Session 4.7

Enabling Technology: Supporting People, Driving

Efficiency, Delivering 21st Century Services

Margaret Duffy

Chief Operating Officer

NHS Forth Valley

Introduction and Opening Remarks

Back to the Future!

Dr George Crooks OBE

Efficiency

Productivity

European Union

Citizens 65+ 81m (2008)

151m (2060) 86%

Number of Carers ↓

Number requiring care

http://upload.wikimedia.org/wikipedia/commons/c/c9/Dublin_Riots_25-02-06.jpg

and another FACT……..

20131,000,000,000,000 (trillion)

devices connected to the internet

USA 31/12/10

Majority of Internet Access is by

Mobile Devices

InternetTV

Telecare

Face To

FaceSMSVideo

Mobile

Phone

Video Conferencing Infrastructure Project

Hazel Archer

• Commission from Regional Planning Chief Executive – fix video conferencing

• Pilot in North of Scotland

• Collaborative approach, working with NSS, NoSPG, SCTT and Northern Boards

Background

The Requirements

• Robust video conferencing over the N3 network

• Improved management of systems

• Phase 2– Increased resilience– Increased capacity to support NHS

Scotland– Access from the Internet

What did we do?

Dedicated video conferencing subnet

00

05

44

5

Janet / NHS GK

NHS Scotland

GK

GDS Dial Plan

N3

WWW

Health BoardHealth Board

Registered Directly

SUB HEADING TO BE

Complete

In Progress

In Planning

Not Participating

Progress by Health Board

What does it achieve?

Next Steps

• Finish what we have started• Business case for

– Ongoing infrastructure costs– Bridging Services– Help Desk– Support Services– Patient home links

• Public Sector VC Network?

Tips on How to Grow a National Telehealth Service

Anne ReochCardiac & Stroke Clinical Lead

SCTT

Where do you start?

Need strong roots….

Europeantelestroke

2005

SMCAlteplase

2004

Scottishinterest2006

SCT2007

Need enthusiasts that can drive forward change and influence strategy…

NAC MCN2008

Europeantelestroke

2005

SMCAlteplase

2004

Scottishinterest2006

SCT2007

First pilots2008

Initial funding2008

Dedicated ITSupport

2009

Need access to regional and national planning

Europeantelestroke

2005

SMCAlteplase

2004

Scottishinterest2006

SCT2007

First pilots2008

Initial funding2008

NAC MCN2008

eHealthP2010

Regional Planning

2009

SCT/NHS 24

2010

Dedicated ITSupport

2009

Europeantelestroke

2005

SMCAlteplase

2004

Scottishinterest2006

SCT2007

First pilots2008

Initial funding2008

NAC MCN2008

Regional Planning

2009

SCT/NHS 24

2010

eHealthP2010

DedicatedITSupport

2008

ScottishTelestroke

network2011

Five networks in place but we have the technical ability to join all together or split up….

Western Isles

Grampian

Forth Valley FifeGreater Glasgow & Clyde

Ayrshire & Arran

Dumfries & Galloway

Borders

Lothian

Highland

Lanarkshire

Patient’s daughter sent this message to the South network hub in the first month it was operational:

“I just wanted to pass on sincerest thanks on behalf of my Mum,

my brother and myself for the treatment you were able to provide my Dad on Saturday. The progress Dad has made

in the space of a few days is incredible and we know that has a lot to do with the clot busting drug you were able to prescribe….

Thank you so much”

www.scot.nhs.uk/stroke.html

A MESH TeleStroke NetworkMark Barber

• Delayed or missed thrombolysis• Highly selective vetting?• Inequity – especially Wishaw patients• Majority of patients won’t be treated• Travel for relatives and repatriation• Continuity of Care/ Communication• Impact on SAS• Impact on South or North Glasgow Hospitals• Impact on local stroke units• Impact on research

Brian MacInnes

Ana TalbotGraham EllisMark Barber

Niall HughesMartin Whitehead

Brian MacInnesNiall Hughes

Martin WhiteheadAna Talbot

Graham EllisMark Barber

MESH Model

• Teleconferencing equipment in each Stroke Unit

• Teleconferencing equipment in each consultant home (N3)

• Bidirectional communication

Home or away

Year to 14.6.11

• 122 recorded as assessed (half by VC)

• 56 treated (30 by telemedicine)

• Guestimated 7-8% treatment rate

• Already achieving QIS standard for numbers treated

Did you feel that you obtained sufficient information from history and examination to

make a management plan?

0

2

4

6

8

10

12

14

16

18

Definitely

not

Probably not Neutral Yes, probably Yes,

Definitely

Consultant confidence

Next steps......

• Video links to ambulance..........?

Telehealth for Children

Scottish Centre for Telehealth and Telecare

Marcia Rankin – Service Development ManagerSharon Levy – Telemedicine Nurse Specialist

The Scottish Centre for Telehealth and Telecare (SCTT)

Paediatric Workstream

Six live project areas, involving the support of

1. Unscheduled Care/Critical Decisions2. Clinical Networks3. CAMHS trials4. Child Protection communications5. Educational activities6. Care at Home

We adopted an incremental approach to our pilot with an initial focus on service users at the Scottish Spina Bifida Association

To date 4 families have used the home video links and provided valuable insight to using remote interaction to support babies, children and young people with complex needs

A further 4 families have used home video links for palliative care needs

We are most grateful to them all

Care at Home

Supporting remote care of children with complex and palliative care needs – at home.

Telehealth for Children and Young People…

“Caring for children with life limiting or terminal illness in their

own home is cheaper and less emotionally stressful for family members than caring for them in hospital”

Anne Harris – director of care services at the children’s charity Rainbow Trust

Nursing Times 107(18) p7

Parent Comment…

“ … there is so much offered for adult palliative care … there are a lot of things in place but in paediatrics… because it such a taboo subject there is very little in place… so certainly, paediatrics is a place where huge benefits could be gained (from using Telehealth from home).

A view of a father whose little girl died at home whilst participating in the pilot

Matching Technology to needs…

Aims:

To test a technology solution that provides a potential for enhanced healthcare communications for patients, parents or carers in their own home

A range of video conference systems were tested:

a traditional video conferencing systema ‘video phone’ type device anda laptop using a webcam

What we found:

Following evaluation, it was found that a laptop using the Tandberg Movi video conferencing software provided a good, cost effective and manageable platform for the trials.

Matching Technology to Needs…

Aim:

To review the infrastructure for supporting video conferencing access from patients home, or a home like environment, to a remote NHS service provider;

What we found:

The provision of home based video links to the appropriate clinical location has proved to be a significant challenge. This has been primarily due to the lack of a national IP based video conferencing network running over N3.

Next Steps:

The National Video Conferencing Infrastructure Project is implementing the necessary infrastructure to support some calls out with the North of Scotland.

Matching Technology to Needs…

Aim:

To evaluate the benefits obtained and challenges encountered during the care at home pilot and to assess the feasibility of wider rollout.

What we Found:

Families were asked to complete a web based survey tool, which had 10

questions around the theme of ‘patient centeredness’1. Families are also

given an opportunity to reflect on their experience in an in depth interview a few months after the last VC session. This is still on going.

Doctors and nurses were asked to complete a paper based survey which

was based on Guy’s Communication Questionnaire (GCQ) 2. This tool

includes 5 questions with spaces to record free text for comments and observations.

Clinicians at NHS Tayside

Guy’s Communication Questionnaire (GCQ)

1. Did you achieve your aims during the consultation? Yes * 8

2. In your session, could you see everything you needed to see? Yes * 8

3. Could you hear all you needed to hear? Yes * 7

4. Would you like to have another session like this again? Yes * 8

5. How close did you feel to the person you were talking? Just right * 8

Comments? Plenty!

Clinician comments from NHS Tayside

Early benefits included:

1. Increased parental satisfaction with the service2. Parents valued the enhanced support during the difficult end-of-life phase3. The option of accessing the expertise of the clinical team, from home, improved the therapeutic interaction and the sense of ‘partnership’ with the family4. Innovative practice significantly reduced the need for the patient to attend hospital visits and prevented possible admission to the ward

The team in Tayside suggest that there were at least 3 occasions where an admission to the ward was averted – one day admission typically costs £450, total savings = £1350

When the planned care was going well there was less need for home visits and the family experienced an increased sense of being ‘in control’

Feedback Lothian:

• “…its another way of improving communication with the family, especially if there was a crisis at a time when we could not go out to the family …the visual clues from their facial expressions is a huge benefit - a much, much better way of communicating with the family than the normal way, via the phone or text which we rely on in between home visits. When we did use it (telemedicine), it worked extremely well”

Lead consultant NHS Lothian

Outcomes

• Efficient utilisation of high quality specialist resources

• Reduction in travel costs and carbon emissions

• Increase in satisfaction and positive care experience

• Reduction in parental/patient sense of isolation, stress and anxiety.

Efficient utilisation of high quality specialist resources

A new born discharged home to Dumfries needing to attend an outpatient clinic in Glasgow some 140 miles away. Four virtual sessions scheduled with parents (and local Health Visitor) where the surgeon was able to:

– monitor surgical wound healing and developmental growth, – offer parental education and reassurance, – support local health care providers and ensure continuity of care,

and– demonstrate innovative practice to accompanying medical students.

Reduction in travel costs and carbon emissions

Edinburgh Sick Kids Hospital – Child’s home in Stirling

– Travel distance one way – 36 miles RAC website– Travel time one way – 49 minutes RAC website– Average Fuel Cost per single journey – £6.60 RAC website– NHS Lothian travel claim cost per single journey - £17.14 (47.6 p per

mile private car)– CO2 emissions (kgCO2) – 4.21 medium car RAC website

5 saved return journeys

– Time = 490 minutes– Fuel Cost = £66.00– Expenses Cost = £171.40– CO2 Emissions = 421 kg

Increase in satisfaction and positive care experience

“… there was a marked deterioration in the condition of the child during a week of extreme weather, were everywhere was covered in snow. The Telemedicine link proved extremely valuable then. Swift and appropriate action was taken following the virtual visit. The team could determine the care and treatment requirements prior to setting off on urgent home visits. Drugs, equipment and appropriate support were provided ‘just in time’ and the impact of such action on the child’s quality of life was remarkable…”

Lead consultant, NHS Tayside

Reduction in parental/patient sense of isolation, stress and anxiety

A number of teenagers in the Grampian area were able to participate remotely with the SSBA Youth club:

“ There are no other young people with this condition locally and going to Cumbernauld means a 4 hours drive… so its really good to be able to take part. They are all really friendly and you were able to say anything – it was great!”

M age 13

Telehealth for Palliative Care

“Telehealth is gaining wide spread acceptance and is perceived to be both usable and acceptable to both patients and professionals in palliative care settings”

Kidd L, et al., Telehealth in palliative care in the UK: a review of the evidence. Journal of telemedicine and telecare, 2010. 16(7): p. 394 - 402.

Conclusion

• Current telecommunication technologies offer an opportunity to deliver excellent care closer to home for children, young people and their families

• Using devices which are already in use within the home environment will reduce costs and increase the availability of Telehealth in Paediatrics in the future

• There is strong support from Parents/Patients, Clinicians and charities that telehealth supports patient centred themes

• There is emerging evidence to support the efficiency argument

• There is much more to do in this area to strengthen the evidence and awareness

Telehealth for Children...

If you would like to, contact us at marcia.rankin@nhs24.scot.nhs.uk