[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/02/Utopia-project-report-2018.jpg” thumb_width=”150″ /]An important and comprehensive evaluation of telecare in use in UK social care has been published this past week by King’s College London. The UTOPIA Project (Using Telecare for Older People In Adult social care) surveyed local authority telecare managers (114 valid responses or 75 percent of responders) November 2016-January 2017 to find out how telecare is being used by local authority adult social care departments in England to support older people.
This study springboards from the £80m Whole System Demonstrator (WSD) and its “curious neglect” by those engaged in UK telecare. The WSD’s findings contradicted earlier research in finding that telecare did not have long-term improvement of outcomes, gauged after only 12 months. It created, in the UTOPIA’s study’s terms, a ‘policy problem’ among major stakeholders. “The WSD remains an important study and its neglect is curious. The research team wondered why the findings had been overlooked and what, if any, consequences might have flowed from this.” The study thus looks at local authority aims, how local evidence is being collected, and how telecare is operationalized and delivered.
The areas surveyed and some highlights of the findings are:
- Use of research: 33 percent were informed by research and 47 percent were aware of but did not agree with the WSD’s findings which were negative on the long-term value of telecare.
- Where does telecare fit in?: “Telecare ‘fitted’ best if it was provided alongside social care (77%), to support reablement (77%), for people eligible for and funded by the adult social care department (75%) as well as for people who pay for their own care (75%).” Only 24 percent collaborated with the NHS or other partners. There was full (100 percent) agreement that telecare helps to reduce risk and promote safety and 81 percent agreement that it supports unpaid carers.
- Achieving strategic aims and monitoring of progress: Over half (53 percent) of respondents said their local authority was accredited to the Telecare Services Association (TSA) Codes of Practice for Telecare and Telehealth.
- Barriers and facilitators: Barriers mentioned were skill deficits among professionals and installers, as well as contract inflexibility with suppliers. There was also concern about the reduction of face-to-face contact and care. Access to telecare and availability of advice and support were good for both users and family carers, but levels of awareness about it were only average.
- Financial commitment: Not surprisingly, funding is scarce and usually cobbled together from several sources including local authorities, CCGs, and users. 24 percent felt it saved money but many found it difficult to provide hard evidence.
- What’s considered in telecare assessments?: Nearly all (92 percent) agreed that a key assessment included the user’s ability to move around, their memory status, the person’s ability to communicate, and their daily routines. Flipping the script, “40% of respondents said that their local authority’s telecare assessment focused on what it was hoped would be achieved through using telecare.”
- Who are the assessors, and is assessment always required?: (more…)
- Telehealth has been confirmed as the way forward for sustainably treating the leading chronic diseases in Australia says a report published following a scientific study. The study, which analysed the effects of monitoring a mixed group of patients with chronic conditions using home-based telehealth equipment, concludes that use of home-based telehealth will not only reduce the hospital admissions but will also reduce the length of stay when admitted. The analysis of the data from the trial has shown that for chronically ill patients, an annual expenditure of AU$2,760 could generate a saving of between AU$16,383 and AU$19,263 representing a rate of return on investment of between 4.9 and 6. This is equivalent to a saving of AU$3 billion a year, says the report.
The Australian study, carried out by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) is reminiscent of UK’s Whole System Demonstrator (WSD), the world’s largest randomised control trial of telehealth. Although the Australian study is much smaller with a total of 287 participants over 5 sites (covering the 5 States) compared with over 6,000 in the WSD, the principles are similar. Due to the smaller sample sizes and the need to have patients connected to the National Broadband Network (NBN) the selection of patients was not random but other techniques were used to obtain statistically significant results. Patients selected had unplanned acute hospital admissions indicationg one or more of Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Hypertensive Diseases, Congestive Heart Failure, Diabetes and Asthma.
The TeleMedCare Systems Clinical Monitoring Unit (CMU) was used as the home-based unit although not all features offered by the device were utilised in this study. The CMU system deployed in this study was developed in Australia, registered with TGA (Therapeutic Goods Administration) and has been extensively used and tested in previous trials.
Typically patients would have some or all vital signs measurements scheduled at a convenient time, typically in the morning. These measurements were blood pressure, pulse oximetry to measure arterial blood oxygen saturation, ECG (single channel), lung capacity, body temperature, body weight and blood glucose concentration. In addition to scheduled times, patients could take their vital signs at any time. A full suite of clinical questionnaires was also available.
The full report Home Monitoring of Chronic Diseases for Aged Care is available to download here.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/02/AAR-logo.jpg” thumb_width=”200″ /]The Accelerated Access Review (AAR)
aims to speed up access by NHS patients to innovative medicines, medtech and diagnostics, and digital health. Of these, digital health is the newest, and because it enables care to be delivered in a far more efficient and patient-centric way, offers great hope for the future of improved patient outcomes and controlled costs.
As someone outside government who was drawn into the digital health stream of the AAR, this blog aims to capture key learnings from the experience.
The initial list of obstacles to innovation in the NHS was depressingly long, until carefully differentiated. Top of the pile were items like the NHS’s asymmetric attitude to risk – successful innovations are forgotten, unsuccessful innovations are a life sentence for those involved – which are soluble only by those at the very top.
Then there were the surmountable challenges – for example the fear, uncertainty and doubt over digital health regulation was overcome by (more…)
As Prof Mike Short pointed out recently, 2016 is the tenth anniversary of the start of the Whole System Demonstrator (WSD) programme that in retrospect, because of poor trial design, probably slowed the uptake of digital health in the UK more than any other single action. It seems appropriate therefore to look at how telehealth* has fared over that period, and perhaps even more importantly, is poised for the next ten years.
The mistakes of the WSD are well documented (eg here, here & here) – suffice it to say that it proved beyond all reasonable doubt, at least to this editor, that unlike medicine-based interventions, which seem less sensitive to their care pathway, digital health delivers most of its benefit through enabling a different, patient-centred care delivery, so every digital health intervention needs to be evaluated holistically, and in its own care pathway. Sadly over the ten years, much of the academic work looking at the benefits of telehealth has continued to evaluate the technology in the time-honoured way that medicines have been evaluated, with predictably largely equivocal results.
Those of us who have delivered telehealth projects though have a sense of disconnect as, time and again, a focused implementation – not a pilot – in which the staff delivering the service understand that it will be a permanent change for which they need radically to change the way they deliver care, yields huge returns on investments through savings typically in the 50-90% region. (more…)
In line with my fellow editor, forgive this editor engaging in a little nostalgia – going back to 2006, when the Whole System Demonstrator was a still a wonderful idea, before the competing forces of academia and management consultancy put short-term financial gain before long term patient outcome improvement. Those were the days when we genuinely believed that recording vital signs was what it was all about.
Move on nine years and it’s clear from the American Heart Association review referred to in this column recently, and subsequent articles, that one key success factor is drip-fed education. To quote:
“The amount of information that must be conveyed and the support that is necessary to counsel and motivate individuals to engage in behaviors to prevent CVD are far beyond what can be accomplished in the context of face-to-face clinical consultations or through traditional channels such as patient education leaflets,” the researchers say. “Mobile technologies have the potential to overcome these limitations and to transform the delivery of health-related messages and ongoing interventions targeting behavior change.”
This is underlined by a recent study of attempting to control hypertension using just text messaging, which was far from an unqualified success.
Another major driver of course is cost saving, as demonstrated by (more…)
Trying at least temporarily to distract this editor’s attention from his recent unfortunate experience with Jawbone technology, here are some interesting app and wearables snippets received over the summer.
We begin with news of the first CE certified mole checking app, SkinVision which rates moles using a simple traffic light system (using a red, orange or green risk rating). The app lets users store photos in multiple folders so they can track different moles over time. It aims to detect changing moles (color, size, symmetry etc.) that are a clear sign that something is wrong and that the person should visit a doctor immediately.
This contrasts with the findings of a paper published in June examining 46 insulin calculator apps, 45 of which were found to contain material problems, resulting in the conclusion that :”The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control.”, which to say the least of matters is worrying. (more…)
Long in development, the NHS Commissioning Assembly’s Technology Enabled Care Services (“TECS”) Online Resource for Commissioners has just been launched.
It was developed by NHS commissioners, with input from a wide number of organisations including DHACA and the TSA, to help maximise the value of technology enabled care services for patients, carers, commissioners and the whole health economy. Its purpose is to help raise awareness of how the wide range of TECS can support commissioning intentions and benefit patients, commissioners, families, health and social care professionals and provider managers. It also addresses the demand from commissioners for information on how to commission, procure, implement and evaluate these types of solutions effectively. For more information visit the NHS Commissioning Assembly home page.
In view of its importance, this editor has elected to post this document without subjecting it to a full review – that will come in due course – however first impressions are positive: the style is short and to the point, and the pages very informative. The one additional thing this editor wanted to see, ideally in 72 font or bigger, is a clear statement at the beginning that, as the WSD proved beyond doubt, the benefits of TECS are only fully realised by changing the model of care: whilst there are comments that together make that point, my one concern is that it is not stressed sufficiently so we risk repeating history…or did I miss it in my haste?
Hat tip to Clive Flashman.
When this editor was running a telecare & telehealth programme in Surrey, there was always the dread when meeting professionals that one of the daily internet newssheets would publicise another paper about the Whole System Demonstrator (WSD) that ‘proved’ that one or other form of remote patient monitoring (RPM) cost more per QALY than a voyage on Virgin Galactic. The day was then spent unconstructively, making some or all of the points encapsulated in my original post on 22 July last year entitled “Time to bid farewell to the WSD”.
Thankfully the flow of WSD papers has since dwindled. Doubtless many hoped they had stopped for good, in view of their total irrelevance to the real world in 2014. However, on the offchance that some poor reader has found themselves being challenged about the abstract of a recent paper picked up by Pulse, on the high cost per QALY of telecare by one of the few professionals who still do not accept the value of appropriated technology, here is what you might tell them (more…)
When this editor was running the Whole System Demonstrator in LB Newham, he watched as a firm of management consultants that were assisting the DH steadily became ‘experts’ in telecare and telehealth delivery as they watched us struggling to deliver a new technology to demanding academic trial requirements. It was almost a caricature of the “lend me your watch; show me how to use it; now I’ll charge you for telling you the time” joke.
A different firm allied with the leading provider of telehealth equipment at the time to offer a kit + redesign care package that shifted many boxes (more…)
A new report analysing the telehealth development in the UK and proposing improvements has been [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/03/Tackilng-telehealth-report.png” thumb_width=”150″ /]produced by Inside Commissioning. The report Tackling Telehealth – how CCGs can commission successful telehealth services is written by a panel of authors led by Dr Ruth Chambers who co-chairs NHS England’s Task and Finish group for commissioning skills and capability for the delivery of Technology Enabled Care Services (TECS).
The UK has been experimenting with telehealth as much as any country in the world and has notably carried out the largest clinical trial of telehealth anywhere, the Whole System Demonstrator (WSD). WSD produced some valuable results with regard to telehealth benefits, including reduced mortality, and was instrumental in the launching of the key government telehealth programme, 3 Million Lives (3ML) in 2011.
Last year the GP magazine had carried out a major survey of telehealth implementation in the UK by making information requests from all 176 Clinical Commissioning Groups (or CCGs, a new administrative unit introduced by the current government) under the Freedom of Information Act (a common technique to gather official data). A comprehensive analysis of the returned data (108 out of the 176 had responded) forms a major part of the Tackling Telehealth report.
The research results reported are mixed. Some of the results make painful reading. The 3ML target of 100,000 telehealth users in seven pioneering “pathfinder” areas by end of last year was dismally missed with the actual figure being below 3,000. In one pioneer area the local council had withdrawn a telehealth tender due to lack of a supplier able to meet the requirements. Another 3ML pioneer area had decided to decommission its telehealth services. Meanwhile other CCG areas have reported more than 1,000 telehealth users each and one had budgeted £1M for services this financial year.
The report looks at what needs to change for telehealth to be successful and follows this up with a case study.
This is a very well written and professionally presented report. I do have one reservation though. The case study deals with the selection of a supplier for telehealth products in Nottinghamshire and quite blatantly that selected supplier is noted as a co-producer of the report. I think this does bring the independence of the report into question and somewhat spoils the authority which it may otherwise have had.
The report is free to download so long as you register on the Inside Commissioning website here.
If like me you are frequently asked for a summary of what has happened recently in the world of telehealth & telecare and are forced either to sit down and cut & paste/write one or politely turn down the request, you’ll be pleased to know of the recent four-page summary produced by the Parliamentary Office of Science and Technology (POST). Written by Peter Border, it is a competent summary of recent developments in remote monitoring in the UK, including 3millionlives & ALIP, extending to mention of the regulation of medical apps.
Of course there are bits I’d have written differently. For example (more…)
Getting the bad news out of the way first, the seemingly-eternal researchers have thrown their grappling iron into the ancient store of data from the now-only-historically-relevant Whole System Demonstrator data pool and dragged out yet another unexploded bomb that they have then endeavoured to detonate, in the form of a short research article.
Thankfully the explosive has deteriorated with age so (more…)
Can there be two greater contrasts than the recent decisions by the Dept of Veteran Affairs in the US (VA) to award a five year $28.8m telehealth contract to AMC Health and that of the E Riding of Yorkshire CCG to “axe” its telehealth service?
The sheer size of the VA deal makes every recent deal in Europe seem very small in comparison. AMC’s CEO said: “AMC Health’s outcomes-based approach to telehealth and ability to actively engage patients to proactively self-manage their chronic conditions perfectly aligns (more…)
Times are tough for those who believe that technology can help improve the efficiency and effectiveness of healthcare delivery to improve patient outcomes. As pointed out by Richard Vize in the Guardian recently, telehealth has become the weapon of choice in the battle between GPs and the NHS, with publications such as Pulse and, most recently the HSJ, continuing to remind readers of the historic, and wholly-unrepresentative-of-telehealth cost effectiveness comparisons for the Whole System Demonstrator (WSD).
At the same time, the national Telehealth Forum’s survey of potential users indicated (more…)
Richard Vize has written a highly-recommended article in the Guardian today entitled “GPs continue to do battle with government over telehealth”. This gives some valuable context to why publications such as Pulse continue to dredge up the historic Whole System Demonstrator (WSD) cost/QALY statistics as it did on Wednesday and Thursday last week.
TTA readers will of course be aware of the reasons why those figures are so unrepresentative of the technology from our recent post on why it’s time to bid farewell to the WSD.
Particularly pleasing is to see recognition of the role of telehealth as a means of promoting wider improvement in the way care is delivered:
“Eventually, other costs will start to fall as telehealth becomes a catalyst for wider system change. At present it is a bolt-on to a care system poorly integrated and not adapted for telehealth. It will require clinicians to work together in new ways, particularly in more effective joint working between community and hospital staff.”
At the Royal Society of Medicine every year there is a medical students careers fair at which the Telemedicine & eHealth Section runs a stand. Unlike other sections such as cardiology and general practice, we don’t see telehealth and other related technologies offering a career for many – the stand is purely to raise awareness because, scary as it may sound, many of the students who have visited us in recent years have never been taught about these technologies at medical school. It is therefore good to see an article by Ben Heubl in Medcrunch, an online magazine aimed at tech-savy young doctors, discussing the reasons for slow adoption of telehealth (and telecare) which in part built on a meetup of the London Health 2.0 chapter last week.
In this context it’s also worth mentioning an article by Atul Gawande in the New Yorker on why some medical innovations spread fast, and other slowly. He begins by contrasting the rapid adoption of anaesthesia with the slow adoption of antiseptics, both of which were discovered at about the same time. From this he draws the lesson that where doctors see a clear benefit – in the case of anaesthesia, no longer having a patient struggling and screaming whilst being operated on – the adoption was fast. Where the immediate benefit is harder to see and in particular it challenges the modus operandi – washing hands, sterilising instruments and replacing frockcoats caked in blood for clean white operating gowns – as with antiseptics, adoption was much slower even though the impact on patient outcomes was dramatic. This not in any way a complete summary though – I would urge you to read this excellent piece in its entirety as there are many nuances…and important lessons for the future.
Rounding this post off, Pulse has just introduced a GP Guide to Telehealth (written and funded by MSD) which is short and to the point, balancing the UK experience of the Whole System Demonstrator with the very positive experiences of the Department of Veterans Affairs. Much to be welcomed and with the added bonus of CPD points too.