Between 2006 and 2036 the proportion of New Zealand’s population aged 65 or over as a proportion of the working-age population is expected to rise from 18 to 40%,” The number of people over Chronic conditions are estimated to account for 70 percent of health funding and 80 percent of all deaths in New Zealand and health workforce numbers per person are expected to decrease over next 20 years. This presentation explores the potential of Telehealth to address these challenges
1. Pathwaystothefuture
The Role of Telehealth in Emerging Models of Care
- moving from information exchange to person-centred,
technology-enabled care
Ross McKenna
Portfolio Manager, Health System Infrastructure
Information Strategy and Architecture
National Health Board Business Unit
Ministry of Health
HINZ Telehealth Seminar 2009
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TheRoleofTelehealthinEmergingModelsofCare
Recommended definitions
Telehealth
Provision of heath care and information at a distance using
Information and Communications Technology
Telemedicine
Application of clinical medicine at at a
distance using Information and
Communications Technology
Telecare
Provision of health care and support
using Information and Communication
Technology to empower people to
remain independent in their own homes
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TheRoleofTelehealthinEmergingModelsofCare
Telehealth – enabling health system change
Workforce
effectiveness
Personalised
care
Preventative
Care
Resource
effectiveness
Connected Health – networks, architecture, standards
Integrated Family Health Centres
TELEMEDICINE TELECARE
Chronic conditions Education
Self
managementFamily/whänau support
Remote consultations
Video conferencing
Peer review/support
Shared systems
Home Based
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TheRoleofTelehealthinEmergingModelsofCare
Telecare – evolution from recipient to participant
First Generation
User activated alarms
Call centre organises a response
POTS based dial up service
Second Generation
Sensors monitor home – smoke, flood, power
Sensors monitor vital signs, physiological measures
Store and forward
POTS, ADSL based
Third Generation
Interactive services, part of integrated care
Includes Video services – family, care giver support,
doctor or specialist consultations
Education, self management
Broadband, Internet enabled – home PC, mobile,
wireless
REACTIVE
PREDICTIVE
PREVENTITIVE
Three “generations” based on– Telecare in Scotland, Benchmarking the Present, Embracing the Future, February 2008
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TheRoleofTelehealthinEmergingModelsofCare
Models of care – moving from recipient to participant
Provider delivered at the hospital
Illness and treatment
Site of care focused
Episodic care
Workforce constrained
Solitary decision making – referral based
Efficiency
Decentralised, independent
Person & whänau involved in the community/home
– provider as colleague/advisor
Wellness and
informed/responsible/participating/empowered
Continuum of care – home and mobility
Disease prevention and management
Demand managed
Patient involved, collaborative, evidence based
decisions – co-diagnosis, co-care
Efficiency and Effectiveness
Coordinated, specialised care
(technology enabled)
MODEL R(ecipient) MODEL P(articipant)
CSIP, UK Department of Health “Supporting Long-term Conditions and Disease Management through Telecare and Telehealth: evidence and challenges, January 2008
Preparing for Success: Readiness Models for Rural Telehealth Jnl Postgrad Med December 2005
Journal of Participatory Medicine
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TheRoleofTelehealthinEmergingModelsofCare
Moving care closer to home
Early detection
Education
Community Medicine
Alerts
Education
Self care
Feedback loop
Monitoring
Electronic consultations
Support – care giver/family/whänau
Home-based Telecare
Home assessments
Electronic consultations
Sharing health records
Billing/payments
Monitoring – 24/7
Support/advice
Education
•Consults
•Tests
•Referral &
discharge
•Share health
records
Hospital/DHB
Peer review
Consult
Train
Share systems &
health records
Diagnostic
Imaging
Videoconferencing
Other provider sites
SECONDARY PRIMARY COMMUNITY
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TheRoleofTelehealthinEmergingModelsofCare
Broadband
Linked to the Primary Care Implementation Plan – IFHCs.
IFHCs supporting the community – enabling services such as:
videoconferencing, diagnostic imaging and home based Telecare
EOI selection process informing the roll-out of Broadband
Key steps:
November 2009, EOIs selected to proceed to business case
December 2009, proposals from potential LFC co-investors.
- Indicate the regions likely to receive the first phase of funding from this initiative.
- Ministry of Health will advice on the requirements identified from EOI process to
align, where possible, any plans for fibre deployment.
Early 2010, identify rural schools and hospitals/health sites outside
the 75 percent coverage are able to be connected.
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TheRoleofTelehealthinEmergingModelsofCare
Emerging Telecare models – enabling self care
Increasing Internet access, connectivity and information availability
Developments in care and monitoring devices
Cost and availability of analysis and computing power
Some examples of emerging person-centred models
Health social networking
Consumer personalised medicine
Self tracking and management
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TheRoleofTelehealthinEmergingModelsofCare
Health Social Networking
Information and research sharing
Keep updated on latest developments/treatments
Learn and try new approaches – participate in clinical trials
Physician Q&A – free or fee
Social connection and emotional support – “I am not alone”
Track health progress
Source of condition data
E.G Patientslikeme.com
45,000 members, 10% per month growth
Free to join
16 conditions
Largest dataset on ALS
(Amyotrophic Lateral Sclerosis)
Sells data to drug and medical companies
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TheRoleofTelehealthinEmergingModelsofCare
Consumer personalised medicine
Using individual biological characteristics to tailor therapies and
remedies
Combines genetic, blood, biomarker, environment, lifestyle data
Personalised genomic information
Biomarker/blood testing – blood count, thyroid, lipid, liver, kidneys,
diabetes, etc (see www.directlabs.com)
Environment testing – pollutants, pesticides, etc. Blood or hair testing
Predictive bio stimulation – project a “virtual” patient (e.g. Entelos)
Quantified self-tracking
Implanted and external devices monitor health metrics
Current web based services require external input
Wearable devices
- Energy expenditure, sleep measurement (www.fitbit.com)
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TheRoleofTelehealthinEmergingModelsofCare
Going forward…
Recognise the opportunities to drive positive change through new models of
technology enabled care – Telemedicine and Telecare
Focus on Telecare services development – person centred, home based
Supporting changes
Establishment of IFHC as “technology hubs” and wider broadband deployment
Continue development of Connected Health
Supporting information and policy
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TheRoleofTelehealthinEmergingModelsofCare
QUESTIONS?
Web references
Presentations from the supported self management seminars held in June 2009:
http://www.moh.govt.nz/moh.nsf/indexmh/longtermconditions-masterclasses
2007 Synergia Self Care Literature Review
http://www.synergia.co.nz/assets/file/Role%20of%20information%20in%20self-care%20July%202007.pdf
Link to Genetic and Bioinformatics resources:
http://www.ornl.gov/sci/techresources/Human_Genome/posters/chromosome/tools.shtml
NZ Government Broadband Initiatives – MED site
http://www.med.govt.nz/templates/StandardSummary____40551.aspx
Hinweis der Redaktion
Paediatrics and Mental Health
Good morning everyone.
I would like to help set the scene for the presentations to follow by offering some suggested common terminology, talking about the New Zealand context for Telehealth and outlining the potential opportunities, providing some information on current relevant initiatives, discussing a couple of emerging Telehealth care models. And summarising some actions going forward.
Telehealth, Telecare and Telemedicine are terms that are often used interchangeably,. Given the wide range of definitions used to describe technology enabled health care I though it would be useful to simplify the debate and this presentation by offering some common definitions.
While there are a wide range of definitions, some common themes are apparent across UK US and Australian usage. These align reasonably well to the definitions for Health, medicine and care. The term Telehealth is most often used in the context of an overarching term for all forms of technology enabled health care provided at a distance.
Telemedicine involves the application and practise of medicine, generally between health professionals and for diagnoses and referral – subsets are specific medical disciplines such as Teleradiology and teledermatology. Areas that are becoming increasingly accepted as part of mainstream care models – evidenced by decreasing use of the “tele” prefix in areas such as paediatrics.
Telecare now has wide usage and formal acceptance in the UK as the provision of care to end users in the home setting and is evolving to mean services that allow aging and chronically ill people to stay out of institutional care. The spin off benefit is greater independence and it is this area where the benefits of person cantered Telehealth – where people are participants rather than simply receivers of care – is increasingly recognised as providing the potential for major improvements in health system productivity.
both Telecare and Telehealth offer significant potential to address many of the current pressures on the health system and I’d like to spend a few moments discussing these 2 areas today.
It is no surprise to anyone here that we are about to experience a significant increase in demand for health care.
“Between 2006 and 2036 the proportion of New Zealand’s population aged 65 or over as a proportion of the working-age population is expected to rise from 18 to 40%,” The number of people over Chronic conditions are estimated to account for 70 percent of health funding and 80 percent of all deaths in New Zealand and health workforce numbers per person are expected to decrease over next 20 years Not a system. Department of labour projections show that the number of paid caregivers required in New Zealand will rise almost three-fold from 17,900 in 2006 to 48,000 in 2036.
There is likely to be a significant time lag between the economy returning to growth and fuller employment and the Government's deficit being reduced by increased tax revenues. In other words, next year's budget will be even tighter. The Government is borrowing $250m a week for the next 4 years. So we have to get maximum value out of every health dollar.
We also have a health environment where there is an increasing range of medicines and interventions available - they all cost money so how do we decide where to focus any technology investment.
Evidence from overseas experience suggests that Telehealth offers scope to support long term condition self-management and to provide scope to better use health resources.
In terms of telemedicine this has potential to provide more efficient and effective treatment and diagnostic services
Keeping people out of hospital/aged care by allowing them to be treated in primary care and stay at home
Enabling more effective use of increasingly stretched resources though education, support and removing the barrier of distance.
Telecare proves the capability for people to stay out of hospital by being in a position to confidently care for themselves without leaving the home. The Scottish Government has been running a Telecare Development Programme that has shown some success in these areas and they believe these benefits can be significantly improved by moving to a mainstream “third generation” Telecare service.
However, evidence also shows that this is very difficult to achieve if you are employing models of care where the person is viewed as a recipient rather that a participate in the care process.
Moving to this kind of person-centred, co production health care model is no small thing and will require new ways of working and interaction for all involved. However, there are a couple of initiatives in terms of the establishment of IFHCs and Connected health that can support this transition to mainstream “3rd generation” services.
EU 2009 has reinforced requirement for Interoperability Standards Mandate M403 on adoption of standards to support Health record sharing as an enabler for a more patient centred health system/s
Connected Health is a programme of work focussed on enabling safe sharing of health information and will support the system interoperability needed for Telehealth to gain wide adoption.
First Generation medic alert type services – as in common use in NZ today – react to user generated need
Second – Kent, England example were 12 types of passive devise were used in 3 trials beginning in 2004 – movement sensors, call buttons, smoke flood and fall detectors – bed, chair and exit (house) sensors
At the end of 2006, 320 people using Telecare services through the pilots – main measured benefits were psychological – helping them be confident they could safely remain in the home.
3rd Generation
In the Netherlands, - with 2.4 million people over 65! The Koala project provides video phones to 600 users with clinic conditions, diabetes and heart conditions and use TV remotes to set up calls to remote nursing centers who can see the patients care record and remote devise monitoring details
As Telecare has evolved from simply reactive response services there is increasing research and support for care models that enable “participatory” medicine – or “patient centred collaborative care, This focuses not on treating people that are ill, but fostering and supporting people who could be healthier if it were simpler to care for themselves. Telecare can assist in helping people with understanding there own condition through monitoring and alerts as well as medication management and guiding them on treatments and prevention. In the pacific and New Zealand context this approach also fits well with the concepts of family well being in providing individuals with support for self care.
The Better, Sooner, More Convenient, primary Care plan also provides an opportunity for programmes that move care from the hospital to primary care and, potentially, into the home. The EOI process will, based on the successful submissions in the first wave create more than 32 new community based IFHCs and whänau ora centres that can provide the capability to run home based Telecare models. They are intended to be technology hubs and if the business cases can show benefits in terms of reduced load on hospital services they could result in a significant growth in the number of telecare models in place.
Person centred services as part of integrated preventative and chronic care management programmes that result in quantifiable benefits – e.g. reduced admissions and bed days
Some potential use cases
Health Education,
Rehabilitation
Intermediate care
Hospice/palliative care
Home safety and activity detection – e.g. falls
Assistive technologies,
Self care
Monitoring, health condition and device performance
Note – Evidence that increasing sophistication and cost does not always equate to better health outcomes
Expected benefits of UFB for Health are in deployment of:
Video based services
Greater sharing of electronic health information – improved access and workflow
Integrated Family Health Centres
Diagnostic Imaging
Telecare – home based
Shared systems and applications
In August 09 Cabinet agreed that:
to take advantage of the governments $1.5 Billion UFB investments for Health, MoH will work on behalf on clinicians and consumers to help ensure that:
the priorities for the health sector are understood and that services are, as much as possible, able to be implemented in areas of high need
“use of Faster Broadband and the potential for technology enabled improvements in healthcare are a part of new Integrated Family Health Centre proposals”
While this will not directly enable Telehealth initiatives, it should remove barriers in areas where lack of any level of broadband is limiting the deployment of Telemedicine or Telecare. Also, the general wider availability of broadband over the years of the deployment will support more availability of services such as those based on video.
Given all this potential for Telehealth, I’d like to paint a bit of a picture of a possible future based around a few models of care that are emerging due to the massive changes in availability and accessibility of health care information, technology development and increasing ability to analyse and synthesise data.
Health Social Networking sites are providing people with the opportunity to be supported in the self care efforts – through access to health information, easy access to medical advise and support, a community of caring supporters and even the opportunity to participate in clinical trials.
As an example, this site now has the largest available set of information on a particular health condition. However, there are still significant potential issues in terms of ownership and privacy of information.
The range of test information available today also has potential to support self care and home based telemedicine. Here is an example of a set of tests ordered from direct labs.
Entelos partners with pharmaceutical and biotechnology organizations to develop new treatments for disease and reduce the time and cost needed to develop them. Entelos develops dynamic large-scale computer models of human disease. integrating data (e.g., genomic, proteomic, physiologic, environmental) in the context of a disease or therapeutic area, focusing on understanding and determining clinical responses to potential treatment
Consider how these models plus personal health tracking devices might start to converge and enable person centre, participatory Telecare based models to evolve that can keep people healthier and out of hospital.
I hope you agree that there is opportunity to make use of Telehealth to drive positive health system change. The challenge will be to do this in such a way that it results in real quantifiable benefits in terms of keeping people independent and health. The more significant opportunity seems to be in terms of enabling them to practise supported self care in the home.
We do have some changes that should support these types in approaches in terms of changes to primary care the Connected Health programme and wider broadband availability over time
.Capitalise on existing Telehealth initiatives (E.g ASSET and West Coast)
Assess the need for central policy on; applicability, assessment and safety aspects of Telecare
Move to a shared health record approach that will allow for integration and interoperability with personal health records.
Thank you for your time and any questions?