1. International Telehealth Case Studies…
and what we’ve learned from them.
David Chang
Business Development Manager
Tunstall Healthcare , Taiwan
1

2. Tunstall Healthcare Group at a glance
• World’s leading telecare and telehealth
provider
• Global company headquartered in the UK
• Operating since 1957, celebrated 50 years
anniversary in 2007.
• Full suite of telecare and telehealth solutions
and systems including integration of
hardware, software, service, support and
24/7 personal response
• Operates in over 30 countries worldwide.
• 4.8m users around the world, of which
Tunstall has 2.5m (more than 52% market
share)
• 1,150 employees worldwide
• 5% of revenue invested in R&D pa
© 2009 Tunstall Healthcare 2

3. The Continua Health Alliance
• Tunstall is a founding member
• 200 member companies
• Global standards
• Interoperability focus
• Collaborative product development
© 2009 Tunstall Healthcare 3

4. Telehealth definition
• Telehealth is the remote monitoring of patient vital signs by a clinician,
nurse or doctor
• Enables the collection and transmission of
a patients’ vital signs to a clinical
information system
• Health care provider can review data to
make informed decisions
• Serves as communicator between the care
provider and the patient
• Assists the patient in their own healthcare
management
© 2009 Tunstall Healthcare 4

5. Telehealth versus Telecare
Intel Health Guide or RTX solution
Complex case management Complex intensive
care case management and
Increasing capacity
Chronic Disease/Condition Genesis or RTX Solution:
Management Single condition, usually less complex
case management, can be both a step
Beneficiaries of down or step up approach to telehealth
telehealth technology monitoring for patients
Telecare Solutions:
Prevention, Self-Care & Broader implementation criteria, larger
self management and scale patient usage. supported self care
community care and condition engagement. Ideal for
broadening the pyramid base and
preventing escalation up the pyramid
Self Care Professional care
© 2009 Tunstall Healthcare 5

6. How telehealth monitoring works
Data transmitted to
Telehealth Patient Providing
Management clinical reports
System to health
professionals
Exceeded limits send
an alert and agreed
protocol put into action
Patient measures vital
signs at home
© 2009 Tunstall Healthcare 6

7. Vital signs which can be monitored
Vital sign devices: Other functions:
• Blood pressure • Disease specific Intelligent health
• Pulse questions
• Weight • Patient reminders
• Blood oxygen saturation • Self care advice
• Blood Glucose
• Medication prompts
• PT/INR (Blood clotting)
• Temperature
• Spirometry / Peak flow
• ECG
© 2009 Tunstall Healthcare 7

8. Telehealth suitability
• Suitable for:
• Require assistance:
– CHF
– Patients with cognitive
– Hypertension impairments such as – dementia,
– Stroke cerebral palsy, downs syndrome,
– Other vascular disease schizophrenia
– Kidney disease – High anxiety levels
– COPD – Technical phobias
– Asthma – Some physical disabilities
– Diabetes – Parkinson's disease
– Post hospitalization support and – Rheumatoid arthritis
monitoring – Multiple sclerosis
– Cancer support, post cancer – Children
treatment monitoring
Consider your patient’s needs, their skills and abilities before
prescribing Telehealth
© 2009 Tunstall Healthcare 8

9. Telehealth drivers…
growing prevalence of long-term conditions
Chronic Health Conditions
• Globally over 860M people with a
chronic disease*
• 75-85% of healthcare expenditure is
related to chronic disease*
• 40% of people over 65 have a chronic
disease, set to double over 10 yrs
• Without action, an estimated 388M
people will die from chronic diseases
in the next 10 years
Telehealth solutions support both social care and healthcare needs
2003 WHO report, FT 4th August 2006
Ldam.org * World Health Organisation
© 2009 Tunstall Healthcare 9

10. Tunstall UK Telehealth over 60 projects
• Sheffield PCT (COPD) • Quality Healthcare at Home
• Camden PCT (COPD) • Housing 21
• Leeds PCT (COPD) • Milton Keynes Community Alarm Centre
• Weavervale Housing Trust (MC/CM/DN)
• Knowsley County Council • Nottingham City PCT (CM)
• Blackpool Care Line (CM/DN) • Carlisle (S21)
• Greenwich Care Line (COPD) • Wolverhampton (HF)
• Ulster Community Hospital (Diabetes) • Wirral (CHF)
• South Gloucestershire PCT (CHF) • Torfaen LHB (COPD)
• Swindon PCT (COPD) • Pembrokeshire LHB (LTC)
• Rotherham PCT (COPD/CHF) • Northumberland PCT (COPD)
• ChesterCare Alarm Centre • Wandsworth PCT (HF)
• Guildford Council (S21) • Doncaster PCT (COPD)
• West Lothian Council • Hull PCT (CHF)
• Medway PCT • Newport Monitoring Centre
• Northern Health Board- NI • East Riding County Council
• Western Health Board – NI • Denbighshire Health Board
• Southern Health Board – NI • Conway health board
• Fold Housing Association • Birmingham North and East PCT
• South West Essex PCT (COPD) • Conway LHB
• Gloucestershire PCT • Northamptonshire PCT
© 2009 Tunstall Healthcare 10 • Bexley County Council

11. COPD Case study: Sheffield PCT
THE CHALLENGE
• Sheffield’s local population has a high
prevalence of COPD
• Three times higher than the national
average
• 2,000 COPD related hospital
admissions a year
THE SOLUTION
Telehealth units were rolled out to 30
high-risk patients for a duration of
five months.
© 2009 Tunstall Healthcare 11

12. COPD Case Study: Sheffield Outcomes
THE OUTCOME
• COPD hospital admissions decreased by
50%.
• Saved £30,000 to £40,000,
• PCT could then justify to purchase 15
more monitors.
• Based on a cost of £2,000 per admission;
– by reducing 50 admissions a month
– PCT savings equate to £1,200,000 per
year.
• Home visits were reduced by 80%,
– cutting travel costs and
– allowing healthcare staff to prioritise
their workload
– increasing productivity and case
management
© 2009 Tunstall Healthcare 12

13. COPD Case Study: Sheffield Outcomes
• For patients
– Increase in patient confidence and ability to
cope
– Enhanced understanding of condition
– Reduced anxiety and increase in security and
peace of mind
• For the PCT
– Reduction in demand on unscheduled care
– Reduction in admissions to hospital
– Reduction in demand on primary care
– Increase in capacity for case managers
© 2009 Tunstall Healthcare 13

14. Mainstreaming Case Study: Nottingham PCT
• Initial telehealth pilot 9 months
• Reductions seen in :
– Hospital admissions and
Emergency Department
presenations
– GP Events
– Community Matron visits
• Post pilot evaluation determined way
forward for mainstreaming telehealth
© 2009 Tunstall Healthcare 14

15. Mainstreaming Case Study: Nottingham PCT
• 2009 implemented mainstream Telecare and
Telehealth program
• 300 telehealth monitors measuring:
– COPD
– CHF
– Diabetes
• Phased implementation plan over 12 months
– 2/3rd Long term monitoring
– 1/3rd short term monitoring (800 patients
per year)
• Multi-user monitors based in wards and also
in a local prison
• Commissioning targets for telehealth referrals
• University evaluation
© 2009 Tunstall Healthcare 15

16. CHF Case Study: Orchard Medical Centre
Background
• Medical Centre based in Bristol
• Services 13,500 patients
• 100 patients with CHF
Pilot telehealth Program
• Commenced 2007
• 7 telehealth units
• Focus on CHF patients particularly
those discharging from hospital
• Joint venture with NHS South
Gloucestershire and South
Gloucestershire Council community
care & housing department and
Takeda UK Ltd
© 2009 Tunstall Healthcare 16

17. CHF Case Study: Orchard Medical Centre
Summary Results
• Patients & clinicians found system easy
to use
• Medication changes and monitoring
easier
• Medication compliance increased
• Trends noticed more easily
• Early intervention facilitated
• Patients have increased confidence in
managing condition
• Patients reported increased reassurance
and quality of life
• Hospital admissions appear to have
decreased from some patients
• Full evaluation is pending
© 2009 Tunstall Healthcare 17

18. User Case Study: Orchard Medical Centre
• Patient Name: Margaret
• Age: 60 years
• Condition: CHF
• Issues: Medication non-compliance,
frequent presentations to A&E
• Results: Improved medication
compliance, no admissions for 18
months
“The equipment has made me more
positive, it reduces anxiety, and
therefore I need less doctor and
hospital visits. I would feel lost with
out it now.”
© 2009 Tunstall Healthcare 18

19. Australian statistics
• 77% of Australians have a long term condition*
• 71,000 people are severely disabled by
bronchitis/emphysema
• 3.7M people have cardiovascular disease+
• An estimated 106,000 new cases of cancer are
diagnosed each year**
• 11.3% of all deaths in Australia are due to, or
associated with, kidney failure^
• Over 850,000 Australians have been diagnosed
with diabetes. The same number again may
have it but not know it.^^
*ABS 2006, + AIHW 2004-2005 Key facts about cardiovascular disease in Australia,
** Cancer Council Australia, ^Kidney Health Australia, ^^Diabetes Australia
© 2009 Tunstall Healthcare 19

20. Tunstall’s first Australian Telehealth project
• Operated by Ipswich Community Aid (ICA)
• Aim is to investigate the effects and benefits of
daily monitoring on individual’s with chronic
disease
• Each participant using the system for a period
relevant to their condition and needs
• The project will focus on four different patient
groups: 1. Cardiac, 2. Respiratory, 3.
Endocrine, 4. Other
• Project commenced 4th Feb
• Project length 18 months
• For more information contact Erik Jansink at
Ipswich Community Aid (icaiinc@bigpond.net.au)
• www.tlcproject.com.au
© 2009 Tunstall Healthcare 20

21. Remote Area Monitoring in Tasmania
• Central Highlands Health
• Services a wild and remote region of
Tasmania
• 1 patient over 3 hours driving distance
from nearest clinic
• Identified 5 patients with chronic
conditions who regularly present to
Hobart Hospital
• Implemented a telehealth program to
support remote living patients
• Primary aim is to reduce presentations
to hospital
• Secondary aim: proactive
management and improvement of
patients condition
© 2009 Tunstall Healthcare 21

22. Transition Care Pilot
• Federal government funded pilot
• Community care provider: Baptist
Community Care
• Evaluation by: Southern Cross
University
• Pilot objective: to evaluate the use of
telecare and/or telehealth within a
transition care program (hospital to the
home)
• Length of pilot: 12 months + 6 months
evaluation
• 80 places, on a 10-12 week transition
care program
• In total over 200 participants located in
Western Sydney and country areas
© 2009 Tunstall Healthcare 22

23. Transition Care Pilot - Participants
• Randomized control study with five
groups:
1. Control group
2. Group with Telehealth for duration of
transition care intervention (12 weeks)
3. Group with Telehealth for duration of
transition care intervention and an
additional 12 weeks of monitoring
4. Group with Telehealth and Telecare
for duration of transition care
intervention
5. Group with Telehealth and Telecare
for duration of transition care
intervention with an additional 12
weeks of monitoring
© 2009 Tunstall Healthcare 23

24. Transition Care Pilot - Evaluation
• Four principle sources of research
data
1. Service entry data about the
participants including demographics
and clinical indicators.
2. Pre- and post-service survey using the
Depression, Anxiety, Stress Scale
(DASS)
3. The BCS Data Monitoring Centre
4. Pre- and post-service survey to
identify existing patterns of service
usage, such as GP usage, HACC
services, hospitalisation
© 2009 Tunstall Healthcare 24

25. How to setup a Telehealth program
1. Establish goals and outcomes
2. Identify how Telehealth can integrate
in to your organisation
3. Review available Telehealth systems
4. Identify a funding source
5. Develop a business proposal including
an outline of a project plan
6. Setup a project team
© 2009 Tunstall Healthcare 25

26. Developing a Telehealth program budget
Consider and identify costs:
• Human resources
• Equipment
• Software
• Telecommunications
• Training
• Research
• Contingency
© 2009 Tunstall Healthcare 26

27. Telehealth pilot’s are all about collaboration
Sponsor
Patient
Healthcare
Tunstall
provider
© 2009 Tunstall Healthcare 27

28. Pilot Programme Sponsor’s Role
• Project sponsor and direction
• Pilot funding
• Defining outcomes/KPIs
• Ethics approval
• Evaluation of pilot
• Contract development with healthcare
provide
• Member of project steering committee
© 2009 Tunstall Healthcare 28

29. Pilot Programme Healthcare Provider’s role
• Project Management
• Patient assessment and eligibility
for pilot
• Develop patient care plans
• Telehealth monitoring
• Equipment installation
• Patient training
• Second level training of care
professionals
• Equipment maintenance and
infection control
• First level technical support
• Program reporting
© 2009 Tunstall Healthcare 29

30. Pilot Programme Tunstall’s Role (Supplier)
• Project Management Support
• Source and supply Telehealth
equipment
• Set up patient management database
• Establish data communications
• Provide a train the trainer program:
– software
– equipment
– installation
– maintenance
– support materials
• Help desk technical support
© 2009 Tunstall Healthcare 30

31. Pilot programme implementation planning
• Experienced project manager to be
appointed and steering committee
formed
• Scope, objectives and deliverables
defined and agreed
• Project plan developed
• Stakeholder engagement
• Risk management plan
• Staged implementation approach:
– Pre implementation planning
– Commencement
– Testing
– Full Implementation roll out
– Program completion
– Evaluation
© 2009 Tunstall Healthcare 31

32. Pilot programme expected outcomes
1. Reduced care costs
• Less hospital admissions and reduced
time in hospital
• Less use of ambulance service
• Reduced travel costs for community
carers
2. Efficient utilisation of human resources
• Deliver more effective care to more
people
3. Increased participation of the patient, family
and carers in their own health care
• Improved medication compliance
• Increased sense of involvement and
responsibility
• Reduced episodes
© 2009 Tunstall Healthcare 32

33. Characteristics of Good Telehealth Projects
• Communication bringing social care and
health together
• Forward thinking clinicians - willing to try new
approaches to care – service redesign
• Clinicians who allow patients who are
borderline to participate
• Well designed policy, procedure and care
pathways – But don’t reinvent the wheel!
• Senior management support with clear
telehealth vision and operational support
• Key partnerships with all stakeholders (multi
partnership working) i.e. IT, GP’s, Consultants,
Community based staff, Social Services etc
• Focus on training and support for telehealth
projects – 10% Technology – 90% people
The equipment is only as good as the individuals that are using it!
© 2009 Tunstall Healthcare 33

34. Way Forward
• Form your Steering Committee
• Start with ‘clear objectives’
– Patient centric
– Clinical outcomes
– Economical benefits
– Social welfare benefits
• Planning and preparation is essential
• Buy-in from all stakeholders
• Proven technology – including robust
equipment and reliable software
• Start out small 30-50 then scale up
• At least 12 months of data is required
• Measureable outcomes with quantifiable and
qualitative data
© 2009 Tunstall Healthcare 34

35. Why?
Provide a foundation to effect support and funding
for large scale implementation
Move healthcare systems from: Find and Fix to Predict and Prevent
© 2009 Tunstall Healthcare 35

36. For more information:
Taiwan: www.tunstall.com.tw/home
UK::www.tunstall.co.uk/
AU: www.tunstallhealthcare.com.au.
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© 2009 Tunstall Healthcare 36