Implementation of ICT/Telemedicine:

Experiences of Yorkshire

Rachel Binks

Nurse Consultant, Critical and Acute Care

Airedale NHS Foundation Trust

Tele care

Tele monitoring

tele medicine

tele coaching

Tele coaching

tele medicine

Tele medicine

The Airedale journey

new ways to deliver early specialist opinion

Using technology to work differently

Development into the

Mainstream NHS

Market

Received grant from the Technology Strategy Board

Development of telemedicine solutions for the home

Worked with local company to develop video capability for the

patients’ own home

Pilot for 28 Diabetes patients to receive outpatient appointments via

telemedicine

Regional Telehealth Hub Partners

Airedale NHS Foundation Trust

-Telemedicine

Hull University and Hull and East

Yorkshire NHS Trust

- Telemonitoring

Barnsley PCT

- Telehealth and telecoaching

Regional

Telehealth

Programme and Hub

2008 - ALIP programme

TSB funding, 4 partners

Aims:-

develop product for home use

TV as the display device

standard broadband link

carry out planned teleconsultations using

diabetes as the exemplar

Home teleconsultation

Hub at Airedale

Dedicated facility opened September 2011

24/7 telemedicine service

Acute care nurses

Consultant physicians

providing remote consultant opinion to the

English prison service

supporting elderly patients with long term

conditions in their own homes, nursing and

residential care homes via Telehealth HUB

supporting children with diabetes to manage

their condition at home via Telehealth HUB

supporting rural communities with community

based remote outpatient consultations

enhancing recovery for stroke patients through

stroke telemedicine service

Bringing healthcare

home

Telemedicine

Deployments

Hospice

1 Hospice

5 end of life pathway patients

Integrated Pilot

6 GP surgeries

7 residential home

2 COPD patient

Telemedicine

Deployments

Patients’ own homes

42 COPD patients

30 Heart Failure

patients

25 Diabetes patients

Nursing and Residential

Homes

29 Care Homes + 33

this month

Evidence Base to

December 2012

578 Clinical Consultations

357 primary consultations

221 follow up consultations

198 admissions avoided

52 admissions

The big question

Does it Work?

Feedback

• from patients in their own

homes

• Nursing and residential

home patients

• And carers

• And clinicians

• And nurses

Patient feedback

“…there is no expensive journey to and from hospital.

No re-organising of work commitments to then

spend time sitting around in waiting rooms…

…simply a live link up where I can talk freely and we

can swap ideas as to how to improve my life…”

Gillian, Diabetes Patient,

talking about her home based telemedicine service

http://www.airedaledigitalhealthcarecentre.nhs.uk/Videos/

Care Home feedback

“Very good service, made me feel confidant within my job role so I could do the best I can for our residents. So often we are left in confusion whether we should call a doctor or an ambulance. This service takes the pressure off us as we have access quickly to a health professional who can advise us the best route to follow. Dr Pope was fantastic when one of our dementia patients fell and bashed her nose. I would have called an ambulance and she would have endured an A&E visit which would have terrified her. Dr Pope saved her from this and reassured me that the cut was superficial, which was true - and she was fine.”

Residential Home Care Worker

Nursing Home staff

• ‘made me feel confident in my job role’

• ‘quick, helpful and much easier than going

through telephone triage as (I was)

recognised as a professional, with

knowledge, rather than a complete lay

person as often occurs via telephone’

Does it work?

“It’s a brilliant concept”

“ [the telemedicine system]…has been a Godsend to me. Thank you

for getting me one”

“came into its own 4th Feb when snow and ice brought traffic to a halt.

Geoff’s condition deteriorated suddenly and having visual, instant

contact with the team was very reassuring. A wonderful service”

“I’m only sorry it wasn’t out years ago”

“All the people in my block came round for coffee and saw it working –

they are all quite envious of it now!”

“The best thing about it is knowing I am not alone”

“the picture is faint and the sound keeps coming and going”

http://www.airedaledigitalhealthcarecentre.nhs.uk/Videos/

Overall level of

satisfaction

95% patients and 90% of clinicians described themselves as being “very satisfied”

or “satisfied”.

• Several patients have mentioned the positive benefit of including

family members in the consultation:-

“It was good how we can all have input; Dr. Pope, Jackie [DSN],

myself and my wife all round the TV”

Level of satisfaction – ability to communicate issues and

concerns during the Teleconsultation

When to use?

numerous potential use

cases:

• long term conditions

• outpatients

• nursing homes

• employee health & well

being

• early supported discharge

• admission avoidance

• dementia – carer support

• social care

• purely social calling

• specialist networks

Deploying at scale

Just imagine….

…the number of patients lives

that could be enhanced

…the number of carers and

families that could be

supported

…the amount of time released

to care

…the resources released for

better utilisation/reinvestment

..if we maximised the potential of telehealth at scale

Future Developments

3 year end of life project

- Telephone and telemedicine

North Yorkshire commissioners developing

business case for 40 care homes

Enable telemedicine site wide across Airedale

Does it work?

Patient survey – on going

How satisfied were you with:- Ave Score (0-10 scale)

(a) the teleconsultation 8.7

(b) the video quality 8.5

(c) your ability to use the link to

communicate your issues and

concerns 9.0

(d) the advice you received 8.7

Useful data

• A&E admissions/attendances

• How many admitted

• Length of stay

• Reasons for admission

• Examples of TH Hub support

• Any change in attendance/admission

since Telemedicine enabled

Admissions from September 2011 – August 2012

Time of Attendance in ED

0

10

20

30

40

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80

90

12:00-

12:59 AM

01:00-

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08:00-

08:59 AM

09:00-

09:59 AM

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10:59 AM

11:00-

11:59 AM

12:00-

12:59 PM

01:00-

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07:00-

07:59 PM

08:00-

08:59 PM

09:00-

09:59 PM

10.00-

10:59 PM

11:00-

11:59 PM

No of Patients

Admissions from September 2011 – August 2012

6

(0.98%)

612

(53.5%)

1144

0

200

400

600

800

1000

1200

1400

Emergency Department Attendances for

Nursing/Residential Home Residents

Number Admitted Number Deceased within 24 Hours

Numbers of admissions

Admissions from September 2011 – August 2012

LENGTH OF STAY

0 10 20 30 40 50 60 70 80 90 100

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101112131415161718192021222324252627282930313233343536373839404142434445464749505253545559

>

Nu

mb

er

of

Da

ys

Number of Patients

Admissions from September 2011 – August 2012

0 10 20 30 40 50 60

Cerebral infarction, unspecified

Lobar pneumonia, unspecified

Pneumonia, unspecified

Unspecified acute lower respiratory infection

Chronic obstruct pulmonary dis with acute lower resp infec

Constipation

Urinary tract infection, site not specified

Syncope and collapse

Fracture of neck of femur Closed

Pertrochanteric fracture Closed

Top 10 Admission Reasons

Admissions from Non

Telemedicine Enabled

Homes

• 43 Homes with data from 2011 and 2012

• 34 had a reduction in admissions in 2012

• Overall the reduction in admissions was

31%

Admissions from Non TM Homes

0

2

4

6

8

10

12

14

16

18

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

Home

Ad

mis

sio

ns

2012 - Blue

2011 - Red

Overall Reduction in

Admissions = 31%

Admissions from

Telemedicine Enabled

Homes

• 14 Homes with data from 2011 and 2012

• 12 had a reduction in admissions in 2012

• Overall the reduction was 46%

Admissions in TM Enabled Homes

0

5

10

15

20

25

30

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Home

Ad

mis

sio

ns

2012 - Blue

2011 - Red

Overall Reduction in

Admissions = 46%

1 year results – 24 hr

teleconsultations at home

Year pre post

Year pre post

-29.5% -36.5%

Quotes from patients

• “The telemed literally brought tomorrow’s technology into my living room today; without any need to travel I can talk to a specialist!. The system puts me in control of my diabetes care instead of my illness governing or interfering with my lifestyle.”

• “There is no expensive journey to and from hospital (2 bus journeys each way), no reorganising of work commitments to then spend time sitting around in waiting rooms: simply a live link up where I can talk freely and we can swap ideas as to how to improve my life”

• “The consultation is an active two way process…it makes a huge difference to how I feel about my diabetes and therefore about myself”

What more could we want?

Any Questions?