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NextGen Telehealth Improving Outcomes for Pa4ents in
the Community
Stephen Hope Business Development Manager Docobo Ltd [email protected]
16/11/2011 1
Copyright © Docobo Limited Not to be reproduced without permission
Docobo Company • UK company formed in 2001
– To commercialise output from an EU R&D project – Designed and developed by us – not a distributor (we control the IP) – Customised to specific needs (e.g. Philips) – High level of local, technical and customer support – Focused on eHealth technologies to enable Care in the Community
• Regulatory Status -‐ A medical device and solu4ons company (accredited to EN13485) – doc@HOME Telehealth System is a Class I medical device, HealthHUB and
CarePortal are Class IIa – TGA approval for use in Australia and NZ – Docobo is NHS N3 (Intranet) approved – as such meet s Informa4on Governance
requirements to hold pa4ent data
• NHS Procurement – Buying Solu4ons Framework • 40+ UK PCT’s using doc@HOME • Interna4onal – Portugal (original pilot), Australia, New Zealand, others early
stage (Brazil, India, China, Mauri4us, Bahamas)
16/11/2011 2
Copyright © Docobo Limited Not to be reproduced without permission
Enabling Technologies suppor4ng care in the Community
• Telehealth – Managing pa4ents – doc@HOME® – Self management
– Professional care assisted by technology
• Assisted Living – Managing the elderly and vulnerable -‐ CarePortal® – Social isola4on, fragmented families, digital divide
– Alpha Daughter/son responsibili4es – Access to support and wider world
• Care delivery logis4cs – Managing Staff -‐ ComCare – Staff self management
– Make every interven4on count
– Performance management
16/11/2011 3
TELEHEALTH
16/11/2011 4
Copyright © Docobo Limited Not to be reproduced without permission
Telehealth
• Remotely monitoring vital signs and lifestyle of pa4ents on a regular basis and as frequently as the pa4ent’s condi4on requires
• Passing and sharing this informa4on to appropriate clinicians to allow early interven4on; on going management of pa4ents
• Improving outcomes
16/11/2011 5
Copyright © Docobo Limited Not to be reproduced without permission
doc@HOME® Telehealth System Overview
16/11/2011 6
Copyright © Docobo Limited Not to be reproduced without permission 16/11/2011 7
Copyright © Docobo Limited Not to be reproduced without permission
Ques4ons on doc@HOME • Ques4on 4mings (programmable)
– Ques4ons can be asked in fixed 4me periods, e.g: • morning ques4ons, say 06.00 – 12.00 • alernoon/evening ques4ons, say 16.00 – 22.00 • carer ques4ons, say 22.30 – 23.30
– Ques4ons can be asked “Any4me” • To capture events
• Ques4ons are fully programmable – Default ques4ons
• Docobo will work with SAHS to define – Ques4ons selected for individual pa4ents
• Enabling management of whole person
• Ques4ons can be added and customised – Mul4ple ques4ons types (not just YES/NO)
• Mul4ple choice • Numeric entry • Nested • Numeric scale • Test Scale • Prompt
– Fixed ques4on types • BP, Sp02, Peak flow, ECG, etc
16/11/2011 8
00:00 6.00 12.00 16:00 22:00 23:50
Morning Evening
Carer
Copyright © Docobo Limited Not to be reproduced without permission
Viewing the clinical database
16/11/2011 9
Copyright © Docobo Limited Not to be reproduced without permission
Viewing pa9ent specific data
16/11/2011 10
Copyright © Docobo Limited Not to be reproduced without permission
Self Management -‐ 4 week feedback display
16/11/2011 11
NHS Direct study -‐ South East Essex • 999 calls – the average number of 999 calls made per
month by the pa4ents whist using the Telehealth service reduced by 72%.
• GP visits – the average number of visits made by the pa4ents 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 pa4ents whilst using Telehealth reduced by 75%
• Hospital admissions – the average number of hospital admission per month for the pa9ents reduced by 83%
16/11/2011 12
NEXT GENERATION TELEHEALTH AND ASSISTED LIVING
16/11/2011 13
Addressing all Levels of LTC Triangle for Maximum Impact
16/11/2011 14
Level 3: Highly complex patients As people develop more than one chronic condition (co-morbidities), their care becomes disproportionately more complex and difficult for them, or the health and social care system, to manage. This calls for case management – with a key worker (often a nurse) actively managing and joining up care for these Level 2: High risk patients Disease/care management, in which multidisciplinary teams provide high quality evidence based care to patients, is appropriate for the majority of people at this level. This means proactive management of care, following agreed protocols and pathways for managing specific diseases. It is underpinned by good information systems – patient registries, care planning, shared electronic health records.
Level 1:70-80% of CDM Population With the right support many people can learn to be active participants in their own care, living with and managing their conditions. This can help them to prevent complications, slow down deterioration, and avoid getting further conditions. The majority of people with chronic conditions fall into this category – so even small improvements can have a huge impact.
Copyright © Docobo Limited Not to be reproduced without permission
Enhanced doc@HOME® Infrastructure Overview
16/11/2011 15
Pa4ent & Care Giver • Elderly • Poorly • Symptoma4c
• IT Literate • Mild LTC’s Ø Diabetes II Ø Asthma
Case Management Wellness
Email / SMS with URL
GPRS, 3G Broadband
CarePortal® HealthHUB®
GPRS, POTS
GPRS, 3G Broadband
Tablet Apps
Web Services
3rd Party Analy4cs
3rd Party eHealth vendors
• Call Centres • Clinical Teams
Web Applica4on
Browser • Case Co-ordinators • Clinical Teams
• Tailored to needs of patient. • Self Management • Medication management
Prompts and ques4ons etc
Scheduling Engine
Clinical Database
doc@HOME®
Telehealth Service Provisioning
Copyright © Docobo Limited Not to be reproduced without permission
Clinicians View
16/11/2011 16
Copyright © Docobo Limited Not to be reproduced without permission
CAREPORTAL® – Solu4on for Assisted Living • CAREPORTAL® is a solu4on consis4ng
of bespoke Docobo designed hardware and an open source solware platorm
• Designed to be able to give an older or less technically capable user access to social networks and services
• The product is likely to be purchased / rented by a carer for the user.
• The purchaser will typically be child, rela4ve or partner who wants to opens access to a virtual world
• Sold through mobile retail outlets and other community organisa4ons
16/11/2011 17
CAREPORTAL® is a Class IIa Medical Device Platorm
Copyright © Docobo Limited Not to be reproduced without permission
Telehealth Services
doc@HOME®
Other Health IT Systems
Web Browser Clinical
Teams eNABLE™ Service Provisioning Telehealth Service Provisioning
ClientPa4ent & Care Giver • Elderly • Poorly • Symptoma4c
• IT Literate • Mild LTC’s Ø Diabetes II Ø Asthma
Case Management Wellness
Docobo Independence Infrastructure Overview
16/11/2011 18
3rd Party Services
Delivered Meals Other
GPRS, 3G Broadband
Tablet Apps Email / SMS with URL
HealthHUB®
GPRS, POTS
Social Contact
Peer to Peer groups
Family Web access • Diary • Photos
BeTogether™
Community access
Assistance Services
Community groups: • 3rd sector • Local volunteer • Private providers
Community Assist
Web Browser
concierge@HOME™
Environmental Controls Interface
GPRS, 3G Broadband
Loca4on Services
CarePortal®
Copyright © Docobo Limited Not to be reproduced without permission
Interoperable Solu4ons for Assisted Living
16/11/2011 19
Tynetec Ac4vity Trend Analysis
IP based connec4vity
ADL Alerts
Docobo, Tynetec and JonTek bring you: • Interoperability • Use of legacy kit • UK innova4on • New business models
NEXT GENERATION COMMUNICATIONS
16/11/2011 20
Future Connected Care
16/11/2011 21
care profs
Friends and family
Tele-‐carer
Care response service
Emergency services
NHS Direct
Care professionals
Care Portal
Elderly living independently
Records
• NHS
• Social Care
• Housing
• Personal Health Record
Telehe
alth
Telecare
Home au
toma9
on
Cholesterol monitor
Blood-‐ pressure cuff
Pedometer
Glucose meter
Sensor networks
Medica4on tracking
Lights Doors / Windows Mo4on / Ac4vity Bed Kitchen Bathroom
Service Hub
CRITICAL COMMUNICATION REQUIREMENTS
16/11/2011 22
Next Genera4on Telehealth Communica4on Requirements • Mobility -‐ Seamless to The User
– Seamless Mobility vs Service Discovery
• Emergency Buwon priority across any network technology • Minimised delay
– Real-‐4me duplex communica4on – Video call
• Loca4on aware – Posi4on – seamless service mobility from outdoor to indoor loca4on techniques
• Reliable Connec4on across any Network type to Assistance Centre • Secure Data Connec4on across mul4ple networks
– Full data protec4on for Vulnerable Adults and Children – NHS N3 Security approvals
• Separa4on of Telehealth, Telecare and Public Domains • Security -‐ password and enrolment -‐ encryp4on • QoS, Priority and Pre-‐Emp4on across any Network type • Mul9ple Cri9cal Uplink Services on Asymmetric NG Technologies
biased towards downlink
16/11/2011 23
THE FUTURE ASSISTED LIVING BUSINESS MODEL
Implemen4ng the personal budget/ private pay integrated model
16/11/2011 24
The Personal Budget/Private Pay Model • Statutory and Elec4ve e-‐Health Services combined • More choice to the individual • Allows rela4ves to purchase services • BUT WHO
– Recommends – Monitors – Supplies Equipment and Services – Supplies Communica4ons Packages – Bills
• WHO PAYS and HOW • Companies will now need to address the Personal Consumer Domain as well as the Enterprise Domain
16/11/2011 25
Copyright © Docobo Limited Not to be reproduced without permission
TELECARE Services CHUBB AGEUK SCPCT DOCOBO
Community Services AGEUK, SCPCT
HDLHB GLENSIDE
The Future Personal Budget/Private Pay Business Model Framework
16/11/2011 26
BT O2
TELEHEALTH Services DOCOBO
Content Provider Content Provider Content Provider
AGEUK
Terminal Supplier Terminal
Supplier Terminal Supplier
User
Programmes, News Games Shopping Videos, Music Web Page Adverts
HealthHUB, Wrist Unit, Handsets
PDAs
People,+ Equipment
Health Care Services
SCPCT HDLHB GLENSIDE
Telehealth Service Roaming
Prime Assisted Living Service Provider DOCOBO
Arrows represent Flow of Money
Communica9ons Providers and Retail Outlets
Interac9ve Content Provider
DOCOBO GUIDANCE, HWC etc
FINALLY
16/11/2011 27
What did Stan tell us? • Produc4vity / Efficiency / Burden
reduc4on – The nurse has reduced the number of
visits per week by 4 enabling her to visit other needy pa4ents
– Stan is empowered – no longer anxious – reduced calls on Health Service
• Climate / Environmental – Reduc4on in unnecessary home / clinic
visit
• Pa4ent experience – He’s doing it from his lounge
in his usual chair – He has become an expert
pa4ent; knowing when vital signs are high
– He is confident and able to live in his own home with his wife
– His wife’s quality of life has improved
– He’s no longer grumpy!
16/11/2011 28
[Note: Stan was the subject of an independent BBC Video]
Summary • Telehealth can significantly improve the quality of life of pa4ents with Long Term Condi4ons
• Pa4ent Selec4on is key • Next Genera4on Communica4ons will enable Next Genera4on Assisted Living Services
• But Who Pays for Them and How is yet to be determined
• Above all Next Genera@on Networks need to be engineered to ensure that my Heart ADack alert is not obstructed by someone else watching Eastenders on HD IPTV
16/11/2011 29
Thank You
16/11/2011 30
Docobo Limited The Old Granary 21 High Street Great Bookham Leatherhead Surrey KT23 4AA
Tel: +44 (0)1372 459 866 [email protected]