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Telehealth: Looking to the future

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Telehealth: Looking to the future

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    1. Telehealth: Looking to the future

    2. Agenda / Plan NHS Connecting for Health Emerging trends in telehealth Working towards interoperability Information issues Intro on CFH Talk about observations on trends, through our work with industry suppliers & forums and where commissioning needs have been articulated Emerging key themes of particular relevance to working with the spine/CFH environment, considerations for sharing of data / interoperability Issues surrounding provisional of access to advice of information in Telehealth world All things that commissioners of new services need to be aware of plan for when thinking about deploying Telehealth @ scale in order to access the benefits such a service is expected to bring Intro on CFH Talk about observations on trends, through our work with industry suppliers & forums and where commissioning needs have been articulated Emerging key themes of particular relevance to working with the spine/CFH environment, considerations for sharing of data / interoperability Issues surrounding provisional of access to advice of information in Telehealth world All things that commissioners of new services need to be aware of plan for when thinking about deploying Telehealth @ scale in order to access the benefits such a service is expected to bring

    3. “So over the next few years we will give 100,000 people with long-term conditions the opportunity to manage their care in this way …..… and 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” Gordon Brown 7th January 2008 New challenges Emphasise the changing environment and increasing profile : PM declaring v recently revised emphasis on management of LTCs and its importance to users of care services So 100,000 in next few years and ultimately extend option to 15M – implies commissioners need to be doing something now and not merely thinking about pilots but large scale!Emphasise the changing environment and increasing profile : PM declaring v recently revised emphasis on management of LTCs and its importance to users of care services So 100,000 in next few years and ultimately extend option to 15M – implies commissioners need to be doing something now and not merely thinking about pilots but large scale!

    4. NHS Connecting for Health Reminder about CFH & objectives CFH is the IT agency for NHS and the organisation charged with delivering the National Programme for IT Modernise Health IT in England Patient centric Single record for life Info @ point of care Simpler, quicker, interactive Secure Interoperable – core design Focused on joining acute/primary care records Automating high volume processes such as transfer of GP records + prescriptions Reality – not everywhere yet, local reality maybe paper but hope (of programme) full coverage NHS CFH are interested in this field Telehealth – need to understand what Telehealth means for NPfIT How will it work alongside the modernised IT / What need to be in place? Can it work in the way users want to use it? Reminder about CFH & objectives CFH is the IT agency for NHS and the organisation charged with delivering the National Programme for IT Modernise Health IT in England Patient centric Single record for life Info @ point of care Simpler, quicker, interactive Secure Interoperable – core design Focused on joining acute/primary care records Automating high volume processes such as transfer of GP records + prescriptions Reality – not everywhere yet, local reality maybe paper but hope (of programme) full coverage NHS CFH are interested in this field Telehealth – need to understand what Telehealth means for NPfIT How will it work alongside the modernised IT / What need to be in place? Can it work in the way users want to use it?

    5. So heard a lot today about Telecare and Telehealth Services are increasingly becoming blurred Role of lifestyle monitoring / dementia treatment When does it become ‘health’ not social care? Does it matter? So heard a lot today about Telecare and Telehealth Services are increasingly becoming blurred Role of lifestyle monitoring / dementia treatment When does it become ‘health’ not social care? Does it matter?

    6. Layered approach and a portfolio of services If we look at intentions for Telehealth / where will it be used? Intention to increase capacity of professional care to cope with expected increase in nos of patients with LTCs. BUILD Telehealth (vital signs monitoring) will be one of a number of options, selected through considering: Patient suitability Patient choice Cost effectiveness of investment for benefits And to an extent reliant on charging models (where the clinical benefits are clear but perhaps not the financial – patient contribution?) So that’s where Telehealth will fit in overall care services….what’s around today?If we look at intentions for Telehealth / where will it be used? Intention to increase capacity of professional care to cope with expected increase in nos of patients with LTCs. BUILD Telehealth (vital signs monitoring) will be one of a number of options, selected through considering: Patient suitability Patient choice Cost effectiveness of investment for benefits And to an extent reliant on charging models (where the clinical benefits are clear but perhaps not the financial – patient contribution?) So that’s where Telehealth will fit in overall care services….what’s around today?

    7. Very simple (and focussed on vital signs) Patient provided data Monitored by a Telecarer + patient themselves Lifestyle questionnaire / indicators Issues Currently closed system - operating in isolation of other health / social care needs OK @ small scale (manual work arounds) But when looking for large scale / mainstreaming need to think about Clinical safety: robust, foul safe, processes TH alarms/response requests feeding into other main stream IT systems? Data integration – what data is useful, valuable, vital even to move to other services?Very simple (and focussed on vital signs) Patient provided data Monitored by a Telecarer + patient themselves Lifestyle questionnaire / indicators Issues Currently closed system - operating in isolation of other health / social care needs OK @ small scale (manual work arounds) But when looking for large scale / mainstreaming need to think about Clinical safety: robust, foul safe, processes TH alarms/response requests feeding into other main stream IT systems? Data integration – what data is useful, valuable, vital even to move to other services?

    8. Technology trends Some key themes: Integration and interoperability Convergence Single service (alarm to support) Interactivity and empowerment Reducing infrastructure costs Moving with the patient Smarter sensor technologies So these seem to be the key themes emerging in relation to mainstreaming? Methods of sharing data – how and what – CFH working to define national standard Convergence of systems/services: one service alarm – Health monitor – remote support Increasing demand of self-empowerment and involvement Resolved infrastructure costs Single service Flexible not new investment Patient needs Mobile Smarter/usable – lifestyle fitSo these seem to be the key themes emerging in relation to mainstreaming? Methods of sharing data – how and what – CFH working to define national standard Convergence of systems/services: one service alarm – Health monitor – remote support Increasing demand of self-empowerment and involvement Resolved infrastructure costs Single service Flexible not new investment Patient needs Mobile Smarter/usable – lifestyle fit

    9. Whole System Capabilities These trends for interoperability + ‘single flexible service’ can be explained when you think about moves towards ‘whole system approaches: Work across services for case funding Single and joint assessments Choice of services to suit need Mobile community based workforce able to respond and be informed real time Interoperability is one are where connecting for health have a key role:These trends for interoperability + ‘single flexible service’ can be explained when you think about moves towards ‘whole system approaches: Work across services for case funding Single and joint assessments Choice of services to suit need Mobile community based workforce able to respond and be informed real time Interoperability is one are where connecting for health have a key role:

    10. Work is underway towards large scale interoperability: CFH supporting the Continua Alliance: A collection of industry leaders who are focussing on developing interoperable personal health systems help individuals to manage health + wellness Initial focus on core Telehealth/Personal health services, because Control of design/offering Sensible step forward Market test / validate Assess the demand for further?Work is underway towards large scale interoperability: CFH supporting the Continua Alliance: A collection of industry leaders who are focussing on developing interoperable personal health systems help individuals to manage health + wellness Initial focus on core Telehealth/Personal health services, because Control of design/offering Sensible step forward Market test / validate Assess the demand for further?

    11. Information Security New challenges: New environments, new standards Identifying patients Usable solutions for secure access Consent to share and compartmentalised access Data provenance Working in this new world brings challenges: New standards requiring compliance Are able to identify the right patient in all records?Working in this new world brings challenges: New standards requiring compliance Are able to identify the right patient in all records?

    12. With new technologes and new capabilities, naturally will want to do more – things that there is not a great deal of experience around: DATA what is needed where Who owns it? Certifies it for use? New formats? LINKING Safe working Useable/performant (Speed / accuracy/ reliability) SHARING Wider sharing – consents? How will they be acquired in a large scale service? What is needed and how does it change (GPS don’t want it all?) Demographic – linking care history so you truly understand who needs what & whyWith new technologes and new capabilities, naturally will want to do more – things that there is not a great deal of experience around: DATA what is needed where Who owns it? Certifies it for use? New formats? LINKING Safe working Useable/performant (Speed / accuracy/ reliability) SHARING Wider sharing – consents? How will they be acquired in a large scale service? What is needed and how does it change (GPS don’t want it all?) Demographic – linking care history so you truly understand who needs what & why

    13. Conclusion Emerging market Ethics & consents Interoperability Uncharted territory: Data provenance Patient ID Security Infrastructure Building for flexibility So in summary, This is an emerging market – requirements are being investigated & new products being offered Services will be used in new ways bringing challenges such as Ethical considerations Consent to use And demand for interoperability and other trends The danger is that so much of this is new that current initiatives might quickly lose relevance in the changing world: To protect against this we would recommend that you plan for the following areas: New environment Change to current infrastructure Flexible for future change as needs evolve Don’t want to be stuck in a position where the small, initial pilot that convinces local users of value cannot move forward.So in summary, This is an emerging market – requirements are being investigated & new products being offered Services will be used in new ways bringing challenges such as Ethical considerations Consent to use And demand for interoperability and other trends The danger is that so much of this is new that current initiatives might quickly lose relevance in the changing world: To protect against this we would recommend that you plan for the following areas: New environment Change to current infrastructure Flexible for future change as needs evolve Don’t want to be stuck in a position where the small, initial pilot that convinces local users of value cannot move forward.

    14. Thank you! michaeldillon@nhs.net

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