Telehealth - Guidance for Clinicians

Telehealth - Guidance for Clinicians

2 Background to Telehealth in Wandsworth Telehealth is a way of using technology to support the delivery of tailored health care to patients in their home. There is emerging national and international evidence that supports the use of telehealth, with over 100 projects running across NHS organisations in England. Assistive technology, including telehealth and telecare, is the vision in many Government documents, such as the NHS Mandate, for the care of patients with long term conditions in the future. The use of telehealth has been identified as a key tool to achieve efficiency and effective service delivery that improves the quality of the care pathway for the patient. In Wandsworth, telehealth has been acknowledged as an enabler of the Community Adult Health Service redesign. As we move to care for more people out of the hospital setting, telehealth is an addition to the toolbox of our health professionals. Through remote monitoring it is hoped that we can support more people to maintain a good quality of life within their own home or, if necessary, within a residential setting. Dr Seth Rankin Joint Clinical Lead Wandle Locality Clinical Lead of Wandsworth Community Adult Health Services Transformation Dr Soleman Begg Wandsworth CCG Telehealth Clinical Lead

3 Telehealth at a glance Uses a range of devices to take readings such as blood pressure, weight, blood glucose and oxygen levels. Ensures the patient has contact with their clinician when they need it. Reduces the risks of hospital admissions by identifying and acting on the early warning signs that a patient s condition is deteriorating. The large colour display and buttons make the unit easy to use. Gives patient added peace of mind that their condition is being monitored. Audio instructions guide the patient through the process of taking their readings. mymedic Home Unit Weighing Scales Blood Pressure Cuff Thermometer Pulse Oximeter better care and a healthier future for Wandsworth

4 Telehealth in practice 1Patient uses telehealth Schedule defined by clinician. Patients usually monitor once every day for five or seven days a week. Typically between 6am and 10am, but this can be tailored. Vital signs options Blood pressure Pulse Oxygen saturation Temperature Weight ECG Blood sugar Health interviews COPD Heart failure Diabetes Medication prompts Escalated by phone call, email or fax at suitable times of day (e.g. 11am and 2pm) NB: On average 3% of all alerts received by the service desk are passed to clinicians Service desk Technical triage performed as soon as data is received. Data is filtered for technical alerts and high severities are 2validated before clinical escalation Practice or Community Service contact Nominated contact co-ordinates 3activity to relevant clinician 4Assessment of validated alerts Health care professional assesses Action alerts based on rich trend data from within the telehealth software Contact patient Telephone contact Give self care advice Remote medication management Schedule a practice (GP/Nurse) or tier 3 clinic appointment either same day or next day Schedule home visit 5

5 Who s it for? COPD and heart failure have trackable vital signs indicative of health deterioration; e.g. patients having a COPD exacerbation usually have a reduction in oxygen saturation levels and patients having a heart failure decompensation usually have an increase in weight through fluid accumulation. These 'trackable' vital signs can be monitored using telehealth in conjunction with a number of health and wellbeing related questions. Telehealth is the electronic exchange of personal health and wellbeing data, from a patient s home to front-line clinical staff who assist with the on-going diagnosis and monitoring of long-term conditions. Once the patient's condition has been stabilised they are more receptive to coaching and education to selfmanage their condition(s). Telehealth encourages a more proactive relationship with health professionals where the patient knows what questions to ask. Telehealth is designed to be an additional tool to assist GPs, respiratory consultants, practice nurses, nurse practitioners, community matrons, case managers and specialist nurses (both in acute and community settings) in managing their patients with COPD, Heart Failure and Diabetes (as a comorbidity). However, telehealth can be used for any patient where a health professional thinks it could be beneficial, particularly those who are at risk of an acute admission. Who s involved in telehealth Community Staff By the end of 2014/15, all community staff will have received training appropriate to their role that may include the use of telehealth and its software. Staff that have been involved with the delivery of telehealth so far are reporting that it enables them to prioritise their workloads more effectively. Acute Trusts WCCG intend to engage with all of the main providers of acute care to explore all opportunities. General Practice There are several GP practices across Wandsworth currently identifying, referring and monitoring patients and a number of practices have also been visited and allocated demonstration kits for use with patients. The PACT Contract Specification 2014/15 includes a section on telehealth for those practices who wish to participate. better care and a healthier future for Wandsworth

6 The benefits of telehealth Patient Timely, accurate and targeted health information More frequent and regular information gathered Vital sign observations Health questionnaires Targeted self care advice given Patient engages daily with their care Clinician Better self management Patient has increased awareness and understanding of their condition and how it affects them. Greater likelihood of lifestyle changes being adopted Patient engages more proactively in their daily care Timely and appropriate care Identifying trends allows early intervention to prevent exacerbations Maintain patient in a low cost setting while improving care Prevent patient presenting in practice in advanced condition Support better medication prescription and compliance Easily gauge the impact of medication change Improved health for the patient Conditions stabilised, better health and less likelihood of exacerbations Fewer unplanned interventions Reduction of A&E visits and hospital admissions Improved quality of life Patient feels more in control Reduced anxiety Patient remains at home for longer Cost savings Savings in reduction of non-elective admissions Shift to less costly interventions (such as telephone consultations, nurse visit/self care intervention instead of GP/A&E attendance) More effective medication management

7 Managing Alerts Taking into account the case history of a patient, appropriate parameters can be set and through effective monitoring and responding to changes in trend, telehealth alerts can be avoided. However, when they do occur, alerts are managed and technically triaged by Tunstall which means that the alert is validated before the health professional group whose care the patient is currently under (GP practice or Community Services) is notified. Below is an example process for managing an alert once notification has been received from Tunstall. Managing Alerts Example Validated alert breach received from service desk (validated - retest confirmed breach) Patient breached their alert limits but patient said they feel well Patient breached their alert limits and said they feel unwell or worsening symptoms Review alert limits set for patient? Significant change in observations in last 24-48 hours No significant changes in observations but generally unwell as ongoing illness, with no recent changes Phone call to patient if this occurs frequently Arrange review with the GP/nurse they know best, telephone/ surgery/home visit as appropriate Arrange same day appt or telephone appt with GP/nurse they know best, or on call doctor. If unavailable to surgery then arrange home visit better care and a healthier future for Wandsworth

If you would like a copy of this leaflet in another language, in large print, in Braille or on audio tape, MP3 or CD, please phone us on 0208 812 5000 We would be delighted to receive any comments you have about the telehealth service and you may be invited to take part in questionnaires or feedback groups. If you are interested in participating, please contact your healthcare professional. You can also give feedback on the form at this web address www.wandsworthccg.nhs.uk/contact/pages/give-us-feedback.aspx Send email to this address waccg.customercare@nhs.net You can also telephone this number 020 8871 5176 If you have any questions about telehealth, please contact your healthcare professional. For any technical questions about telehealth equipment, please call: 0844 415 9387 Monday Friday, 09.00 17.00 or 0844 855 1564 outside of these times www.wandsworthccg.nhs.uk 306/5/14