OnePerspective: How the shift from analogue to digital telephone services affects telecare provisioning

TTA has an open invitation to industry leaders to provide a personal perspective on issues of importance to readers. This week, Charlotte Rathbone, Product Account Manager for CareUnity Digital, Chubb, examines the ongoing transformation of the UK telecommunications industry and how the shift to digital technology will affect telecare provision.

Interested contributors should contact Editor Donna. (Pictures and graphs/infographics are welcome)

According to the Technology Services Association (TSA), the representative body for technology-enabled care, more than 1.8 million vulnerable people* rely on telecare in the UK. In most cases, telecare consists of a care alarm in a person’s home, which when triggered by pressing a button or an automated sensor, sends data via the Public Switched Telephone Network (PSTN) to a monitoring centre, where an operator will give advice or seek help.

The UK telecommunications industry however is undergoing rapid change. By 2025* all analogue telephone services across the UK will be switched off as infrastructure is upgraded to digital connectivity. This approaching switch highlights the need for dedicated digital telecare solutions. 

So how will this affect telecare services in the UK?
As early as 2023*, British Telecom (BT) customers may not be able to buy an analogue phone line. Instead, BT will move its customers to a digital Internet Protocol network in readiness for the shutdown of traditional telephone lines in 2025. It’s then that we’ll see the PSTN and all Integrated Services Digital Network lines switched off. These lines are currently used by many telecare services to feed alarm data into their monitoring centres.

While the digital migration is underway, analogue telecare alarm services are reporting a rise in the number of failed alarm call attempts – with one service provider reporting a failure rate of 11.5% for the first alarm attempt*. This is concerning.

Another concern is failed care alarms through loss of power. When analogue alarms run on a digital network, they require a router to be plugged in at home. In the event of a power failure, this router will stop working, so if a vulnerable person triggered their alarm, it would duly fail.

It’s little surprise that telecommunication providers and Ofcom are all recommending a shift away from traditional analogue devices to digital devices to ensure consistency of access to care*. Some countries including Sweden are ahead of the curve when it comes to switching to digital. More than 95% of Swedish digital alarm installations now use mobile network connections*. There is some way to go in the UK.

Currently, there are approximately 1.6 million analogue telecare devices** across the UK that need to be changed to digital-dispersed alarm units so it’s going to be a gradual process. There are, however, benefits for telecare service providers that make the change sooner rather than later. 

Why switch now?
As we approach the switchover date, the time to replace analogue units in the field reduces. This will likely result in significant resource pressures for customers to complete the transition; by switching early, this can be completely avoided.

References
*TSA, 10 Facts about Analogue to Digital: How it will affect telecare.   ** TSA survey of service provider members, May 2021.

Hat tip to Kathryn Ranger of PRG Marketing Communications

OnePerspective: Covid-19 accelerates digital stroke care for the East of England

TTA has an open invitation to industry leaders to provide a personal perspective on issues of importance to readers. This week, Lynda Sibson, telemedicine manager for the East of England Stroke Telemedicine Partnership, reflects on how the coronavirus pandemic enabled its successful service to move into new areas at speed.

Interested contributors should contact Editor Donna. (We like pictures and graphs too!)

The East of England Stroke Telemedicine Stakeholder Partnership was set up in 2010 after a review found the region was struggling to meet national target times for delivering ‘clot busting’ drugs to patients with acute ischaemic stroke.

A shortage of consultants made it impossible to offer a 24/7 consultant-led thrombolysis service at all of the region’s hospitals, but long journey times made it difficult to transfer patients quickly to specialist centres.

Now, when a suspected Acute Ischaemic Stroke (AIS) patient arrives at one of the seven hospitals that we support out of hours, a telemedicine cart is taken to their bedside by the local stroke team. The stroke nurse specialists quickly establish the video link to a specialist, on-call consultant, using technology from our partner Visionable.

Since the telemedicine service commenced 10 years ago, up to the end of March 2021 we have assessed over 4,300 patients. Of these, 1,846 were thrombolysed, and just a fifth of those who weren’t had missed the national 4.5 hour target (the rest saw their condition change or were not experiencing a stroke).

A health economic analysis by the University of East Anglia showed that the service is cost-effective and delivers clinically effective outcomes for patients, with reduced length of hospital stay. So, we have been looking to expand.

Pilots and frustrations:

Supported by the Eastern Academic Health Science Network’s (AHSN) Digital Pioneer Programme, we were able to run a feasibility study undertaken with East of England Ambulance Service NHS Trust. In conjunction with Ipswich Hospital, we have been exploring how we can utilize the existing telemedicine system to assist paramedics in the assessment of ‘stroke mimics’ more effectively. Up to 40% of stroke presentations are ‘stroke mimics, and commonly include mini-strokes (known as Transient Ischaemic Attacks) and migraines, amongst others.

The paramedics were provided an iPad with the Visionable app loaded on it, so they could use it to contact the stroke consultant for advice and the aim was to avoid admission to A&E since most strokes mimic patients can be safely managed in a less urgent setting than A&E. In our feasibility study, all but one patient (who had a chest infection) avoided this trip to A&E, with most patients being managed in a follow-up hospital clinic or by their GP.

We plan to roll this project out across the region, commencing initially with Ipswich, Norfolk & Norwich and The Queen Elizabeth Hospital King’s Lynn. We are also currently running a daily pilot at Ipswich Hospital, and later with The Queen Elizabeth Hospital Kings Lynn, of a virtual ward round for low-risk stroke patients who need consultant review within 14 hours of admission, to meet government targets. Early data suggests that this is working well, with positive feedback from both stroke consultants and the stroke specialist nurses.

Let’s learn lessons and keep up momentum:

Virtual consultations and just one of the many tools that can be used to address healthcare challenges, and it is important to make sure that they are deployed appropriately, safely, and effectively.

In ten years, we have learned a lot about IT infrastructure, technology, and its associated governance: we use Visionable because it enables the consultant to see the patient, is user-friendly, and meets IG because no patient identifiable data is transmitted over the video link.

We have also learned that finding clinical champions, supporting the consultant team, and training junior doctors and base teams are essential. However, we have also shown that digital consultations work; and the wider NHS has just learned the same lesson in the pandemic.

Let’s keep using technology-enabled care to support clinicians and make sure patients have access to safe, high-quality care they need, when and where they need it.

Always remember FAST – if ANY of the following – FACE, ARMS, SPEECH are affected, it is TIME to call the emergency services for help.

Hat tip to Chloe Bines of Highland Marketing

Perspectives: How Advanced Communications Technology Has Created A ‘New Normal’ In Healthcare

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today, we have a contribution from Dave O’Shaughnessy, Avaya’s Healthcare Leader for EMEA and APAC, with a brief discussion of how AI and advanced communications technology can help healthcare in the long term. (It’s hard to say ‘a post-COVID world as France and Germany are experiencing second round lockdowns, and UK may not be far behind.) Interested contributors should contact Editor Donna. (We like pictures and graphs too)

Across industries, we see working patterns being transformed to create the ‘new normal’ as a result of COVID-19 and our reactions to the pandemic. The healthcare sector has been no different. The pandemic and its restrictions have brought a great number of new challenges to healthcare systems. And as has been the case across so many other sectors, communications technology has stepped in to plug the gaps caused by the pandemic.

The good news is that, not only have communications solutions successfully plugged the gaps, but they’ve also provided a blueprint for the future of healthcare. As we’ve found in other industries, we’ve actually seen the intelligent adoption of this technology lead to better experiences for patients, and better outcomes for providers, than were present before.

The most important (and immediate) area where this is most obvious is in contact tracing – tracking the physical, interpersonal interactions of those who have tested positive for COVID-19. This helps identify people who may need to be quarantined more quickly, therefore reducing the spread of the virus.

Helping government and healthcare organizations across the world with their contact tracing efforts, what we’ve found is that the most effective contact tracing efforts make use of artificial intelligence and automation. After all, the effort involves mountains of meticulous information gathering and analysis—all required to meet standards set by global health and government agencies. Acting upon that data manually just isn’t feasible, given the immediate needs at hand.

Therefore, the best systems employ AI virtual agents for initial patient contact, as well as for the simple data collection interactions – only falling back to live agents when the interaction becomes more complex. AI is also employed to deliver cloud-based, proactive notifications to automatically reach out to individuals or groups with optional response tracking, text interaction, and auto-forms to capture critical information.

Patients benefit from a smoother experience while providing the tracing information required, while healthcare providers and governments are able to collect more information with the resources they have.

Even without these focused AI technologies, however, our customers are putting their advanced contact centers to good use in combating the pandemic. In Saudi Arabia, for instance, one medical facility adopted a multi-experience approach, making it easy for patients to get the COVID-19-related information they need through a wide range of communications channels. This provided demonstrated results for improved knowledge on coronavirus safety measures in the community.

Going forward, we see tremendous use cases for extending this technology to make it easier for patients to directly engage with their doctors through asynchronous messaging. Such capabilities are of particular interest to mental health providers, who have found themselves unable to conduct in-person therapy sessions in the face of increased demand.

All of these solutions were implemented because of specific, pandemic-related challenges. But once the pandemic subsides, they’ll continue providing value, making it easier for patients to consume healthcare services, while delivering increased efficiency for providers.

Hat tip to Mary Burtt of AxiCom UK

OnePerspective: Analogue telecare is a dead horse: stop flogging it

Editor’s Note: ‘OnePerspective’ articles are written by industry contributors on issues of importance to our Readers. They reflect the opinions of their authors and are archived under ‘Perspectives’.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/06/Tom-Morton-CEO.jpg” thumb_width=”150″ /]By: Tom Morton

Call failures to alarm receiving centres in the UK are rising but the reasons for this are currently the subject of hot debate.

The problem is linked to the roll out of the next generation network (NGN) replacing the UK’s analogue Public Switched Telephone Network (PSTN), a task which will be complete by 2025.

What is not debatable is that 1.7m of the most vulnerable in our society are being placed at risk as calls to alarm receiving centres (ARCs) increasingly fail or are delayed in their delivery due to incompatibilities of existing technologies.

At the Telecare Services Association (TSA) conference in November 2017, technology-enabled care services company Appello, with circa 100k telecare system users, identified a 7.5 percent call failure rate and announced the problem as “deeply worrying”.

At the same event, Communicare247 presented a report which highlighted a significant 12.3 percent spike in call failures identified by Falkirk Council. This was part of an ongoing analogue to digital assessment program operating across 12 percent of the existing Scottish telecare user base, and significantly this spike occurred in Falkirk within a short three month period. Both Falkirk Council and Appello have published their evidence of increasing call failures in a TSA whitepaper.

The TSA white paper, A Digital Future For Technology Enabled Care, highlights that the 1.7million people in the UK reliant on telecare need answers as their service is “threatened by disruption as UK telecommunications shift from analogue to digital”.

Yet the link to call failures and the rollout of NGN has been called into question by a major equipment provider. In a recent blog, they asked a very challenging question: Are network issues causing a greater number of alarm call failures?

Their answer delivered by the blog was, in essence, ‘maybe not yet’.

In a comparison between one ARC, where call failures were high versus another where they were low, the blog claimed that “while the use of NGN networks has grown in the last few years this cannot account for the increasing trend”.

As a potential compromise, the author also said that they could overcome any potential issues through the use of hybrid terminal adaptors (ATAs).

However, evidence both in the UK and Sweden plainly demonstrates call failures increase as the network switches to digital. (more…)

OnePerspective: VA shows how technology can improve mental health care

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Gigi-Sorenson-GlobalMed.jpg” thumb_width=”150″ /]By: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

(more…)