Introducing telehealth into practice:Unit C4

Learning outcomes

• By the end of this section, you will be able to;– Identify the key challenges associated with

introducing telehealth into practice– Understand strategies for effective

implementation of change– Understand the importance of effective

commissioning and procurement– Discuss methods for evaluating the effectiveness

of telehealth services

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Changing clinical practice can be hard!

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Change in clinical practice

• Think of a recent change introduced in your workplace (either by you or someone else)– Was the introduction of change successful?– What worked in its favour?– What worked against it?– Did people resist change? Why? How was this

overcome?

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The diffusion of innovation and ‘the chasm’ (Moore/Rogers)

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Factors that influence adoption

• Relative advantage– Is it better than we already do?

• Compatibility– does it fit with current processes?

• Simplicity– How easy (or difficult) is it to use?

• Trialability: – Can it be tested easily?

• Observability– Can others see the benefits of using it?

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The process of delivering change (Kotter)

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Pilot to Scale

TO

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Service Operation

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Selecting a patient population

Telehealth patients

Risk stratification

Impactibility assessment

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Service Operation

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Some things to consider…• What will you measure; what peripherals will you use?• How should information be gathered and transferred;• How should technical triage be delivered?• How should clinical triage be delivered?• What is the boundary between ‘technical’ and ‘clinical’

triage?• What will be the operating hours for triage?• How long will you deploy telehealth for?• What are the support structures for users, carers and

practitioners?

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Technology, Interoperability and Governance

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• “Information Governance (IG) is about setting a high standard for the handling of information and giving organisations the tools to achieve that standard” (Connecting for Health)

• Considerations when using telehealth are;– Data confidentiality– Information security– Security of transmission– Records management

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Information governance

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Workforce and Education

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It’s about confidence and responsibility

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How is telehealth bought and paid for?• Usually procured through ‘Buying Solutions’

(Government Procurement Framework)• Options for procurement include;– Buying lots of technology!– Leasing/renting technology from one provider (‘pay as you

go’)– Buying or renting a specific piece of technology for a specific

patient whenever you need it (‘Pick and mix’)– Commissioning a managed service (the ‘all-inclusive’ option)

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Identifying benefits

• What do you want the service to achieve?– Clinical benefits– Benefits for practitioners– Patient and carer benefits– Financial benefits

• How will you know when these benefits have been achieved?

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Activity

• In groups, think about the potential benefits for different telehealth stakeholders;– Acute Trusts– Commissioners (including CCGs)– Community care providers– General Practitioners– Patients/Carers

Acute Trusts • Bringing emergency admissions below the 30% tariff baseline• Reducing <30-day readmissions• Reduction in length of stay and total bed days• Ability to release cash savings by allowing reduction in bed base

Commissioners (including CCGs) 

• Reduction in hospital admissions (not including <30-day readmissions)• Reduction in 999 calls and ED attendances• Reduction in out-patient appointments• Reduced transport costs

Community care providers 

• Reduction in need for community visits• Ability to target community visits more effectively• Increased productivity (e.g. higher caseloads)• Reduced transport costs

General Practitioners

• Reduction in GP appointments by reducing demand• Enhanced quality of care (links to QOF) • Reduced practice workload

Patients/Carers 

• Increased insight into condition and self-management behaviour• Ability to engage with other patients in an informed way • Reduced anxiety• Increased freedom and flexibility

How could we evaluate results/benefits?

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The basics of return on investment…

• Telehealth and telecare services cost money to implement and run.

• The costs will include;– One-off (capital) costs: e.g. purchasing equipment or

building a call centre– Ongoing (revenue) costs: e.g. leasing equipment,

staffing, maintenance costs (for equipment and/or buildings), software licences

• Given the costs involved, investment in these services will only be approved if there are clinical, societal, quality or financial benefits to be gained

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Return on Investment (ROI)

• One measure of whether or not investing in a telehealth or telecare service is worthwhile is to calculate the ROI

• In its simplest sense, this can be calculated by simply subtracting the costs from gross benefits. An example is below;

Benefits£300,000 in year one

Benefits£300,000 in year one

Costs£100,000 capital

£12,000 revenue in year one

Costs£100,000 capital

£12,000 revenue in year one

ROI£188,000 in year one

ROI£188,000 in year one

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Quantifying cost benefits in healthcare

• There are two broad methods by which telehealth services can bring cost benefits;– Healthcare utilisation benefits, including;

• Reduced need for nursing home care• Reduced hospital admissions• Reduced GP appointments• Reduced A&E attendances

– Workload optimisation benefits, including;• Less need for face-to-face consultation• Reduced travelling time and cost• Greater ability to prioritise workload

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Telemonitoring savings case study

• In this case, let’s imagine someone with COPD who has – on average – 2 A&E attendances (£87 each), 2 in-patient episodes (£2168 each) and 6 outpatient appointments (£104 each) each year because of worsening symptoms – total annual cost £5134

• Assume that the installation of a telemonitoring service costs £1500 as a one-off and then £50 per month thereafter – total annual cost £2100

• If the telemonitoring system prevents 1 A&E attendance, 1 in-patient episode and 2 OPA, it will provide gross savings of £2463

• The ROI for this patient alone is therefore £363 in year 1 (and will be more in subsequent years when the capital cost of £1500 is not required)

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