01.06.13
Making Connections – new pathways enabled by technology are essential for England
Source: National Health Executive: May/June 2013
Charlotte Morris, research assistant at think tank 2020health.org, discusses the lessons the NHS in England can learn
about digital healthcare from the US Veterans Health Administration.
We are at a crossroads in England in the delivery of healthcare. New technologies mean that we have the potential to deliver healthcare and monitoring in patients’ homes at lower cost and higher quality. Only by using technology can we hope to meet the growing demands driven by the rising number of those living longer, many with long term conditions.
At the same time though, the current economic climate means there is virtually no budget growth, which is delaying decisions regarding the implementation of these new technologies. It is important that action to remodel health services in England is taken soon, before the quality of care is jeopardised and funds are further wasted through labour-intensive, inefficient and inadequate services.
Telehealth represents a vital element in the shift towards more home-based care and benefits for patients with long term conditions. In January 2012, 2020health published a short report ‘Telehealth: What can the NHS learn from experience at the US Veterans Health Administration?’ which looked at what the NHS could learn from the largest implementation of telehealth anywhere in the world (see NHE Jan/Feb 2012 for more).
A year later, we have published a second report – ‘Making Connections: A transatlantic exchange to support the adoption of digital health between the US VHA and the England’s NHS’ – which builds on the first, adding much greater depth to our findings and recommendations. It not only reflects the impressive use of technology currently provided by the Veteran’s Health Administration (VHA), but also draws on the innovative progress that has been made in the NHS through its experience of telehealth.
Our research discovered a number of outstanding uses of telehealth both in the VHA and the NHS which we wanted to share.
The use of Clinical Video Telehealth (CVT) in the VHA
The extensive use of CVT in the VHA has been beneficial to patients and staff alike. CVT allows video-based meetings and consultations between patients, in community clinics near their homes, and medical specialists based at VHA Medical Centres, which may be far away. Patients living in remote and rural areas value the service highly. They not only save time and money on travel, but for many for whom it may be difficult to travel, avoids considerable upheaval and pain. Those living in increasingly sprawling urban environments have valued the same benefits. A patient can simply visit their local clinic and have real-time access to any medical specialist. In fact, the use of CVT has been increasing by 30% year on year, and this has been put down to patient satisfaction.
CVT take-up is highest among mental health patients, and also those on weight-loss programmes. The VHA claim that outcomes from CVT replicate or even exceed those of face-to-face appointments, especially in such sensitive areas as post-traumatic stress disorder and sexual traumas. For mental health patients, CVT has found to reduce bed days of care (BDOC) by 28%.
For staff, they feel reassured. Using CVT gives them wide access to specialists in their region and from across the continent. Before the introduction of CVT, remote areas were finding it difficult to recruit new staff, especially talented young graduates. Allowing remote areas direct access to specialists in other parts of the country through CVT has solved this, as well as other health inequality issues. It also allows staff to see more patients, as travel time for them is also reduced.
We urge the NHS to look at taking up best practice from the VHA’s experience here. To be successful, they’ll need to make sure that relevant pathways are redesigned, to make the most of the capabilities that technology provides, and in order to embed such technology as the new normal.
The use of mobile health in the NHS
On the other side of the Atlantic, the NHS considers mobile health to be one of the most important recent developments in healthcare. The NHS Information Strategy, ‘The Power of Information’, has described an ambitious plan to make more use of mobile technology, with over 90% of the UK population having at least one mobile phone. One of the pioneers in this space is Safe Patient Systems Ltd, an independent company spun out of the Heart of England NHS Foundation Trust’s R&D department. Its telehealth solution, ‘Safe Mobile Care’, is a mobile app that empowers patients to manage their condition at home while allowing healthcare professionals to safely monitor and prescribe for their condition remotely.
Every day the medically accredited phones prompt patients to complete clinically validated questionnaires and automatically capture relevant vital signs using wirelessly connected monitoring triage. Where appropriate alerts are generated they are sent to the relevant nurse or doctor by text message, email or a website alert. The doctor or nurse can then call the patient on the smartphone device, advise on what course of action should be taken, and then capture this intervention as part of the patient record.
This simple intervention has been shown to reduce emergency hospital admissions by 58%. A study has also shown the benefits that clinicians derive from basing decisions on much more regular information, facilitating earlier intervention. Safe Mobile Care is now being used by both NHS Bristol and NHS Somerset.
These two snapshots of how telehealth is already being used show that if the NHS is to meet public expectations for quality, access and efficiency then it must recognise it needs new ubiquitous capabilities. Capabilities such as the ones above will allow the NHS to collaborate, transact and access information and expertise on demand, as well as deliver advice and care in non traditional settings including the home and the workplace.
The VHA and the NHS have a history of working together to share learning and experiences with the aim of driving improvement.
Our report provides the foundation for a recently launched three-year exchange programme between those in the VHA and the NHS. Please let us know if you would like to know more about the exchange. The aim is to give participants the tools and connections for the implementation of digital health in mainstream services in the areas in which they work.