Delivering telehealth services at scale Lessons from the first 1,000 patients in Northern Ireland Kevin McSorley, Service Delivery Director, TF3 Eddie Ritson, Programme Director, CCHC TSA Conference 13 th November 2012
On The Long & Winding Road Who are we? What were we asked to do? What have we done? What lessons can we share?
Building capacity, capability, credibility Prime Contractor Patient Equipment Monitoring Applications Hosting and IT Service Delivery Patient Monitoring Patient Visits Training Solution Design Solution Integration Implementation Solution Testing
NI Chronic Disease Challenge 2/3s of over 75s Population 1.8M H&SC budget 4.3Bn Rising to 4.66Bn in 2014/2015 60% of all GP visits 72% acute bed days Department of Health (2008 ) Raising the profile of long term conditions care INIsPHO (2010) Making Chronic Conditions Count 69% of health & social care spend
What do People Want? Improved quality of life, health & well-being To be supported & enabled to self-care & to live as independently as possible To be involved in decisions about them and to have some choice & control over their care & support To have services which are integrated, flexible, proactive & responsive To have services that are high quality, efficient & sustainable
Anticipated Benefits More & better targeted proactive support to patients. Enabling them to: have greater control learn more about their condition live more independent lives Bringing timely information to professionals to inform patient-centred case management Enabling: improvements in the quality of care & quality of life for patients reductions in inpatient admissions optimised use of staffing resources
Managed Service Model Commissioner Responsibilities Defining Service Requirements Defining KPIs (as SLAs and Quality Metrics) Defining how health professionals will interact with and support the service interface points (e.g. escalations from Triage) Stakeholder engagement Selecting patients to be referred on to the service Managed Service - Outcome Based Risk/Reward Managed Service - PAYG Customised /Integrated Service Combined Technology + Service Purchase Technology Purchase + Service purchased separately
Managed Service Model - Provider Responsibilities Providing all aspects of a joinedup service involving people, process and technology Responsible from Referral to discharge Meeting defined service requirements & SLAs Technology selection, maintenance and equivalence Incentivised to generate service delivery efficiencies Managed Service - Outcome Based Risk/Reward Managed Service - PAYG Customised /Integrated Service Combined Technology + Service Purchase Technology Purchase + Service purchased separately
Programme Structure 6 year contract awarded March 2011 Procurement, service definition and implementation process led by ECCH a part of Public Health Agency 1 Service Definition, 5 customers 3,500 patients per annum 12 condition categories 2-52 week monitoring periods >2.8 million monitored days 18m investment
TF3 Managed Service Overview Core Values Patient Centred Clinically-led Partnership approach Robust service levels
Service Delivery - supporting the Patient Pathway
Story so far Service is making a real difference to people s lives 1,283 patients referred onto the system since Operational Service Commencement Approximately175,000 Monitoring days accrued across the service Strong relationships built between the clinicians on the ground and the Triage Centre Nurses Anecdotal feedback on the Triage Centre from Clinicians and patients has been very positive
Overall Patient Monitoring Days 140000 120000 100000 80000 Actual Monitoring Days 60000 40000 20000 0 April May June July August September Cumulative Actual Monitoring Days April 19064 May 39937 June 60471 July 82133 August 105077 September 128438
500 Overall Patient Referrals 450 400 350 300 250 200 150 100 50 Actual Referrals Cumulative Actual Referrals April 80 May 137 June 206 July 280 August 379 September 450 0 April May June July August September
Key Lessons Change is Constant From pilot decision to mainstream detailed design procurement implementation operation Leadership, ownership and stakeholder engagement is required at every stage. Learning & adaptation is required at every stage. There is learning, improvement and even evidence at every stage but also and often opinions and ill-informed prejudices Requirement for both professional buy-in yet also challenge to existing practice
Realising the Vision Its all about people Its all about clarity of roles and responsibilities Its about knowledge, skills, attitude Its all about trust and confidence Its all about partnership and commitment
Requirements for Driving Change Provide top down intervention and leadership Better align payment & incentive systems Engage & excite professional community Engage patients to encourage market pull Don t wait for a cultural revolution
Among Northern Ireland s Champions Michael and Jean Jim and Wendy Michael, Marie and Hilary Alan and Mary
How do I learn more? Visit: www.telemonitoringni.info
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