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Opportunities and challenges in telehealth

Opportunities and challenges in telehealth. Simon Brownsell Email: simon.brownsell@dh.gsi.gov.uk. Overview. 1. Drivers for telehealth 2. Telehealth example 3. Implementation challenges 4. Conclusions. Telecare practiced by telephone. BTiE & 1.6m community alarm users. NASA Telehealth.

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Opportunities and challenges in telehealth

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  1. Opportunities and challenges in telehealth Simon Brownsell Email: simon.brownsell@dh.gsi.gov.uk

  2. Overview 1. Drivers for telehealth 2. Telehealth example 3. Implementation challenges 4. Conclusions

  3. Telecare practiced by telephone BTiE & 1.6m community alarm users NASA Telehealth Community alarm 1876 1920s 1957 1980s 1900s 1948 2005 1970s Telephone invented Telehealth Morse code Implantable sensors Telehealth video conference The journey so far.....

  4. Telehealth drivers • Community alarms and PTG has laid a telecare foundation. • Darzi review http://www.integratedcarenetwork.gov.uk/index.cfm?pid=486&catalogueContentID=2457

  5. Telehealth drivers “The way healthcare is presently delivered has to be deeply reformed… The situation is becoming unsustainable and will only worsen in the future as chronic diseases and the demographic change place additional strains.” Call for a “new healthcare delivery model based on preventative and person-centred health systems. This new model can only be achieved through proper use of ICT, in combination with appropriate organisational changes and skills.” • European Commission Information Society and Media. (2006). “ICT for Health and i2010: Transforming the European healthcare landscape towards a strategy for ICT for Health.” Luxembourg. ISBN 92-894-7060-7.

  6. Telehealth drivers Prime minister “Over the next few years we will give 100,000 people with long-term conditions the opportunity to manage their care as 'expert patients’. And during 2008 we will bring forward a patients' prospectus that sets out how we will extend to all 15 million patients with a chronic or long-term condition access to a choice of 'active patient' or 'care at home' options - clinically appropriate to them and supported by the NHS.” 7th January 2008 http://www.number10.gov.uk/output/Page14171.asp

  7. Opportunities • Users • Maximise health goals, improve health outcomes & QOL • Empower, Independence (and carers), Enable to stay at home for longer, Choice... • Reduce hospital admissions and length of stay • Prevent or postpone residential care admissions • Enable people in residential care to return home • Reduce the number of GP consultations • Improve medication compliance • Compress morbidity through preventative and enhanced services. • Providers • Enable preventative services and less crisis management • Improved risk management – EBDs, carer hours... • Potential to improve services at reduced overall spend.

  8. Implementation challenges • Reliable academic research literature is mixed • “A large number of studies have been conducted, with about half suggesting clinical benefits and the other half finding no effect.” • Barlow J, Singh D, Bayer S & Curry R. (2007). “A systematic review of the benefits of home telecare for frail elderly people and those with long-term conditions.” Journal of Telemedicine and Telecare.13:172-79. • An integrated approach is required • Is telecare and telehealth the same thing? • Systems should be user and not technology led

  9. Implementation challenges • Receptive organisational and policy context • Clearly defined outcomes and success criteria • Organisational leadership • Competent project management and team skills • Involvement of key stakeholders • Engagement and leadership by clinicians • Action to overcome cultural barriers to change • Training and support • Sufficient time to make the shift • Arrangements for sustaining shifts and scaling them • up, including developing the business case. Ham C, Parker H, Singh D, Wade E. (2007). “Getting the Basics Right. Final report on the Care Closer to Home: Making the Shift Programme.” University of Birmingham. Gateway ref 8283.

  10. Early adopters Pragmatists Innovators Sceptics Evidence chasm Main market Customers want technology and clinical efficiency Customers need clinical effectiveness and cost-effectiveness

  11. Conclusions • A telecare foundation has beenlaid - but only just beginning • Telehealth drivers and policy support is strong • Real benefits for service users and providers are emerging • BUT... • Joint working between organisations is pivotal • We need to fill the evidence chasm. Email: telecare@csip.org.uk

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