ll-health is an acute problem in Barnsley, South Yorkshire. Astonishingly, a quarter of the borough’s 225,000 residents are recognised as living with chronic conditions such as coronary heart disease, hypertension and diabetes. That puts the local primary care trust – Barnsley PCT – under immense financial and organisational strain.
With serious illness so endemic among the local population, it’s perhaps not surprising to see that Barnsley has emerged as one of the most progressive centres of telehealth in the country. Later this year, the second phase of a trial that began in 2010 will see several hundred patients start to use a sensor-based system that will allow them to take vital measurements such as blood pressure and blood glucose levels in the comfort of their own homes. The telehealth system then transmits the data to health providers across secure links through the internet, with the patient and medic connected via display interfaces. The system is aimed at reducing the number of visits that patients need to make to local medical facilities, which in turn saves money for the PCT.
Such remote-monitoring technologies are already popular in the US, but the Barnsley trial is the first of its kind in the UK. And now other health bosses are watching the progress closely: primary care trusts in Leeds and Hull are also considering adopting the system in a bid to cut costs.
The first stage of the trial has been deemed a success, with initial fears that the use of telehealth would lead to patients feeling isolated from doctors and nurses proving unfounded. Instead, says Sue Wing, deputy director of operations at Barnsley’s health delivery unit, the system has encouraged patients to take a greater interest in their own specific health conditions. People living with chronic conditions who are supported with telehealth have been found to be more likely to take control of their own well-being, such as stopping smoking, losing weight, taking more exercise, and looking after their mental condition.
Wing says that medical care has also improved. Once patients access the telehealth system, care providers can assess their needs and direct them to the right services based on the findings recorded, providing greater efficiency in time and resources.
“It has really empowered people to manage their long-term condition,” says Wing. “The vast majority of those involved in the trial have embraced the technology – they absolutely love it. We have had some quite elderly patients with complex conditions telling us that it has delivered real benefit to them. I view telehealth as a vital toolkit for the delivery of our clinical services and for increasing self-directed care. It also brings us some real efficiencies, as well as helping us drip-feed educational support.”
The Barnsley trial is based on the Telehealth Plus system developed by Bosch. The key components are the patient’s home-based display interface, the required monitoring devices and tailored health management programmes that are delivered across a telephone line or Ethernet connection. Patients measure their vital signs such as blood glucose, blood pressure and pulse rate, weight, oxygen saturation and peak expiratory flow. The interface automatically transmits these measurements and the healthcare professional can call up the results through a web-based terminal. With the help of a partially automated process, the healthcare professional can identify the level of risk associated with each patient and act accordingly, therefore preventing and/or reducing the number of acute situations that may lead to hospital treatment.
Telehealth Plus can be used to monitor a wide range of conditions, including congestive heart failure, coronary heart disease, diabetes, chronic obstructive pulmonary disease and hypertension, and mental health.
Dr Jasper zu Putlitz, president of Robert Bosch Healthcare, says that the popularity of the system in the US, and its emergence in the UK, proves that telehealth is becoming an acceptable technological solution. “Critics will quickly point out that the patient/doctor relationship has been compromised. But that is not the case,” he says. “If you look at a typical deployment you will see that the patient feels more connected because they have the chance to articulate that they don’t feel well and this will trigger a call from a medical professional. A nurse or a doctor will call them if one of the vital signs is not so positive. It’s a much more targeted way for a doctor or nurse to get personally involved with the patient.”
But he admits that telehealth might not be suitable for all chronically ill patients. “There will always be some resistance,” he says. “Ultimately it is not possible to reach every chronically ill patient with this technology because there will be some people who are too shy or too reluctant to use it. But the patients who do engage tend to become very engaged. Once they are converted to telehealth technology, they stay with it.”
Bosch says that research it has carried out proves that letting patients take their own vital sign measurements leads to them becoming more in-tune with their condition. The health management programmes are developed to improve patients’ knowledge of their particular diseases. “Where they really tend to get excited is when they actually learn about their condition and receive tips on how to improve and manage their progress,” says Putlitz. “Therefore Bosch concentrates on making sure that therapy management programmes are built-in, which helps patients to manage their disease much better than they normally would.”
While the price of the Telehealth Plus system depends on the size of the deployment and the specific type of sensors required, Putlitz insists that, on the whole, it has been proved to result in cost efficiencies for health authorities. “It is not a one-size-fits-all approach to healthcare – the priorities for each provider are always very different,” he says.
“But we have published 30 studies in the US that have analysed a large number of patients. Typically a telehealth intervention can potentially save 20-25% of patient costs, and hospital admissions can be reduced by more than 20%. It’s not a very expensive technology given that the health provider is creating a lot of clinical and financial impact.”
Putlitz says that while the UK has been slow to adopt telehealth, certainly in comparison with the US, there are now signs that care trusts are recognising the benefits that it can bring. As a result, Bosch is setting-up a dedicated UK healthcare operation to scale-up its business.
“This is not about spending money for a fancy piece of technology – it’s about improving care and improving financial outcomes. It’s investment that pays off, and more and more people are appreciating that,” he says.
“We are already working with NHS Direct and healthcare providers in Leeds and Hull and we have had many requests from PCTs who also would like to use the technology. We believe there will be widespread appreciation of the potential of telehealth in the UK, and so we believe this is going to be a pretty big opportunity for us.”
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