Remote In-Home Tele-

Monitoring in Western NSW

2016-2018:

Monica Murray Project Manager – HiTH/Ambulatory Care

Integrated Care Strategy

Western NSW Local Health District

Monica.murray@health.nsw.gov.au 0428641162

Overview

1. Background

2. Trial 1 – WNSW LHD

3. Trial 2 – Aboriginal Health Services

Partnership

4. Barriers, Enablers, Learning

5. Current status & potential

6. Points for consideration

7. Future Vision

What is Remote In-Home

Tele-Monitoring?

• Automated biometric devices in home -

BP, Temp, HR, PO2, BGL, Weight, ECG,

(+-spirometry), +/- videoconference, +/-

targeted health coaching

• Data transmitted to secure website,

checked daily Mon-Fri by local nurse

• Telstra Mobile 3G network

• ↑ NGO’s offer THM under Home Care

Packages & Commonwealth Home

Support

What does the literature say?

Objectives of trials

Process Evaluations

Objective Measure

1. Acceptance and relevance of tele-home monitoring with a variety of clinicians and patients.

Demographics of staff and patient uptake,

2.Useability of tele-home monitoring within a range of existing service delivery models

Pre and post-trial staff confidence and usability with the technology, perceived patient benefits and workload impact

3.Improvements in patient knowledge of symptoms and capacity to self-manage

Patient reported experience

Sites involved

Trial 1: WNSWLHD (May 2016-June 2017)

Bathurst, Orange, Dubbo

Parkes, Cowra

Cobar, Molong, Wellington

Trial 2: Bila Muuji Aboriginal Medical Services

Partnership (Nov 2016- Feb 2018)

Brewarrina, Bourke, Coonamble, Dubbo

Forbes, Orange, Walgett, Wellington

Resources…

TeleMedCare Secure Website

Brief Demographics of Trials

Trial 1 (LHD) May 2016-June 2017

• 8 LHD facilities

• Total 20 enrolments in trial

• 12 Female / 8 Male,

• Median age – 68 yrs

• Length of monitoring:

range 4 day – 138 days

average LOS monitoring – 32 days

• Report available with full details

Trial 2 (Aboriginal Medical Services)

Oct 2017-Feb 2018

• 8 Aboriginal Medical Services

• Total 52 enrolments in trial period

• 65% Female/35% Male

• Median Age – 60-69 yrs (range 23-87yrs)

• 56% used for a month duration

• Report available with full details

Patient evaluations • Overall patient feedback was very positive

in both trials

• 88% rated THM as easy to use

• 88% felt THM improved their knowledge about their health condition & symptoms

• 89% would recommend to others

• 82% felt that THM improved communication with their doctor

• 79% reported LESS anxiety using THM

Challenges

• Rate of technological advances

• Implementation requires significant flexibility, frequent review and adaptation.

• Workforce capacity & readiness site dependent

• Workforce variable skills to manage and escalate biometrics in the community

• Staff comfort/skills with self-management & patient access to additional biometric data

• Limited strong evidence to determine HTM cost/benefit

Enablers

• Additional external funding to purchase and trial technology in partnership model

• Adequately resourced support team

• Local leadership of early adapters, comfort with technology and culture to accommodate change.

Learning for WNSW

Proportion of the population within our region suffering one or more chronic conditions is attributable to remoteness and Aboriginality, the comparative ease in which clients of the Bila Muuji Partnership Trial have been enrolled in HTM is an early success and should be explored further as a means of better managing chronic conditions in WNSW

Current Situation……Bila Muuji

Aboriginal Health Services Partnership

• Partnership Closure April 2018 – planned withdrawal of LHD support

• Aboriginal Medical Services now self-

sustaining their own THM • Average 10-12 patients being monitored

each month

Current situation: WNSW LHD

• Conservatively support current devices until (2020) • Loss of key project staff– didn’t aggressively market

after trial to consider directions/models → low numbers ~ 6/m active patient monitored currently

• Review manuals/protocols • Support new sites to implement THM • West Morton Qld model - visit July 2018.

Future Potential for RIHTM in WNSW

• Patient Flow, Remote Critical Care Consultation & Patient Transport Unit (Dubbo) • Expansion & move to airport. Commence

24/7 2019 with after-hours nurse/doctor • Stage 1 - ‘IN-HOSPITAL Remote Monitoring’

- supporting rural/remote hospitals with IN-HOSPITAL monitoring to assist in detection of clinical deterioration inpatients on wards

• Potential to support IN-HOME monitoring as

subsequent stage

Points for consideration • Gap between perceived/expected enrolments….and actual

• Model of Care – choosing right fit

• Target patients – narrow or broad criteria

• Vendor comparison/variance

• Funding & Activity reporting under ABF

• Governance

• Evaluation

• Other community players

• Change management support & leadership crucial

• Health Coaching/Chronic Disease Management

• Interface with eMR

• Interface with other VC platforms being used by clinicians

Future Vision