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…)
Favorable news for the growing area of tablet-based telehealth. A six-month trial of an tablet-based telehealth system for congestive heart failure (CHF) with patients at Philadelphia-area Penn Medicine’s (University of Pennsylvania) post-discharge program reduced readmissions from an already low 8 percent to 3.8 percent, a 53 percent positive change, versus the national average of 19.5 percent. The provided 4G tablet+app program through Health Recovery Systems is used by the patient for an average 85 days. He or she sends vital signs, symptoms, medication information (including side effects) to a nurse care coordinator; the app on the tablet provides coaching via patient education, instructional videos and individualized self-care plans coordinated with the telehealth nurse on the program. (more…)
Finally an encouraging long-term, large N study on telehealth reducing same-cause hospital readmissions. Pennsylvania’s Geisinger Health Plan, the managed care arm of integrated health system Geisinger Health, has released findings from a four-year (2008-2012) study of 541 GHP Medicare Advantage beneficiaries with congestive heart failure. Hospital readmissions after 30 days were 44 percent lower and after 90 days 38 percent lower. Return on investment: “for every $1 spent to implement this program, there was approximately $3.30 return on this investment in terms of the cost savings accrued to GHP.”
Patients were assigned case managers and provided with a relatively simple program combining Bluetooth-connected weight scales and interactive voice response (IVR) calls to answer questions such as shortness of breath, swelling, appetite and on prescription medication management. The case managers used a platform to aggregate the data (more…)
Healthcare payer Cigna’s Healthspring Medicare plan unit has been piloting a congestive heart failure (CHF) care management program with Intel-GE Care Innovations in Tennessee to reduce same-cause hospital readmissions. The initial year-long 50-patient program is being expanded to 250 patients who have had a CHF diagnosis plus a previous ER visit or hospital admission. Patients are supplied at no cost a blood pressure cuff, a scale and the Care Innovations Guide on a tablet platform. Daily biometrics are sent to Cigna-HealthSpring nurse practitioners, and also complete an educational program to help them manage their CHF at home. After a 90-day minimum, once certain goals (e.g. weight loss, blood pressure and heart rate) are met, the patients stay in the program, the tablet is withdrawn but they continue to monitor and log their vitals with a case manager. What is curious about this seemingly anodyne (more…)