WSDAN Progress: Sustaining innovation in telehealth and telecare
WSDAN briefing paper: Sustaining innovation in telehealth and telecare (to be published June 2010)
Prepared by Mike Clark for WSDAN
Introduction
An ageing population, with increasing numbers of people with long-term conditions, provides a considerable challenge to traditional health and social care service provision. Organisations providing local services will need to be innovative in their approach to ensure quality services that are also cost-effective.
Between 1.6 million and 1.7 million people in England already benefit from technology-supported services, and this number is growing. England has also taken a lead in testing new products and services, as well as carrying out a large trial (the Whole System Demonstrator (WSD) programme) to examine the clinical effectiveness and cost-effectiveness of remote monitoring.
WSDAN will shortly publish a briefing paper, Sustaining innovation in telehealth and telecare, which considers some of the innovative approaches developed to date. It reviews the challenges and barriers to adoption of technology-based approaches to care, and suggests strategies for how these can be overcome.
What is innovation?
Innovation is a new way of doing something. Innovation is about ‘doing things differently or doing different things to achieve large gains in performance’. [1] Innovation can apply to simple, incremental changes or more radical developments within organisations, systems and processes, and products and services. Innovation occurs when an idea or the result of a creative process is successfully implemented in practice.
The White Paper, Building the National Care Service describes telecare and telehealth as ‘technological innovations that can provide the care and reassurance people need to allow them to remain living in their own homes’.
Although there has been considerable progress on technology development from first generation telecare through to Global Positioning System (GPS) monitoring and sophisticated vital signs trend analysis, it has not yet been fully matched by service innovation such as large-scale telehealth deployment, regional monitoring and remote caseload management.
An issue for many organisations implementing telecare and telehealth is that they have not moved from a project to a mainstreaming approach, based on successful initial outcomes. Organisations will need to move more quickly through their commissioning cycles to implement at scale while continuously auditing and reviewing performance to demonstrate value for money.
An important aim and outcome of innovation is a change for the better or significant improvement for stakeholders. For individuals, this could be reassurance, peace of mind, improved management of a respiratory problem, or fewer hospital visits. In economic terms, there is an important link between innovation and increased productivity.
Innovation is also a key factor in the development and, in some cases, survival and growth of organisations. In tougher financial climates, public sector organisations will need to find innovative solutions that maintain or improve quality at lower overall costs (ie, ‘invest to save’ and QIPP – Quality, Innovation, Productivity and Prevention).
As well as being generally well accepted by users and carers, telecare and telehealth have the potential to provide efficiencies for further service investment.
Moving on from traditional approaches
With closer scrutiny of efficiency savings, health and social care commissioners will need to move from traditional ‘contracting’ approaches to innovative and flexible arrangements that support the following.
Care closer to home and independent living choices.
A range of long-term conditions, including dementia and end-of-life care.
Individual care plans with self-directed support and personal budgets (including personal health budgets).
Preventive approaches, self-care and upstream or early interventions.
Hospital discharge, intermediate care and re-ablement programmes.
Stakeholder engagement in service development.
Quality standards for equipment and services, including device interoperability.
Improved data sharing and connectivity across organisations with user consent.
Individual choice and a range of service providers.
A new balance between face-to-face user/patient contact and remote monitoring support.
Housing options that use technology and provide 24/7 care.
Mobility – ensuring that people can live as independent a life as they choose within their local communities, with technology-supported services.
Monitoring and response services that are timely and appropriate.
Value for money for the public purse.
Closer working between health, housing and social care organisations provides an opportunity to adopt innovative, personalised technology-based solutions as part of formal integrated care pathways, thus moving away from the current patchwork of projects, pilots and limited service mainstreaming.
Using innovative and customised approaches that match sensor configurations with timely data sharing and response services between professionals, there is the potential not only to deliver better outcomes for users and patients but also to release savings for further service investment through fewer admissions to hospitals and care homes.
Addressing the key challenges
While telecare and telehealth offer tremendous potential, there remain a number of challenges and barriers to the large-scale adoption and diffusion of the technologies that need to be overcome. These include the following.
The levels of evidence on telehealth services required by health care practitioners and decision-makers appear to be substantially higher than for housing and social care, which could constrain technology development and learning from experience.
Replacing some face-to-face contacts and interventions with technology support can be a significant issue for both professionals and users, as it challenges their expectations.
Many organisations consider some of the technology, particularly telehealth, to be too costly to deploy at scale at this time.
It may not be possible to adopt larger telehealth caseloads within current service configurations based around home visits.
Telehealth and lifestyle monitoring may identify unmet need through trend analysis, which may have a short-term impact on costs (eg, more GP and hospital visits to diagnose hypertension, Type 2 diabetes or dementia).
Technical, informatics and connectivity issues are significant – this includes device standards and interoperability, telecommunication network updates which affect device functioning, and data sharing.
Competing local priorities for funding, and in some cases a reluctance to try anything new, especially in the tougher financial climate, mean that service champions and strong local leadership have an even greater role to play in driving through innovation, even where there is a strong evidence base.
Mainstream adoption requires recognition within strategic and local policies such as joint strategic needs assessments, local area agreements, and health and social care commissioning plans. Telecare and telehealth need to be integrated into commissioning plans rather than being stand-alone programmes.
Many organisations are addressing these challenges and potential barriers at the local and national levels. Those involved in implementing telecare and telehealth should develop plans to overcome these challenges in the planning or early deployment stages.
Strategies to support the successful adoption of telecare and telehealth
There are a number of strategies that could help in reaching ‘critical mass’ (the point when enough individuals have adopted an innovation for its continued adoption to be self-sustaining). These include:
having an innovation adopted by a respected individual within an organisation or social network – many telecare and telehealth initiatives have been led or championed by cabinet members and service directors
creating an instinctive desire for a specific innovation – this can prove more difficult in public sector services, as many service users or patients have only moved on to telecare after a health or social care crisis
carrying out early audits or evaluations and obtaining stakeholder feedback – many local authorities and PCTs have built some form of audit, evaluation or feedback mechanism into their projects and programmes. Video and written case studies can prove very compelling in understanding the potential benefits.
From the research and the discussions in the briefing paper, we can conclude that the success or failure of telecare and telehealth innovations depends on a number of factors. Focusing on the following areas will help organisations to ensure smoother and quicker adoption of these innovative services.
Leadership and vision – leaders, champions and entrepreneurs can empower and motivate individuals and teams. There needs to be a supportive culture to innovate and change current working practices within national and local policies (eg, personalisation, care closer to home).
Clarity of organisational goals – service and programme goals need to be clear to obtain buy-in from professionals and practitioners, commissioners and service providers, users, carers and patients. With new services, it is particularly vital that team managers and team members are clear about their roles and that service recipients – users and carers – are involved.
Organisational structure and processes – training, awareness, infrastructure, record management systems, data sharing, and operating protocols all play an important part.
Strong commissioning skills – these will be needed to decommission services that are no longer appropriate, and to improve the quality and cost-effectiveness of care through service redesign.
Governance and accountability – with clear lines of responsibility for performance, and full consideration of ethics.
Project and programme management – actions and performance reporting need to be aligned to goals and regularly communicated to all stakeholders.
Communication – from awareness raising to technical expertise, monitoring and response.
Staff empowerment – giving staff the autonomy to improve quality and productivity in their own areas, and to find new solutions to problems, can help embed and foster new innovations.
Sharing information and knowledge – competence and performance can be improved through effective communication of guidance or good practice.
Evaluation and audit – regularly reflecting on progress and outcomes is essential to enable continuous improvement.
The greatest challenge
The greatest challenge remains to scale up telecare and telehealth programmes from successful, local, small-scale projects. The WSDAN briefing paper provides some helpful checklists and links to organisations that are adopting innovative approaches.
In the tougher economic climate, improved productivity and cost-effectiveness will be vital, while at the same time maintaining the emphasis on service quality for users, carers and other stakeholders. Telecare and telehealth are expected to play an important role in service transformations that balance remote monitoring and face-to-face contact with users and patients.
Mike Clark is co-project lead for WSDAN
Reference
[1] NHS Institute for Innovation and Improvement. Available at: www.institute.nhs.uk/innovation/innovation/introduction.html