Alison Rogan

Ali Rogan, our External Affairs Director, summarises a new report about the Model for Optimising Sustainable Telehealthcare (MOST) programme.

The MOST project is about providing a solution to a major healthcare challenge – the need for more efficient models of care delivery, particularly for managing long-term conditions. It is often the preferred option that care be provided closer to a person’s home environment and it is recognised by some that technology can be a good enabler for this.

MOST is part of a Technology Strategy Board competition where Tunstall has been working with Ernst & Young LLP, NHS North Yorkshire and York and Nuffield Trust.

Good Governance Institute (GGI) has now produced a detailed report about the outputs from MOST. This highlights views on day-to-day service issues together with the role of telehealthcare.

By way of introduction to the new report I have summarised some key points below.

Designing a programme

The following questions are crucial when designing a telehealth programme:

  • What are the programme objectives?
  • What are the benefits that can be realised?
  • How will the service be delivered in the future?
  • How will previous services have to change?
  • What are the estimated costs, efforts and timescales?
  • What are the risks?
  • How should a telehealth system be installed?
  • What staff and patient training is necessary?
  • How best can the data be monitored?
  • How best can trend-data be interpreted?

Implementation

A telehealth service should be implemented across four stages:

  • Phase 0: the set up phase, when the business case and contracts are signed off, key stakeholders are identified and engaged and core team members are confirmed.
  • Phase 1: initial engagement, when the overall programme design and governance and engagement strategy are defined and agreed, primary/community care and acute trust engagement takes place, a potential long list for patients is drawn up and there is understanding and agreement on clinical pathways and service delivery.
  • Phase 2: implementation and deployment, whereby the scope of service redesign is established, clinical training takes place and criteria for patient selection are defined.
  • Phase 3: sees the full deployment.

You can also see page 8 of the report for more on what the programme’s governance arrangements should be.

Patient selection

At the commencement of the programme it is advisable to pinpoint patient groups who will most benefit. This will be important when prioritising rollout, and is a valuable tool with which to begin discussions.

Patient suitability

Patients who fit the criteria outlined by the clinicians in the care pathways will not always be suitable for telehealth. This is often a result of physical barriers to using the equipment. Therefore, it is necessary to understand that selection criteria for the use of telehealth is not binding, and that there will always be patients whom the primary clinician deems to be unsuitable to use the equipment.

Designing and commissioning new care pathways

This will require:

  • Careful consideration of the key changes.
  • Where applicable, a cost-benefit analysis of key changes.
  • Service specifications for primary, community, and secondary care.
  • A key decision will be whether to produce one service specification for ‘specialist’ services.
  • Separate service specifications should be produced for non-specialist community services where there is a significant impact from the new care pathways.
  • Information for the contracting team to evidence the fall in levels of non-elective care that will be achieved.
  • Pathway design workshops could include expert speakers/discussion panels, group exercises to critique the current pathways, identify challenges and implementation, and agreement of patient selection criteria.

Of course, any change process can be challenging to manage. However, within this report there are tools and techniques to make the change easier and more effective. Quite simply, through MOST, we are sharing our collective learning from previous large-scale telehealth programmes, to assist others planning or undergoing change.

You can read the report in full here.