• Remote locations – Iraq, Kuwait, Falklands • Reach Back to control centre in NHS Teaching Hospital • UK-SAR 2013
Provision of Healthcare Traditional Doctor centred Reactive Post event Random monitoring Expensive
Tele health Patient centred Proactive Pre emptive 24/7 surveillance More cost effective
Review of technology SMS texting Downloadable Apps Patient portals Box solutions Mobile phone based Technology is an enabler – not a treatment ‘Not one size fits all’ Provides a framework for LTC care to operate on
SMS Texting Use own phone Scalable Depends on accuracy of input
Patient pays for text ? delivery of message ? satisfy new legislation re medical devices (FDA) 5
Downloadable Apps 1st Smart phone 2004
Large numbers Quality control – FDA No recall of App No control protocol Breech of confidentiality Conflict of interest
Patient Portals Increased visits to GPs Increased telephone calls to health providers Increased A&E visits Increased after hours calls Increased hospitalisation Reason: • portals might help uncover health issues • patients more likely to utilize health care were more inclined to sign up for the portal. Modern Healthcare 2012
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Box solutions including Digital TV Ease of use
Video conference facility Not truly mobile
Deployment and installation cost Communication pathway and costs Ties patient to equipment
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Mobile devices with ‘touch’ screen enables fast and easy data capture by patient...
Slate with potential video conferencing
Peak Flow
Smartphone
Weight
Glucose, INR SpO2, Pulse
Blood Pressure
Patients Like It Ensuring a positive patient experience Ease of Use
Patients more confident in managing their condition
“It is a convenient size” “you don’t have to push buttons to go to another screen” “... It is a nice comfortable size and shape to hold and a nice screen to look at” “It doesn’t look like a medical device.... it’s not embarrassing”
Source: South Birmingham PCT – Mosaic July 2010
It was reassuring to know my condition was being monitored – 95%
I would feel happy to reduce my number of routine hospital visits with this system – 90% I felt I was in control of managing my own condition - 90%
Source: NHS South Birmingham PCT - Report on COPD telemonitoring service September 2011
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Healthcare Professionals Like It More accurate and timely diagnostic information, More efficient use of time, better Healthcare professionals track and Safe mobile Care is fast and easy to patient care quantify evidence based outcomes deploy and re-deploy Actions and interventions captured on care record Support robust governance and audit capability Quantifies value provided by healthcare professionals
“The system was incredibly easy for staff and the patient to use. It has really provided improved patient confidence in managing their condition” Community Matron South Birmingham Community Health
Source: Birmingham South SMC COPD Trial – Alert Outcomes
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Commissioners Like It Better resource utilisation, expanding case management capacity, reducing costly Proven to reduce Enables enhanced Reducing the need for unplanned hospital admissions unplanned admissions and productivity and supports unnecessary travel time for save money
patient self management
Community services
Case Study: COPD
On average a 10 minutes per patient consultation
Saving c.£1,152 per patient
Hospital admissions reduction of 58%; gross saving 50% c.£4,000 gross saving per patient
Potential >£3million saving p.a. Based on COPD population of c.8,000 Level 3
Potential W.T.E. nurse productivity increased by over 300%
Up to c.80% reduction in required face to face time
Evidence of patients self medicating
Source: NHS South Birmingham PCT - Report on COPD telemonitoring service September 2011
Source: Birmingham South SMC COPD Trial – Average Red Alerts per Day
Source: NHS South Birmingham PCT Report on COPD telemonitoring service September 2011 – Based on 10 case managed patients
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WSD vs SMC (regression to the mean) WSD 1,570 (£36 million) Average age Mortality rate