paul marriott va presentation final 3 june 14
TRANSCRIPT
Messaging Enabled Care ServicesWashington D.C. Conference 2014
Paul Marriott MA FCIM, TECH Eng. IME
NHS England Northern Senate
Lead Consultant and Advisor of Technology Enhanced Care Services (TECS) to NHS England
Lead professional and advisor in the development and implementation of TECS in the North of England and Clinical Advocate for TECS UK and International NHS England
NHS England TECS - Clinical Advocate 2014 Winner
[email protected]@VallumPaulM
In performing my role
• I lead Telehealth Programmes TECS (Technology Enhanced Care Services) for the NHS in the North of England
• I work Nationally and Internationally for NHS England promoting and advising on TECS implementation clinically and strategically
• I am a key innovator, leader and problem solver for new innovations within TECS
• I am an author and the inventor of the Multi Matrix Telehealth or (TECS) Model
About us
• NHS England Northern Senate is the largest health region in England
• The area covers boarders with Scotland in the North and Yorkshire and Lancashire in the South
• The region is hugely diverse and is an extreme mixture of industrial, rural, agricultural and cities. The region covers 2 National Parks within the UK
NHS England Northern Senate
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• Life is in three parts. It begins with a trauma (birth) and ends with trauma (death) and in between we face life and wellbeing challenges in multiple ways and of multiple magnitudes.
• Nothing is universal to us all except the beginning and the end of life, therefore the middle section of life has to be met by a diverse Multi Matrix Approach to supporting health and wellbeing.
• The Multi Matrix Model of Technology Enabled Care Services is a concept developed by me in 2011 that seeks to match technology with the whole life perspective of patients.
• It links prevention and lifestyle change to disease development and progression through its stages to end of life and in the most cost and patient effective way.
Multi Matrix Modelof Messaging Enabled Care Services
Prevention is Easier than a Cure
I recently met 8 teams of Oncologists and Radiographers and asked them:
How can NHS England help reduce the number of Tumour and Cancer sufferers you encounter?
The answer was simple and universal REDUCE SMOKING!
Optimum Health
Robust Health
Good Health
Average Health
Signs of Illness
Chronic Illness
Irreversible Illness
PrematureDeath
Wh
ole
Lif
e P
ers
pe
cti
ve
Conception
Death
The Multi Matrix Telehealth Model Seeks to Cross the Whole Life Perspective by Proportionally Matching Telehealth Systems with the Patients Needs, Lifestyles and the Clinicians Medicine.
NHS Florence SMS Simple Telehealth System
SMS
Prompts and adviceGP Practices
Specialist Clinicians
Community and SpecialistNursing
Public Health Smoking Pathway
A Useful Tool That We Have Used SOTW is Quality Function DeploymentWe Now Call it “Health Function Deployment”
The Customer Needs or Wants are Listed on the Left
Needs/Wants are Ranked Numerically in Order of Importance to Customer
How these Needs/Wants can be Delivered are Listed
Scores are Totalled Needs Plus How's and a Ranked Set of Needs and How to Fulfil them Emerges
Condition Clinical Lead
Heart Failure, Angina etc. FT, GP
COPD and Respiratory etc. FT, GP
Hypertension GP
Diabetes FT, GP
Gestational Diabetes FT
Pre Pregnancy HbA1c Family Planning FT
Parkinson’s FT
Rapid Discharge FT
Deprivation Medicine and Social Prescribing GP and 3rd Sector
Acquired Head Injury and Stroke FT, GP
Primary Care Step Up Step Down GP
Care and Nursing Home GP
Weight Management FT, GP, LA & PH
Smoking Cessation LA & PH
Remote Wound Dressing Monitoring FT
Community Matron Case Load FT
Alcohol Induced Morbidity FT
FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health
Some of the Current Florence Pathways in the
Northern Senate (there are now over 80)
Messaging Enabled Care Services are the Most Adaptable, Usable Form of Telehealth Care Provision I know
LET ME SHOW YOU SOME EXAMPLES OF WHAT WE HAVE DONE SO FAR
Remote Wound Management Over Wide Geographical Areas
As an Example Addiction Medicine Pathway
GP
Recovering Substance User
3rd Sector Volunteer Patient Buddy
NHS Florence System
None Medical Control Centre
Carer Pathway Local Authority Social Care and Primary Care
GP
SMS TelehealthPatient and Carer
HQ 9 or Questionnaire
Telecare Control Room
Social Care/Housing
The Application of a Message Enabled Care Monitoring and Support Service in Pain Management (Example Pain Diary)
Typical Pain Management Diary
Date After Block
Good Relief of Leg Pain
Partial and Satisfactory Relief of Leg Pain
Partial but Unsatisfactory Relief of Leg Pain
No Relief of Leg Pain
Same Day √
Day 1 √
Day 2 √
Day 3 √
Day 4 √
Day 5 √
Day 6 √
1 2 3 4
Intervention
The outcomes for those patients referred for Telehealth in South Tyneside have demonstrated significant reductions in access to health care in the three months following the use of Telehealth. The Key Outcomes are as follows:
53% reduction in attendance at A&E
55% reduction in Emergency Medical Admissions
14% reduction in access to Urgent Care Service
No patient having more than one hospital admission
71% reduction in costs associated with A&E attendance and Emergency Medical Admissions.
Telehealth Reported Outcomes South Tyneside Hospital COPD and Heart Failure Patients
Patient Case Studies
• Heart Failure patient is admitted for the fitting of an assist device. Operation has to be postponed as the patient fluid levels are too high. Because Telehealth is on the ward and the patient can use it he is discharged from acute HF bed at a saving of £2,000 per day. The patient is then monitored from home by Cardiology Team whilst medicating with diuretics. Six days in an acute bed are avoided.
• COPD patient “Flo has made my life easier. if I have a very poor day when I cannot manage to mobilise, I can take my readings from my bedroom unlike other systems I have used. Also on better days I can take Flo with me. It’s a nurse in my pocket.”
• TB Medication Reminder. TB sufferers have to take medication regularly and clinical staff have to verify that patients have complied with the drug regime for a 6 month period. An enclave of TB patients with whom it is difficult to engage have been given Flo to manage their medication reminders. The patients have largely chaotic lifestyles and mostly don’t respond to clinicians who attempt to contact them. The Flo system has proved successful in that patients willingly comply with the SMS reminders and valuable clinical time has been saved along with a robust audit trail of drug compliance.
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Key PointsNHS England Northern Senate
• Messaging Enabled Care Services is the most adaptable, usable form of Telehealth Care Provision I have encountered. Even disparate patients respond to SMS contact.
• When used in a Multi Matrix way Messaging Enabled Care Services can work across the whole life perspective from Conception to End of Life and from prevention of illness to chronic disease management.
• We in NHS England Northern Senate have developed over 80 pathways and this is only scratching the surface of what this technology can do we believe.
• Our Work So Far in the Community has Shown Telehealth Can Produce53% reduction in attendance at A&E55% reduction in Emergency Medical Admissions14% reduction in access to Urgent Care ServiceNo patient having more than 1 hospital admission71% reduction in costs associated with A&E attendance and Medical Admissions