General FAQs
Although there are many different definitions of telecare the one selected here is that provided within the Whole System Demonstrator Programme, which is referenced in a number of responses that follow and so will provided consistency with these.
“Telecare is a service that enables people, especially older and more vulnerable individuals, to live independently and securely in their own home. It includes services that incorporate personal and environmental sensors in the home, and remotely, that enable people to remain safe and independent in their own home for longer. 24 hour monitoring ensures that should an event occur, the information is acted upon immediately and the most appropriate response put in train.”
Ref: Department of Health, Whole Systems Demonstrator
Telecare is a service that enables people, especially older and more vulnerable individuals, to live independently in their own home. 90% of people say that that is their wish and Telecare allows it to happen. Equally it gives peace of mind to family, friends and carers, knowing that when they are unable to watch over their loved ones, Telecare will.
Telecare is as much about the philosophy of dignity and independence as it is about equipment and services. Equipment is provided to support the individual in their home and tailored to meet their needs. It can be as simple as the basic community alarm service, able to respond in an emergency and provide regular contact by telephone. it can include detectors or monitors such as motion or falls and fire and gas that trigger a warning to a response centre staffed 24 hours a day, 365 days a year.
As well as responding to an immediate need, telecare can work in a preventative mode, with services programmed to monitor an individual's health or well-being. Often known as lifestyle monitoring, this can provide early warning of deterioration, prompting a response from family or professionals. The same technology can be used to provide safety and security through bogus caller and burglar alarms.
As with Telecare there are many different definitions of telehealth and so again the one selected here is that provided within the Whole System Demonstrator Programme, however, wider ranging definitions can be found within the TSA document “Telehealth in the United Kingdom. A State of Play Report”, October 2011.
“Telehealth – often referred to as remote patient monitoring - refers to the use of various point-of-care technologies to monitor a patient’s physiological status and health conditions. When combined with personalised health education within a chronic disease management programme, it can significantly improve an individual’s health and quality of life. Typically, it involves electronic sensors or equipment that monitors vital health signs remotely from home or while on the move. Readings are automatically transmitted to an appropriately trained person who can monitor the health vital signs and make decisions about potential interventions in real time, without the patient needing to attend a clinic.”
Ref: Department of Health, Whole Systems Demonstrator
Telehealth works by monitoring vital signs, such as blood pressure, and transmitting the data to a response centre or clinician's computer, where it is monitored against parameters set by the individual's clinician. Evidence that vital signs are outside of 'normal' parameters triggers a response. To be successful telehealth needs to be part of the local health and social care pathway for managing long term conditions.
What is the Whole System Demonstrator (WSD) programme?
The Whole System Demonstrator programme is the largest randomised ontrol trial in the world. It's purpose was to establish "a clear evidence base to support important investment decisions and show how technology supports people to live independently, take control and be responsible for their own health and care."
Ref: Department of Health, Whole System Demonstrator Programme, Headline Findings – December 2011
The early findings are very positive, with:
• 45% reduction in mortality rates
• 20% reduction in emergency admissions
• 15% reduction in A&E visits
• 14% reduction in elective admissions
• 14% reduction in bed days
• 8% reduction in tariff costs
These early findings will be followed up by the peer review for the telehealth results, and the findings from the telecare element of the trial.
Can QIPP (Quality, Innovation, Productivity and Prevention) resources be used for telehealth?
QIPP is a large scale transformational programme for the NHS, involving all NHS staff, clinicians, patients and the voluntary sector and will improve the quality of care the NHS delivers whilst making up to £20billion of efficiency savings by 2014-15, which will be reinvested in frontline care.
As stated within the Foreword of The Operating Framework for the NHS in England 2012/13, “Meeting the quality and productivity challenge”….
“The role of innovation, too often the forgotten element of QIPP, will be critical. Rapidly spreading changes that improve quality and productivity to all parts of the NHS will be crucial: a clear example is the use of telehealth to improve services for patients with long term conditions.”
What does telehealth and telecare deliver for:
• Improvements in the way patients, and their families, access information about their own health
• Empowers individuals to take more control of their own health and improves self care
• Reduces the need to travel, less time off work and decreases waiting times
• Decreases the number of emergency visits and unplanned hospital admissions
• Enables a person to retain their dignity and independence
• Enables a person to remain safe and secure in their own home for as long as possible.
Telehealth solutions offer a way of delivering tailored care for patients with long term conditions, which helps improve quality of life and prevent avoidable hospital admissions.
“By using Telehealth equipment individuals can take the same measurements that a nurse or GP would take at a surgery thereby avoiding frequent visits to the surgery. Measurements are automatically sent through the telephone line and the nurse or GP will be able to read those measurements from their desk at the surgery to monitor the user’s progress.”
Ref: Department of Health, Whole Systems Demonstrators, An Overview of Telecare and Telehealth
Telehealth can alert to deterioration in a patient’s condition so enabling pre-emptive support or treatment prior to it escalating to an unscheduled admission. Telehealth also provides the support and confidence needed by a patient such that visiting A&E is not their immediate reaction. Together this means that clinicians can much better manage the care of the long term condition rather than always having to react to it.
The outcomes of the WSD study have clearly demonstrated the cost savings attributable to telehealth deployment but also recognise that the initial capital outlay can be the rate limiting step; something all are now working to rectify as again recognised within the WSD study with the development of commercial models that address this issue; so removing any remaining Commissioning obstacle.
The benefits to all are perhaps best summarized by the Northern Ireland Health Minister Michael McGimpsey, who said, when announcing the remote tele-monitoring contract early in 2011 by the European Centre for Connected Health:
“This is a wonderful achievement for the health service in Northern Ireland. The pressures on our health budget over the coming years together with challenging demographic trends such as an ageing population, mean that the health service is going to have to find new ways to ensure that we continue to provide a high quality service.”
“With increasing numbers of people presenting with more and more complex needs and extremely high expectations of the health service, we must continue to provide the highest possible standard of care. There is no doubt that remote tele-monitoring is a prime example of the innovation that will be required going forward.
This new service will mean a better experience and better outcomes for many of our patients, with earlier interventions when they have a flare-up and fewer spells in hospital as a result.”
Can a patient be monitored by both telecare and telehealth services?
Yes. An example of this would be a frail elderly patient with COPD. Use of telecare devices such as a pendant alarm would provide immediate assistance in the case of an emergency such as a fall, intruder etc., whereas telehealth devices could be utilised to monitor the COPD. The benefit of both to the patient being the ability to maintain their independence whilst having the increased confidence of knowing their long terms health condition is being monitored, and that any change is recognised and acted upon, preventing acute exacerbation.
What standards exist for the service delivery of telecare and telehealth?
There are existing, clear, defined standards for the service delivery of telecare, and standards are currently being developed for telehealth. The TSA has led the development of recognised, high quality standards for telecare through its Telecare Code of Practice. Over 140 organisations are independently audited and accredited to ensure the delivery of a guaranteed quality service to users. Separately the TSA is currently working with clinicians and policy makers on the development of a set of service delivery standards for telehealth. This work will be completed during 2012, resulting in a fully integrated Telecare and Telehealth Code of Practice for service delivery in the UK.
