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 C4/1

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/2

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/3

Changing clinical practice can be hard! C4/4

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? C4/5

The diffusion of innovation and ‘the chasm’ (Moore/Rogers) C4/6

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? Rogers: Diffusion of Innovations C4/72

The process of delivering change (Kotter) C4/8

Pilot to Scale TO C4/9

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/10

Service Operation C4/11

Selecting a patient population Telehealth patients Risk stratification Impactibility assessment Based on Lewis (2010) C4/12

Service Operation C4/11

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? C4/15

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/16

Technology, Interoperability and Governance C4/17

“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 C4/18 Information governance

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/19

Workforce and Education C4/20

It’s about confidence and responsibility M4/24

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/22

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) C4/23

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/24

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? C4/25

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? RCT Matched control study ‘Before and after’ study Case studies Opinion C4/26

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 C4/27

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 C4/28

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 C4/29

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) C4/30

Managing Change Infrastructure and technology Resourcing and procurement Workforce and education Service requirements Benefits realisation and evaluation C4/31

Managing Process Project Management Framework: Specify (Scope and Scale of the Objectives) Resource Manage, Monitor, Report Programme Office Benefits Realisation Evaluation Managing Culture Leadership Vision Goals Enablers Normalisation Communication and Engagement Knowing your Audience Champions The Power of a Good Story Retell, Refresh and Regalvanise C4/32