Results of a hub pilot in Yorkshire show that telehealth can reduce hospital admissions, provide care at home and improve patient outcomes, says a new report.
The Yorkshire and Humber Telehealth Hub was set up 2010 with the aim of demonstrating the benefits of delivering telehealth at scale to patients with chronic conditions. Outcomes from the patient point of view have, so far, been overwhelmingly positive, with decreased hospital admissions, care delivered at home and greater patient satisfaction ratings, says health policy think tank 2020health, which has evaluated the outcomes of the pilot.
However, it also says that, in retrospect, the timeframe for the pilot scheme was overly ambitious, as important obstacles prevented the services reaching as many patients as the Hub had envisaged.During the pilot scheme, services were provided from three sites - NHS Airedale Foundation Trust, South West Yorkshire Partnership Foundation Trust (SWYPFT) and Hull and East Yorkshire NHS Trust/University of Hull, with each site providing a different telehealth service.
Airedale Foundation Trust piloted telemedicine services, ie, delivering healthcare remotely through video conferencing technology. In its "lessons learnt" report, Airedale notes that telemedicine technology and the new way of working have "brought about a significant and real culture change in the way clinicians and physicians believe medical consultations can be delivered."
SWYPFT's aim was to encourage patients with chronic conditions to take greater control of their health and well-being. It set up a telecare call centre - a telephone-based health coaching service delivered by nurse care navigators, to support patients through self-care and improve their condition management over the phone.
According to the Hub project initiation documents, it is "well-documented that factors associated with health status are largely behavioural. Therefore, helping people understand how lifestyle choices impact on health and well-being is critical to promoting positive health.
2020health points out that the SWYPFT tele-coaching service, which is almost unique in the NHS, enables the "intelligent dispatch" of services to help people to connect into the appropriate pathway of care. Results for this service show an increased number of people living independently, improved patient satisfaction, 20% fewer hospital admissions and a 30% reduction in length of stay, leading to an overall cost reduction of 32%.Finally, the objective of the Hull element of the telehealth service was to scale up and providing the existing Hull-based clinical triage capability to other tele-monitoring projects around the rest of the region. Analysis of this work found that, for every 100 patients being tele-monitored, 10 all-cause admissions were averted each month and, with potential savings of up to £2,000 per averted admission, this represents a return on investment (ROI) of 48%.
However, the analysis also highlights a number of obstacles which, it says, need to be overcome. These are: - current uncertainties within the NHS mean that the future of funding for these sites is unknown. The new Department of Health Year of Care Tariff may help, but meantime, this is slowing down their development; - structural changes meant that staff who were important supporters of the project were moved to different roles during the trial; and - there is a need to redefine the GP/patient relationship if telehealth is to flourish.
The Hub found it difficult to get GPs to sign up to telehealth, because they expressed a feeling of apprehension towards the use of technology in health in general, and were also worried that they were being asked to take on more work. However, evidence suggests that telehealth allows GPs to see more patients, with a decreased workload, 2020health points out.
Nevertheless, these obstacles meant the pilot scheme did not achieve as much as it had set out to do in the allocated time frame. Notably, not as many patients signed up to participate in the scheme as were hoped, so it was difficult to measure potential savings. However, Hull notes that, as the scale of its scheme increased from 2010 to 2012, its ROI increased from 39% to 48%, which suggests a strong chance that telehealth could make more savings if rolled out at national level.
While these obstacles are not impossible to overcome, more support - both financial and "spoken" - from the Department of Health, professionals and organisations, is crucial, says health2020."Our evaluation suggests that professionals need to evaluate and pursue opportunities to benefit from these technologies and to support a shift to care closer to home, whiles the Department needs to rigorously assess why the uptake of telehealth has been so slow, even in cases without up-front capital costs such as the Hub," it reports.