A digital age

A CCG in Liverpool used telehealth technology to reduce hospital admissions amongst patients with long-term conditions.

Digital technologies empowered by the internet and ‘apps’ are transforming our society. NHS Liverpool Clinical Commissioning group (CCG) is at the cutting edge of implementing new technologies and systems to improve the health and wellbeing of their population. Every day, the people cared for and supported by health and care services use these technologies to talk to one another, work together and organise their lives.
The impact that this technology can have on healthcare is equally as profound. Improved access to and greater quality of patient telemetry allows those providing front line care to make better informed, faster and often safer decisions to support the people that they serve. This is not a new phenomenon. Regardless of the organisation or sector, the use of digital technology allows us to work more efficiently, more quickly and gain better results.
Increasingly, people expect to be able to access information and services 24 hours a day, seven days a week. It is now easier than ever to spend time online and people are increasingly interacting and transacting with the world through digital products. This situation has created a demand for digital. According to the Tinder Foundation, circa 85% of the UK population is now online, regularly using digital products to navigate life. Digital technology has changed the way in which we think and process information. The NHS must be able to embrace this type of technology to ensure it continues to deliver services that meet the needs of our population.
Whilst many areas of the service sector have made a “channel shift” to digital, in part (banking, retail, education) or largely (insurance, travel), state provision of health and care remains largely untouched. Although not often considered in this vein, a failure to offer a digital channel is a form of digital exclusion, causing people to disengage due to a lack of digital interaction to which they are now accustomed. To minimise the impact on widening health inequalities, action is needed for those requiring help to access online resources and those that utilise it for their everyday lives.
In Liverpool, the approach taken to assistive technology is different both in the infrastructure developed to support it and the approach to working with industry. Now driving forward with a large scale ‘Digital Care and Innovation Programme’, NHS Liverpool CCG started its assistive technology journey back in 2012.

Tackling long-term conditions
It has been a badly kept secret that our population is getting older and the associated tidal wave of long-term conditions, such as Chronic Obstructive Pulmonary Disease (COPD), heart failure and diabetes will put our stretched services under even more pressure. In Liverpool the prevalence of these conditions, especially COPD, is already one of the highest in the country so the need for a solution has been obvious for some time.
For this reason, a bid to the then named Technology Strategy Board (now Innovate UK) was made to support the development of infrastructure to support the use of assistive technology in healthcare and to trail-blaze the use of this technology at scale. It was this bidding process for the ‘dallas’ programme that became the genesis for how the programme in Liverpool was to develop.
The process to be selected for funding required bidders to form consortia with a combined aim of developing the technological and practical solutions to scale up the use of assistive technologies. A consortium of like-minded organisations formed, with NHS Liverpool CCG agreed as the lead, covering a wide range of approaches and technologies. In order to truly make this approach work for the telehealth element of the bid, it meant adopting a partnership based on open communication and dispensing with the traditional commissioner – provider/retailer approach. This approach proved highly successful both in terms of securing funding and delivering the project itself.

Involving patients
The telehealth programme utilises Philips Motiva technology with the objective of empowering patients to actively manage their disease and change their behaviour by providing coaching and education supported by clinical monitoring and triage. The patient receives either a tablet device or set top box which is wirelessly connected to scales, blood pressure cuffs and pulse oximeters. Patients also receive questionnaires and educational material specific to their condition through the tablet or their TV covering a number of areas such as medication adherence to mental health.
The results of the vital sign measurements and questionnaires are processed by the system, which generates alerts to the clinical team and steers workflow. Patients will receive a telephone call from a nurse who will support them to self-manage and where necessary refer on to other services supported by the telemetry used to make that referral.
The drive behind the partnership was always to find the barriers and work through or around them. In the end, this approach delivered success and this continues today, moving on from delivery and working together to understand the impact of the intervention and evaluate the process.

Seeing the results
To date, the outcome and output measures have shown the service to be very successful, indicating:

Reductions in emergency admissions and secondary care costs in comparison to the control group of 22% to 32% for patients with a risk of admission above 25%.
Patients reported outcomes show that 90% of patients feel more in control, have gained confidence aand feel better able to cope with their condition.

Such results, delivered by collaboration around the focus on self-care and patient outcomes rather than the technology itself from all parties involved, has helped to build a foundation to drive forward the adoption of assistive technology across a much larger range of condition management pathways.
We need to be brave in establishing new methodologies to identify the effectiveness of technologies and other interventions that allow us to implement solutions in a real world environment whilst accepting the limitations this approach brings.
The Liverpool programme was designed to look at a telehealth intervention at scale with a focus on the implementation for the benefit of the patient and correct care pathway design.
The challenges faced by the healthcare systems both in the NHS and beyond there is an imperative to re-design systems to improve productivity. Healthcare in general appears to be lagging behind other industries in embracing the use of technology. Translating this into healthcare delivery has proven challenging due to the lack of evidence base, understandable professional scepticism and low levels of awareness in the general population.

Resources
Evidence for supported Self Care at Scale, NHS Liverpool CCG
http://www.philips.co.uk/a-w/about/news/archive/standard/news/press/2016/20160527-philips-results-three-year-telehealth-study.html