NI, a pioneering telehealthcare service that is now an international reference point in its field…

This blog summarises my NICON conference talk and covers the progression of Telemonitoring NI and what we have learnt. I will focus on telehealth, but it is important to remember that around 30k people in Northern Ireland have the benefit of telecare.

Telemonitoring NI is a ground-breaking service and, for the right people (and their clinicians), can be transformative. Working in a long-term partnership between the Public Health Agency (CCHSC), the five Health & Social Care Trusts and TF3, as well as front-line professionals, we have been building the basis of a truly integrated and connected health ecosystem for Northern Ireland.

Of course, the introduction of technology in this way has a disruptive impact on the traditional way of doing things – and that is always an interesting experience!

A formal evaluation is being organised by the Centre for Connected Health and Social Care (CCHSC), but here is an overview of what we have achieved together to date.

 

NI pioneering health and care

For people across the Trusts, there are some fundamental outcomes from the programme:

  • Maintaining independent living with reduced isolation and anxiety
  • Ensuring the appropriate intervention to slow down the rate at which a patient’s health deteriorates and enhance their quality of life
  • Reducing the unplanned use of GP, social care and hospital services

The telemonitoring model introduced in NI enables patients to benefit from measuring their wellbeing, safe in the knowledge that their readings will be triaged from a clinical perspective and that help will be proactively offered if required. This means patients do not have to make endless trips to their GP and it reduces the chances of them having to go to A&E.

So, let us begin with the core activity numbers:

Nearly 3,300 people have been supported by the telehealth service to date. Here, I would focus you on the clinical escalations – 250k of them and only 3% needing any interaction with primary care. These are poorly patients who need a lot of support to manage within the existing pathway.

And I have to say that patients love it. We commonly hear from patients referring to telehealth as their ‘guardian angel’ and it is true to say that for many, it has been life changing and given them freedom to manage their condition far more effectively.

 

Innovation to meet growing pressures

So let us look at the bigger picture. We all know that the burden on health and care services worldwide is becoming ever greater as a result of aging populations and the fact that we are living with long-term conditions over many years. We also know that something has to be done to change the way we look at health in the community.

Older people and those suffering from long term conditions place a significant pressure on our health and care services – for example, 80% of all GP consultations relate to a long term condition, whilst we have also seen a 31% increase in hospital admissions for the over 75s in the last decade.

Such simple facts indicate a big problem requiring imaginative thinking around models of care. That is where telemonitoring comes into play – supporting a transformation of the care pathway where it is appropriate for the patient. It is about using the right pathway at the right time for the right patient. It is not a ‘one-size fits all’ and technology gives the platform for personalisation.

 

Telehealth – which patients

The profile of the service has featured strong growth up to the level for which the dedicated funding exists and there is now a stabilising period putting a ceiling on the level of concurrent patients.

The key condition groups supported are COPD, co-morbidity diabetes, heart failure and stroke, but we have also provided support for renal patients and for weight management, as well as for women during pregnancy.

We can also see the average ages of patients on the service, which indicate a wide range of patients, as well as the duration that clinicians are keeping them on the service (they are reviewed every 13 weeks). At an average of 1-2 years, it is clear that the service is being used to provide long-term support to patients with long-term conditions, which is excellent news.

 

Positive outcomes in NI

I would now like to outline some of the findings from clinicians. Every time a patient goes onto the service, the clinician identifies the clinical outcomes they are aiming for from the telehealth pathway. Upon active discharge, clinicians complete a review of the pathway against these multiple outcomes. These can vary from reduced hospital admission, through education about condition/s, to improved self-management.

For all active discharges to date, 83% of cases have been reviewed as having fully or partially met the outcome defined by the clinician. Interestingly, data of this nature is not captured for existing pathways.

So, this all looks pretty positive – yet, it is well known that telemonitoring creates lots of emotion around whether or not ‘it’ works.

 

Disruption brings benefits and barriers

Well, for a start, it is not an ‘it’. Simply speaking, it is a technology enabled information collection service, which fits within a transformed clinical pathway. This is certainly better than having to write your readings on a scrap of paper and taking them to the GP or phoning them in every day.

We have found that benefits are varied from such a service and that there are barriers. Of particular interest has been the resistance to change and need to take action to adjust the existing pathways to save money. This is a common issue worldwide. The new pathway is often considered an ‘added extra’ rather than replacing something else. We had an example where despite a patient being discharged from hospital onto the telemonitoring service, they were given a leaflet when they left hospital telling them to get a blood pressure cuff, take their blood pressure every morning and then phone their case nurse. Straight after doing that, they then took their BP and other readings using the telemonitoring service – with results going to the same nurse. Cue confusion for patient and nurse.

Hence the additional cost attributed to telemonitoring! And there are lots of those examples all over the world…

 

Evidence sets the challenge worldwide

And that brings us to what is happening elsewhere.

The work that we have been doing together in providing a world-class telemonitoring service is ground-breaking and in full alignment with the prevailing conditions and the ambition of Transforming Your Care.

As such, Northern Ireland has become an international reference site for telemonitoring. Worldwide, around 150k patients have home based telemonitoring – mostly in the US. Those close to this arena will know of the Whole Systems Demonstrator (WSD). Whatever you thought of it, the fundamental outcomes of that randomised control trial were clear and very positive.

Moving on from the UK, let us see what is possible when home telemonitoring is used at scale. The Veterans Association (VA) in the US has seen spectacular results in terms of activity reduction, cost reduction and patient satisfaction – and the service is growing at a rate of 22% per annum with fantastic patient feedback.

So, the good news is that Northern Ireland is already providing the foundation of a connected health service, which many are still only talking about.

 

NI must continue pioneering for people

We have to challenge the way we think and act to make it a success. We can see that it doesn’t just ‘happen’.

Today, we see technology everywhere around us and it is integrated in our everyday lives. Telehealth is already happening with fitness apps. You cannot resist that consumer power. With that in mind, why should health and care be any different? Telemonitoring is part of the future pathway of care – patients want it and will start to demand it – and it is available in Northern Ireland today.

To keep pioneering, there are challenges that everyone across the health economy has to respond to.

The key challenges, I would say, are to:

  • Accept the mainstream future of enabling technology by transforming care pathways and the supporting system
  • Respond to the needs of the consumer
  • Remove the barriers and stop doing things when it is no longer required, using that money more effectively elsewhere

Let us remember, telemonitoring should be used in the right way for the right patients and integrated into care pathways. Importantly, it is absolutely not about the technology in itself – it is about bringing together services to benefit everybody. Some call that connected health!

To date, the service has been highly successful. Tomorrow’s success will be determined by the ambition we have to create a truly connected health ecosystem. Looking ahead, NI has the platform it needs to seize the opportunity and create something completely new, which sets the standard internationally, whilst transforming care and support for people locally.

The challenge I make is to progress this ambition and leverage what’s already in place!

Find out more about Telemonitoring NI in this service overview