Telehealthcare on the Threshold

26 June 2008 (Last Updated June 26th, 2008 18:30)

The UK's largest trial of telecare and telehealth recently began with backing of £31m from the Department of Health. Nicola Boyes looks at the trial and what it could mean for patients and, in turn, hospital management.

Telehealthcare on the Threshold

With 6,000 people currently taking part in the largest-ever trial undertaken in the UK, the Department of Health is officially looking for a national business case for a technology which many believe could save money, time and lives.

It is the first time serious funding has been put behind research into the viability of telehealth and telecare and it is hoped the trial will show for the first time on a large scale how health and social data can be linked electronically and in a standardised way.

Launched by Health Secretary Alan Johnson in April, the Whole System Demonstrator Programme (WSDP) covers Kent, Newham and Cornwall testing the potential of telecare and telehealth across three diverse communities with complex social and healthcare needs.

At its launch Johnson said improving care with new scientific advances and innovation is vital if the UK's NHS is to continue to offer the very best services, but he also signalled where the NHS hopes to head, saying innovation must be at the frontline of the NHS to help people manage their conditions better themselves.

While e-health is already being used in the UK as part of the NHS Direct service, the new trial is the first time the technology has been tested on a large scale to show what can really be achieved with integrated care systems.

An evaluation team for the programme will examine the effects of the technology on emergency admission rates, patient/carer experience, and quality of life, as well as looking at the impact on primary care.

The three trial areas represent three distinct user groups covering patients of any age who are at risk of current or future hospital admission from heart failure, diabetes and chronic obstructive pulmonary disease (COPD), to those with social care needs.

PATIENT DATA AND TRENDS

"The technology is being used to detect early signs of deterioration in patients and can be adapted to suit the needs of the individual."

Paul Gee, chief executive, Telecare Services Association says telehealth is on the threshold.

The technology is being used to detect early signs of deterioration in patients and can be adapted to suit the needs of the individual, says Gee.

Someone living alone with social care issues, who has a history of falling over, may be assessed by their manager as needing a package which includes an inactivity and bed occupancy sensor and a night light.

Patients with diabetes and heart conditions take their own biometric measurements including blood glucose levels, blood pressure and oxygen saturation using a simple touch-screen device coupled with audio instructions.

"They become expert patients in their own right," says Gee "If they are feeling off they can check it out against their vital signs and decide themselves if 'it doesn't seem that bad or I am concerned I'll phone my GP'."

Currently the patient sees their own data and trends. The information can go into a local GP's surgery, a community nurse or a regional data base and because the equipment allows a perimeter to be set, if the data pops outside the par, the information will be automatically sent on to the healthcare professional.

In turn, upon seeing irregularities, the health professional can ask the patient to do their signs four times a day so they get permanent tracking of that information rather than once a day. If, for example, someone's blood pressure is going up medical staff can intervene before a crisis.

COSTS AND CONCERNS

Evidence about the cost-effectiveness of telecare and telehealth has always been scarce, which is why enthusiasts believe there has been less investment in the assistive technology. This is why the Whole System Demonstrator programme is seen as so important, says Gee.

"Evidence about the cost-effectiveness of telecare and telehealth has always been scarce."

"Although some of the equipment used has been around for some years I think it's only been of late that people have been able to embrace it with a decent budget to make a difference."

The programme aims to give people the support they need to retain their independence in the community and manage their conditions in their own homes and is consistent with a health service keen to get patients to take more responsibility for their own conditions.

It is hoped the trial will lead to reduced emergency admissions, reduced use of the acute hospital sector and reduced dependence on care homes.

The savings generated should potentially more than offset the cost of the initial investment in the technology.

For basic telehealth models you may be looking at £200 but for more advanced systems which cover more health and care issues you could be looking at up to £2,000 a patient. However, if proved successful this could pay for itself.

Companies like Intel have already seen the potential, says Gee, as they are developing their own set of global technical standards for the technology.

"You wouldn't get someone like Intel involved unless there was huge global opportunity."

PROGRESS SO FAR

"During a five-month telehealthcare pilot, Sheffield Primary Care Trust reduced home visits by 80%."

While England has been a little slower than the rest of Britain to embrace the technology, Gee says areas like Scotland are already showing what can be achieved.

In August 2006, Scotland launched its Telecare Development Programme with the latest TSA report saying 140 emergency hospital admissions had been avoided because of the technology.

Programme manager Moira Mackenzie says, based on information from 13 partnerships in Scotland for the first six months of 2007/08, the Scottish group has saved approximately £2.9m.

The savings were made with 1,800 hospital bed days prevented, 6,900 care home bed days, 1,250 night of sleepover care and 107,000 home check visits all saved.

During a five-month telehealthcare pilot, Sheffield Primary Care Trust reduced home visits by 80% and realised cost savings of around £35,000.

INTEGRATED HEALTHCARE

The challenge is embedding telehealth applications into mainstream service provision and that is not an insignificant undertaking, says Mackenzie.

"Patients welcome the chance to take responsibility for their own care in their own homes."

Gee says the Department's pilot is all about making a business case for the technology.

With stories in mainstream media recently highlighting Britain's care system creaking at the seams and council leaders calling for better funding and care, the trial seems timely.

The UK faces serious challenges in healthcare provision with the looming onslaught of the "silver tsunami", the baby boomers who have reached their twilight years and will not only require but prefer to be cared for in their own homes, says Gee.

Authorities are ready to fundamentally change the way they do things, he says, and patients welcome the chance to take responsibility for their own care in their own homes with 80% of people surveyed by the Association saying just that.

Miles Ayling, director of service design commissioning and system management at TSA, says as the global demand for healthcare increases the adoption of innovations like telehealthcare can help assure high-quality health and social care for all people regardless of their location.

The WSD programme was set out in the Department's white paper, Our Health, Our Care, Our Say and Ayling says the Department wants to test on a large scale what can be achieved through more integrated care systems.

"Any deterioration trend or missing results can be followed up and dealt with before there is an emergency," he adds.

"The technology has the potential to move towards centralised care where patient data is communicated to a central system."

Gee says the technology has the potential to move towards centralised care where patient data is communicated to a central system where is can be analysed by health and social care professionals who can head off potential crisis before they happen.

Eventually he says all the information could be sent and collated at a resource centre like NHS Direct, which currently delivers telephone and e-health information services, or into a national server

Gee says the TSA is working on a set of standards covering who would be responsible for setting up telehealth in the home, monitoring, patient confidentiality issues, and health and safety issues, not to mention the clinical governance issues covering best practice.

In an environment where patient privacy is paramount, however, the move to centralised systems is still some time off. Guidelines and standards are still being drawn up. Widespread implementation could still be far off, but evidence so far suggests that the telehealthcare dream could come true.