Using Technology To Support Better Health Outcomes

Dr Amit AroraMD, FRCP, MSc

Consultant Physician and GeriatricianUniversity Hospital of North Staffordshire

Stoke on TrentChairman, England Council, British Geriatrics Society

18th June 2014

National Issues‘Care in Crisis’ report, Age UK 2014:• People aged over 85 years has increased by 30%• Day centre attendances has reduced by 49%• People needing care homes has increased by 20%• 15.4m people in the UK have one or more long term

condition

We have an Ageing population, limited resources

Dementia• 800k people are living with dementia • Number will double in 30 years

NHS EnglandTECHNOLOGY ENABLED CARE SERVICES (TECS) 3 Million Lives

2014-17 National Delivery Plan

•To support Integrated Care•Management of long term conditions and the enablement of seven day services•Work with NHS, Social Care, Housing and other key stakeholders to simplify procurement and commissioning processes

Admissions and Bed requirements

Digital Health Modality Descriptions 

Telecare Devices in or away from the home that support independence, that can be used as stand alone or linked to a support service such as a call centre. Many of these devices related to social needs in relation to activities of daily living.

Telehealth Devices used in or away from the home that enable health parameter measurements such as blood pressure, glucose, weight, wound management that supports decision making around personalised care planning and appropriate interventions.Tele-health can be used as stand alone or linked to a response service

Mobile Apps & online self management

A growing area of support where people use a mobile device, device or smartphone to manage their own health and well being. This area is mainly aimed at self management and so is most appropriate for the lower levels of need, however increasing use of mobile apps is having an impact in supporting staff and carers in monitoring and care co-ordination

Video Consultations & Tele-Diagnostics

Again growing in popularity and relies on infrastructure being available to support, this includes webex, facetime and skype. This can be between patients and staff, groups of patients and staff and between staff & staff. All allow a non-face to face consultation that enables decisions to be made without the need for anyone to leave their desk or home.Tele-diagnostics include near patient testing and this needs to be used in selected environments / cohorts. This could be patients / carers testing themselves or could be community staff doing testing in the patients home.

AT: clinical solutions• Face time /Skype• Tele-health monitors• Mobile phones apps • Sleep watch• Nan-cams• Virtual clinics

• Incontinence detectors• Bed occupancy alarms• Life Line• Falls alarms• Smoke alarms• Carbon monoxide alarms

Timer pill dispenser

Increasing Staff Capacity through Remote Monitoring and reducing falls in care homes

Care Assist Portable alarmReceives alerts & displays the type of sensor activatedand its location or the name of the person assigned to.

Promoting Independence: reducing falls in care homes

Door SensorsTrigger an alert to the carer via wireless pager whenmovement detected. Placed on doors to alert carerwhen people entering or leaving rooms.

To Promote Continence / Promote Dignity

The system alerts the carer to a build up of moisture via a detector unit. The cotton sheets can be washed.

To Monitor and Manage Epilepsy / Promote Dignity

The system alerts carers to Epileptic seizure activity through registering a combination of BPM, movement, sound and / or moisture.

Packages personalised around needs •Dementia package•Falls package•Learning difficulties package•Safe and secure at home package•Winter chills package•Personalised to meet individual need

AT: benefits to patients• Reassurance and safety• Confidence and self

management• Early safer discharges

from hospitals• Timely medication• Improve dignity • Improve independence• Sense of well being

• Tele-consultations• Monitor drug effects• Help in recreational,

household activities or personal care

• No travelling or parking chaos

• Reducing isolation and loneliness

Most find it enabling; Some may find it a hindrance

AT: benefits to NHS• Early discharges, Lesser follow ups• Shorter waiting times for other patients• Reassurance to health care staff, patients and families• Reduce readmissions and repeated visits to hospitals• Reduce risk of hospital acquired infections• Working smarter- help with 7 day working in NHS• Reminds, prompts, pill dispensers- so better health

AT- benefits to carers:reduces harm, supports carers

• Reassurance

• Safety

• Monitoring

• Reduce travel

• Comforting

• Wanderers

• Falls sensors

• Bed wetting

• LTC monitoring

• Medical back up

Patients want to be at homes, not hospitals

Our experience• Life lines, Continence sensors

• Text, emails, Face time

• Virtual clinics and Nursing Home LES

• Nursing home falls prevention project

•

Reducing the Incidence of Falls in Nursing Homes

>100 people supported with AT / 14 Nursing Homes.

Feedback from early adopters :

> 90% staff satisfaction

30-40% reduction in falls in 1 early adopter home

Relatives feel people cared for in a safer environment

Night staff happy that it removed need for hourly checks

Legal clarity and BottlenecksLack of legal clarity

– Licensing, Accreditation– Registration of telemedicine services and professionals– Data protection, Liability, Reimbursement– Jurisdiction – e.g. cross border provision of

telemedicine services also require legal clarification with regard to privacy

– Broadband access, standardization– Information Governance issues

Using Technology To Support Better Health Outcomes

Not a one size fits all

Technology on wards and homes, why not in housing

Start of an exciting time, sp. as they get widely available and cheaper

Think beyond just a housing association, be a part of the LHE.

Together with local GPs, hospital, Care homes, Social care, housing agencies- all integrated and working together; we can transform our health systems and gain better health outcomes.

‘The opportunity is Huge and the Time is Now’