Inspiring Innovation in Digital Health “ Realising the Potential – Lessons Learned” Kevin McSorley Executive Director Fold TeleCare
The tantalising possibility …… ….. for public policy to meet more people’s desire to remain independent for longer, while at the same time saving money overall. Audit Commission 2004
Telecare Service Model • Telecare • Activities of Daily Living (ADL) www.telemonitoringni.info
Lesson: Leaders & Partners …… www.telemonitoringni.info
The Northern Ireland Challenge 2/3s of over 75s Population 1.8M 60% of all GP Health Budget visits Declining Demand and cost of care increasing 72% acute bed days 69% of health & social care spend
Lesson: Leaders & Partners • Friday, 18 March 2011 Minister for Health, Michael McGimpsey, said: "This is a wonderful achievement for the health service in Northern Ireland. The pressures on our health budget over the coming years together with challenging demographic trends such as an ageing population, mean that the health service is going to have to find new ways to ensure that we continue to provide a high quality service .” www.telemonitoringni.info
Telehealth Service Model Managed Service Overview Core Values • Patient Centred • Clinically-led • Partnership approach • Robust service levels www.telemonitoringni.info
Lessons: Political Support – Defining Success • Thursday, 08 December 2011 The service will now be rolled out to 3,500 patients across Northern Ireland per annum for a period of six years. “The Telemonitoring NI service will allow thousands to monitor their vital signs without having to • leave their own homes … Health Minister Edwin Poots today marked the roll-out of a …is an excellent example of how ground-breaking hi-tech the Health Service can innovate scheme which will enable using modern technology to more patients to monitor their deliver a better service for our health in their own homes. patients." •
Patient Pathway 9 www.telemonitoringni.info
Step 1 – Patient Identification and Referral Clinical care pathways enable clinicians to identify the right cohort of patients suitable for the Remote Monitoring service Each Healthcare Trust has specific Patient selection processes and associated goals Risk Stratification Tools can be used to identify suitable patients The selection process includes a preliminary patient assessment www.telemonitoringni.info
Step 2 – Patient Enrolment on the service HSC Clinicians access an on-line web portal to create a referral and create a patients care plan The TF3 Clinical Triage Team receives and validates the referral Referral requests triggers patient appointments, obtaining consent, installation, training, … www.telemonitoringni.info
Step 3: Patient Self Management Support Patients are enrolled on to the service and start to monitor their vital signs at home Readings are taken with the various peripherals and transmitted to the monitoring centre Qualitative patient feedback be captured via condition specific health interviews/ questionnaires www.telemonitoringni.info
Step 4 : Patient Monitoring Services There are two types of patient monitoring provided Track and Trend - Data recorded by service but clinical monitoring is by patients own care team Triage Service - The Patient is monitored and triaged by the TF3 Clinical Triage Team www.telemonitoringni.info
Step 5 : Escalation of Issues If a patient’s data record outside the parameters set in the care plan, a nurse will contact the patient to check on their health and decide whether there is a need for intervention or escalation There are three types of Escalations : Local Response – the Clinical Triage Nurse escalates to the Local Care Team Out of Hours Service – over the weekend the Clinical Triage Nurse escalates to the Out of Hours Service Emergency Response – Clinical Triage Nurse escalates directly to Emergency Services www.telemonitoringni.info
Step 6: Self Management and Education The patient portal allows patients to review their progress. They can look at trends, comparisons and get health tips Patients can receive reminders and messages as well as information on events related to their condition Patients gain a greater understanding over time of their condition through the patient portal and become empowered to manage their condition proactively www.telemonitoringni.info
Step 7: Patient Review, Discharge and Outcomes At referral all patients have a planned review date set based on the reason for referral and the condition(s) Clinicians review and decide whether to extend or discharge patients On discharge, the patient is assessed as to whether the clinical goals for the referral were achieved www.telemonitoringni.info
Lesson: Learning & Building on Success Thursday, 17 October 2013 Eddie Ritson, Programme Director of the CCHSC, said: “ Telemonitoring is an excellent example of how modern technology can help deliver a better service for the patient, allowing them to take control and manage their condition with confidence. It also allows more efficient use of the healthcare professional’s time and skills. The service has an ambitious programme for development and next year plans to accelerate the uptake of telehealth into broader clinical Jon Darpón Sierra, Basque Minister conditions and expand into telecare. for Health visits Telemonitoring NI
Lesson: Political & Clinical Support for Success 30 th January 2015 The Minister said: I was particularly interested to hear the perspectives of service users about how they have benefited from the service. Telemonitoring NI is a great example of how technology can support the delivery of Transforming Your Care (TYC) and fits with direction of Making Life Better framework for public health with the focus being on the needs of the individual, empowering and educating them so Health Minister, Jim Wells, and that they can take control of their the Chief Medical Officer, Dr condition. It is clear that the service is Michael McBride, making a positive impact on the lives of many people in Northern Ireland.''
Lesson: Political Support for Building on Success 4 th March 2016 Mr Hamilton said, “The opportunity to speak to staff here at the centre has given me a much clearer insight into how the service operates and interacts with clients on a day-to-day basis. The support it provides gives patients and their carers reassurance, as well as more confidence in managing their conditions. There can be no question that in the context of our ageing population, we need to be maximising the potential of solutions such as telemonitoring, telecare and other assistive technologies which can support independent living. To be fully effective in this, we need to work in partnership with other agencies – housing providers, Health Minister Hamilton Visits councils and the community and voluntary sectors .” Telemonitoring NI Centre at Fold
Lesson: Political Support is Key 22 nd August 2016 New Secretary of State Visits Fold Housing Association on NI induction tour www.telemonitoringni.info
Lesson: Political Support for Building on Success 02 November 2016 During a tour Minister O’Neill commented: “Looking ahead, technology will be a critical enabler in delivering the change set out in ‘Delivering Together’, my ten -year vision for the HSC. Having seen for myself how the service operates, I can understand how the continuous, personalised care which it provides helps to keep patients more engaged and focused on their wellbeing.” By fully embracing the potential of technology, I believe that we can shape a more effective and O’Neill visits Telemonitoring NI Centre sustainable health and care system for the future. ”
Referral Activity – from OSC www.telemonitoringni.info
Referral Activity – FY Yearly Comparison www.telemonitoringni.info
Activity : Patients Actively Monitored www.telemonitoringni.info
Monitored Patient Days www.telemonitoringni.info
Length of monitoring 2014/2017 www.telemonitoringni.info
Triage Activity 2014/2017 www.telemonitoringni.info
Expected Outcomes – trend over time www.telemonitoringni.info
Regional Outcomes www.telemonitoringni.info
Outcomes – COPD www.telemonitoringni.info
Outcomes – Diabetes www.telemonitoringni.info
Outcomes – Heart Failure & Stroke www.telemonitoringni.info
Lesson: Engaging Patients Results from a 100 Patient Survey (2014) www.telemonitoringni.info
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