Improving Outcomes And Efficiencies Of Managing Patients In The Community - Adrian Flowerday

Improving outcomes and efficiencies of managing patients in the community

Adrian FlowerdayManaging Director

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Enabling Technologies supporting Community care

• Telehealth – Managing patients– Self care

– Risk Stratification

– Professional care

• Care delivery logistics – Managing Staff– Staff self management

– Performance management

• Assisted Living – Managing the elderly and vulnerable– Social isolation, fragmented families, digital divide

– Son/Daughter responsibilities

– Access to support and wider world

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Issues Surrounding Home based Care Delivery• New Providers

– Vertical and Horizontal Integration, Private providers– New ways of working need to be introduced now– Virtual Wards and Virtual Rounds

• Home based healthcare– Typical district nurses, health visitors and therapists– PLUS complex nursing care (Hospital at home – reduce LoS and

outpatient visits)– PLUS LTC and elderly management (avoidance, empowerment, self

management) – Increasing Social Care issues – Multi-Disciplinary team working

• In Ireland– Approx 10,000 complex and symptomatic LTC patients (CHF, COPD)

– High demand on services and hospital beds– Approx 80,000 Diabetics

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An independent BBC video

What did Stan tell us• Patient experience

– He’s doing it from his lounge in his usual chair– He has become an expert patient; knowing when vital signs are

high– He is confident and able to live in his own home with his wife– He’s no longer grumpy!– His wife’s quality of life has improved

• Productivity / Efficiency / Burden reduction– The nurse has reduced the number of visits per week by 4 enabling

her to visit other needy patients– Stan is empowered – no longer anxious – reduced calls on Health

Service

• Climate / Environmental– Reduction in unnecessary home / clinic visit

Copyright © Docobo Limited Not to be reproduced without permission 12/04/2023 6

Patient & Care Giver• Elderly• Poorly• Symptomati

c

• IT Literate• Mild LTC’s Diabetes II Asthma

Case Management Wellness

GPRS, 3GBroadband

CarePortal® HealthHUB®

GPRS, POTS

GPRS, 3GBroadband

Tablet Apps

Email / SMSwith URL

Web Services

3rd Party Analytics

3rd Party eHealth vendors

• Clinical Teams• Call Centres

Web Application

Browser• Case Co-ordinators

• Clinical Teams

• Tailored to needs of patient.• Self Management• Medication

management

Prompts and questions etc

SchedulingEngine

ClinicalDatabase

Service Provisioning

doc@HOME® Infrastructure Overview

doc@HOME®

• Clinical decision support

• Trending

docoboWEB™


Features:•Simple to use – fit for

purpose for demographic•Handheld cradle based –

used anywhere, no wires•Timeslot questions –

when the patient is ready •Built-in LEAD I ECG and

BioZ – Rythym, AF, HRV and respiration•Class IIa Medical Device

– data collected can be used for diagnosis•Anytime and friends

questions – capture events and impress friends•Unique 4 week display -

empowered


CAREPORTAL® – Assisted Living• CAREPORTAL® a multi-media Android

based, simple to use, platform with colour touchscreen, camera, WIFI, Broadband ,3G and phoneline connectivity.

• Designed to be able to give an older or less technically capable user access to social networks and services

• User group involvement – they specified the look and feel, and they love the result

• The purchaser will typically be child, relative or partner who wants to opens access to a virtual world

• Sold through mobile retail outlets and other community organisations

CAREPORTAL® is a Class IIa Medical Device Platform


Clinicians View

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Example stored ECG (lead 1)

HVI and Rhythm Analysis


Efficiency savings 1

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Prior to doc@HOMEJan 2006 – Oct 2006

With doc@HOMENov 2006 – Mar 2007

Emergency Admissions 23 2

A&E Attendances 12 0

Hospital Admissions 16 2

Unscheduled Out of calls 55 3

Estimated costs >£54,000 <£6,000


South East Essex• 999 calls – the average number of 999 calls made per month by the patients

whist using the Telehealth service reduced by 72%. • GP visits – the average number of visits made by the patients per month to their

GP whilst using the Telehealth service reduced by 56%. • A&E visits – the average number of visits made per month to A&E by the patients

whilst using Telehealth reduced by 75%, meaning a saving of £1091 for 53 patients per month, equating to a total saving of £13092 per annum for 53 patients.

• If Telehealth was implemented for 1000 patients the equivalent savings on A&E admissions would equate to approx £247k per annum.

• Hospital admissions – the average number of hospital admission per month for the patients reduced by 83% indicating a cost saving of £44892 for this group of patients using Telehealth per month. This equates to a saving per annum of £847k.

• If Telehealth supported 1000 COPD patients this could equate to a potential cost savings in A&E attendances and hospital admissions of £10.4m per annum.

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New Directions... Consumer power• Current doc@HOME service is mainstreamed in many organisations, with

over 85% of customers ordering additional product.

• But, established Healthcare providers (NHS) limit potential and supply– Funding incentives not aligned

– Clinicians are gatekeepers

– Keep the Status quo

• Consumer becoming more informed– Aware of what can be done

– Aware of failings of current provision (Care Homes , care of elderly in hospital)

– Want a “Cohesive, Co-ordinated Care Service” for mum, for them

– Its more then just healthcare

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Older/vulnerable people- Independence- Social Isolation

- Fragmented Families- Digital Divide

- Support for Daily living activities- “Soft Assistance”

Medium LTC(Less symptomatic )

Mild LTC(Type2 Diabetes, Asthma,

Hypertension

Complex LTC(poorly and

symptomatic COPD and CHF etc)

Its more than Health.......


3rd PartyServices

Delivered Meals Other

SocialContact

Peer to Peer

groups

Family Web access• Diary• Photos

AssistanceServices

Community groups: • 3rd sector• Local volunteer• Private providers

Community Assist

Web Browser

eNABLE™ Service Provisioning

GPRS, 3GBroadband

CarePortal®GPRS, 3GBroadband

Tablet Apps

Independence Infrastructure OverviewBeTogether™

concierge@HOME™

Community access

TelehealthServices

doc@HOME®

Other Health IT Systems

Web Browser Clinical

Teams

LocationServices

EnvironmentalControlsInterface

docoboWEB™

BeTogether™

Email / SMSwith URL


ComCare – Management of Community Care


Can record multiple wound locations Each wound retains its own history and

progress Graphical representation of the wound

healing progress against the system specified healing parameters (best practice)

History of wound products used during the healing process

Defines the regions of the wound and calculates the area of the wound regions to create the healing graph

Wound Management


Productivity Improvements

More than 60,000 hours of savings

Target Saving = 5,100,000 klms


A typical nursing roundafter re sequencing…..Saving = 1 hr 42 mins and 53 km

A days nursing activity at one locationafter optimisation…..62 hours of travel reduced to 27 hours 3708 kms reduced to 1620 kms

Efficiency Savings

Health & Medicine

Improving Outcomes And Efficiencies Of Managing Patients In The Community - Adrian Flowerday