eddie ritson / jim o'donogue - ecch/tf3/s3 group
TRANSCRIPT
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Telehealth – Benefits for the people of Northern Ireland
Commissioner PerspectiveEddie Ritson (ECCH)
Provider PerspectiveJim O’Donoghue (TF3 / S3 Group)
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• Improved quality of life, health & well-being• To be supported & enabled to self-care & to live as
independently as possible• To be involved in decisions about them and to have
some choice & control over their care & support• To have services which are integrated, flexible,
proactive & responsive• To have services that are high quality, efficient &
sustainable
What do People Want?
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NI Chronic Disease Challenge
Department of Health (2008 ) Raising the profile of long term conditions careINIsPHO (2010) Making Chronic Conditions Count
Population 1.8M
H&SC budget £4.3Bn
Rising to £4.66Bn in 2014/2015
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• Bring information to professionals, enabling more proactive, effective and co-ordinated community based care
• Provide greater support for self-care and for carers
• Part of a new way to manage increasing burden of chronic disease which is both more efficient and better quality
“…investing to build the capacity to cope”
Vision for Remote Telemonitoring
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• Requirements– Scaleable, mainstream service– end-to-end service adding clinical value– flexible enough to respond to individual needs and local
circumstances
• Supporting the modernisation of service delivery
• Framework to support other developments including telecare
NI Remote Telemonitoring Service - Requirements
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RTNI Service Requirements - Considerations
NationalLocal
Clinical OutcomesPatient ExperienceClinical StaffFinancial
Service ModelRoles/ResponsibilitiesPathway ChangesDelivery model
Clinical outcomesFinancial benefitsImplementation costs
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RTNI Service Requirements – Iterative Approach
Commisioner Provider
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Programme Structure
• 6 year contract awarded March 2011
• Procurement, service definition and implementation process led by ECCH – a part of Public Health Agency
• 1 Service Definition, 5 customers
• 3,500 patients per annum
• 12 condition categories
• 2 - 52 week monitoring periods
• >2.8 million monitored days
• £18m investment
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• Comprehensive and robust Office of Government Commerce contract detailing all aspects of Authority and Contractor responsibilities
• High level of detail of service definition & contractual requirements:
• Detailed definition of every aspect of the service to be provided (221 Authority requirements)
• Detailed service levels and associated penalties (20 for ‘core’, 8 for ‘additional’ & a further 19 quality markers)
• Extensive reporting, automated performance monitoring
• 1 Service definition with 5 customers:
• Joint specification, governance and central infrastructure• 5 local implementation plans• Provision of ‘Core’ and ‘Additional’ services
Unique Elements of RTNI - Managed Service Approach
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• Contract Structure• 6 year contract – Long term commitment• Flexibility : patient-days, monitoring periods, monitoring conditions • Bottom-up activity models per condition• 3,500 patients per annum, 2.8m monitored days
• Agreed charging regime• Standing charge for service availability – risk sharing• Per patient day monitoring charge• Installation & de-installation charge
• All backed up by detailed and fully transparent financial model
RTNI Managed Service - Financial Model
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• Promotion of ‘logic’ and evidence base
• Pilots are helpful but need to be strategically aligned, of sufficient scale and designed to be tested
• Scaling an application is significantly more complicated than piloting and takes time
Critical Success Factors - Learning to Date
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• Alignment with strategic and operational health and social care agenda
• Securing local, clinical and corporate support and ownership is vital. Focus on quality, safety and patient experience – efficiency is a by-product
• Design, procurement and implementation are complex – requiring regional leadership, drive and resourcing
Critical Success Factors - Learning to Date
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• More & better targeted proactive support to patients. Enabling them to:
– have greater control– learn more about their condition– live more independent lives
• Bringing timely information to professionals to inform patient-centred case managementEnabling:
– improvements in the quality of care & quality of life for patients– reductions in inpatient admissions– optimised use of staffing resources
Anticipated Benefits
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Telehealth – Benefits for the people of Northern Ireland
Provider PerspectiveJim O’Donoghue (TF3 / S3 Group)TF3 Service Development and Deployment Director
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RTNI – The Managed Service Model
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• Providing all aspects of a joined-up service involving people, process and technology
• Responsible from Referral to discharge
• Meeting defined service requirements & SLAs
• Technology selection, maintenance and equivalence
• Incentivised to generate service delivery efficiencies
RTNI Managed Service - Provider Responsibilities
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Service Delivery Components
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RTNI Service Design Processes
Pathway redesignProcess definitionSLA planningStakeholder Engagement
Solution designTechnology selectionIT Design
Clinical processesNon-Clinical processesTrainingQA Planning
Program GovernanceClinical GovernanceEvaluation
Service ReadinessSolution ReadinessTechnology Readiness
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Service Design – Collaborative Process
Commissioner
Provider
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RTNI Service Delivery Processes
Enrol Patients Patient planInstallTrain ActivateReview
Triage CoachEducatePatient SupportCarer Support
Issue MgmntPerformance MonitoringReportingAsset Mgmnt
Clinical GovernanceProgram GovernanceEvaluation of outcomes
Service EfficienciesFurther IntegrationNew ConditionsNew ServicesNew Technology
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Partnering to deliver integrated servicesUnderpinned by a strong contractual framework
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Partnering to deliver integrated servicesUnderpinned by a strong contractual framework
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Building a provider consortium
• Form early – provide consistency through procurement and delivery• Define the consortium core values • Build relationships and trust
Managed Service Model
• Significant up-front investment on both sides to define requirements and operating model
• Creates a service based, technology agnostic framework for identifying needs and solutions
• Demands a high level of working in partnership• Asks the provider difficult but very good questions
Provider Lessons Learned to-date
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Working together to deliver
Thank You