Forward Thinking: The International Code of Practice for Telehealth Services

Dr Malcolm Fisk

European Economic Interest Group (EEIG) developed from the EC funded TeleSCoPE project

Directors in 3 countriesnon-profit making

Promoting high quality standards in telehealth servicesstrong ethical dimensionMembers’ Charter (in participant packs)

Supporting all stakeholders –service providers; suppliers; users and carers; commissioners;

strategic bodies, regulatory and government agencies

Supporting new ways of thinkingchanging service approaches

www.telehealth.global

International Code of Practice for Telehealth Services TQG Manifesto (in participant packs)

collaborationsupport to membersinfluence policy and practice to promote and develop telehealthevents, training, research, consultancy

During 2016 and 2017build membership to 40 organisations

change thinking about telehealth / challenge outdated approachesdevelop two or more collaborative agreements (internationally)support 10 services in 3+ countries to become Code certifiedrelease to 2017 version of the International Codeparticipate in at least one European Commission funded projectbuild a financial surplus to support TQG activities

www.telehealth.global

TelehealthWhat do we mean by telehealth? 1

[Telehealth Quality Group: 2016 International Code of Practice for Telehealth Services. See

www.telehealth.global]

Telehealth is the means by which technologies and related services concerned with health and well-

being are accessed by people* or provided for them irrespective of their location*.

Source: India Vision

people* … all ageslocation* … all places

Domains of TelehealthAbsolutely not just vital-signs monitoring!

[Telehealth Quality Group:

2016 International

Code of Practice for

Telehealth Services.

See www.telehealth.global]

• …and more!

Health and motivational coaching and advice

Activity and lifestyle monitoring

Safeguarding and monitoring in care settings

Gait, seizure and falls prediction / management

Point of care testing and diagnoses

Vital signs monitoring

Mobile Health technology systems (e.g. apps)

Medication or therapy adherence

Rehabilitation and (re)ablement

Responses to adverse ‘events’ and incidents

Tele-consultation and virtual presence

TelehealthWhat do we mean by telehealth? 2

Not just …• about the ‘delivery’ or top-down management of care

• concerned with clinical and acute conditions• about saving money and avoiding hospital admissions

Rather it’s about …• empowering people to manage their own care

• maintaining and changing lifestyles and behaviours • better mental health as well as physical health

• public and preventative (as well as clinical) health• as relevant to a 26 year old managing her diabetes as it

is to an 86 year old being helped with his dementia

Examples of Telehealth Service Development

• Dignio (Norway)

• Svensk Telepsykiatri (Sweden)

• Fold Group (UK)

… [all TQG members] an indication of the breadth of telehealth

Dignio [TQG member]

Telehealth Service Development in Norway

• Service platform for self-care (‘seniors go digital’) … and home care

• The ‘mobile’ becomes the new social alarm

• Focus on well-being as well as clinical health

• Involvement of users and carers … including notifications

• GPS for people with dementia

• Mobile approach to monitoring as well as through ‘fixed contact centre’

• Support to telecare / telehealth services setting up

Svensk Telepsykiatri [TQG member]

Telehealth Service Development in Sweden

• Psychiatric service on-line

o diagnosis and treatment

o CBT, motivational coaching

• Irrespective of user’s location or country of residence

• Based on video-conferencing

o as good / better than other interventions (for some)

• Clear protocols for interactions

• Support and training for other services

Image: Cloudvisit

Fold Group [TQG member]

Telehealth Service Development in the UK

• Established telecare service

• Part of T3 Group ‘delivering’ tele-monitoring service in Northern Ireland

… includes Tunstall and S3 Group

• 3,000 patients with LTCs… helping them monitor vital-signs at home

• Telecare integral to assessments for dementia care (Northern Trust)

www.clearcare.com

The International Code of Practice for Telehealth Services 1

• Builds on the 2014 European Code of Practice • Incorporates ISO/TS 13131 • Offers flexible framework

- reflecting trends in standards- supporting innovation

- moves away from rigid service models and linked PIs- accommodates services using different technologies• User (and carer) oriented, empowerment approach

• Implications for product and service design • Echoes Canadian standards approach

• Robust Assessment- Self-assessment option

- Independent assessments through DNVGL

•Nine Sections, 54 Clauses- A General Considerations

-B Ethical Perspectives- C Governance and Financial Issues

- D Personal Information Management- E Staff and Staff Management

- F Contact with Users and Carers- G Interpretation of and Responses to Information

- H Communications Networks-J Hardware and Technological Considerations

The International Code of Practice for Telehealth Services 2

Section D – Personal Information ManagementD3 User and Carer Access to Personal Information

D3 User and Carer Access to Personal Information

Requirement:

Services shall make provision for users and carers to access their personal information.

Guidance:

Full access to personal information (including audit trails relating to access to and usage of

the same) shall be available to users and carers, but they shall not be able to alter or add to

such information except in respect of updating their circumstances or service choices; and

when uploading information e.g. regarding measures of their vital-signs. Their right to

request corrections and, in certain circumstances, to object to the processing of their

personal data shall be recognised. …… This right of access extends to users and carers

where the service is provided through a contracted arrangement with an intermediary

organisation.

Services shall be guided by the principles set out in ISO 27001 and the OECD (2013)

‘Guidelines on the Protection of Privacy and Cross-Border Flows of Personal Data.’

ISO/TS 13131:

This requirement adds to and complements those set out in ISO/TS 13131 Health Informatics -

Quality Planning Guidelines for Telehealth Services.

Section E – Staff and Staff ManagementE6 Whistle Blowing Policy

E6 Whistle-blowing Policy

Requirement:

Services shall have a whistle-blowing policy by which staff can report any concerns.

Guidance:

This policy shall ensure that all staff are fully aware of their responsibility to, and the avenues

by which, they can (in confidence and without prejudice to themselves) report if elements of

the service may have fallen or be at risk of falling below the required standards.

…contracts for staff shall contain ‘whistle-blower’ clause and that procedures for reporting

their concerns shall be set out. … in normal circumstances, be to a more senior (or a

designated) staff member … alternative option … (i.e. the TQG or its agents) or the main

national body responsible for … protect anonymity …

ISO/TS 13131:

This requirement adds to and complements those set out in ISO/TS 13131 Health Informatics -

Quality Planning Guidelines for Telehealth Services.

Section F – Contact with users and CarersF3 Tele-consultations

F3 Tele-consultations

Requirement:

Services shall have policies, where included as part of the contracted service, for tele-

consultations with users and carers (via telephone, video-links, Skype, etc.).

Guidance:

Tele-consultations shall only be undertaken by authorised staff and shall follow clear

procedures. These shall include …

Authorised staff undertaking such tele-consultations shall clearly identify themselves on-line at

the beginning of the encounter …

Provision shall be made for tele-consultations to be initiated by users and/or carers as well as by

the service provider … to easily terminate tele-consultations. It shall, in either case, be clear to

them when video and/or audio links have been closed.

ISO/TS 13131:

This clause covers Clauses 12.2, 12.3 and 14.3 of the ISO/TS 13131 Health Informatics - Quality

Planning Guidelines for Telehealth Services.

Section A – General ConsiderationsA7 Service Performance

A7 Service Performance

Requirement:

Services shall record their performance in relation to a set of relevant measures.

Guidance:

Services shall determine the relevant measures of performance. …include operational data …

framework against which measurement of performance can be made … might usefully include

time taken, number or frequency with regard to provision, calibration, testing, installation or

removal of devices and related technologies; examining data and/or responding to needs

indicated through enquiries or device activation; verifying and updating user details, service

choices and consents; dealing with complaints, compliments and suggestions.

It is highly desirable that services honestly and openly display a range of such measures on their

website or in other publicly available material.

A clear declaration regarding compliance … shall be placed on the website or in the Discovery

Zone of the TQG website. The declaration shall be dated and reviewed annually

ISO/TS 13131:

This clause together with A5, B2, C2, C3, C5, F1, H1 and H2 covers Clauses 5.3, 8.1 to 8.4 and 13.6

of the ISO/TS 13131 Health Informatics - Quality Planning Guidelines for Telehealth Services.

And there are 50 More Clauses …

• …that cover all aspects of telehealth services

• that apply to all kinds of telehealth services- from simple prompting

- to telecare- to activity monitoring

- to health coaching- to vital-signs monitoring

… and relate to needs from pregnancy to palliative care

• that focus of the needs and choices of service users (and carers)

Source: Pivotell

What Now? TQG will move positively forward in line with Manifesto Assessors are trained and ready to go

a range of services will be assessed andcertified this year

building on the substantial growing interest in the code

Membership will grow significantlybecause we, together, can change things

transforming the marketwill you join? (copies of guidelines and application forms are on the TQG stand)

Pursuit of telehealth not as a way of saving moneybut of doing things better – for users and carers

www.telehealth.global

Dignio, East London NHS Foundation Trust (TQG members), the TQG and

DNVGL working in partnership …

Thank YouDiolch yn Fawr

Dr Malcolm Fisk malcolm.fisk@dmu.ac.uk