Sheffield Primary Care Trust is one of a number of NHS healthcare providers that has trialled and implemented telehealth technology. The trust introduced the new technology to improve the quality of the service and the ability of patients to manage their own condition.
Patients and their carers are shown how to use the technology by health professionals within the service with the aim of giving them a greater understanding of their overall condition. The telehealth technology is then used to remotely monitor their conditions so that the right support can quickly be mobilised if their symptoms change.
Implementing the technology
Honeywell HomMed telehealth monitors were first deployed by Sheffield PCT in 2007, in a trial that was principally undertaken among sufferers of chronic obstructive pulmonary disease (COPD). In many cases, the technology was found to help improve patient care and make good use of medical and nursing resources.
In order to better enable clinicians to use their clinical judgement about the appropriate use of telehealth, the most recent pilot in the area, first undertaken by Sheffield PCT’s community nursing services in May 2010, has focused on a range of LTCs appropriate for telehealth including heart failure and COPD.
We believe we have a unique arrangement in Sheffield relating to the deployment and installation of our telehealth monitors
“There are currently 15 monitors in use in Sheffield and the PCT has plans for further deployment,” said HomMed clinical account manager, Beverley Hobbs. “The technology is used to help patients suffering from long-term conditions, including patients with illnesses such as chronic bronchitis or emphysema. This area in particular has a higher than average occurrence of COPD, partly because of its history of industry.”
Now Honeywell HomMed Genesis and Genesis DM monitors are used by Sheffield PCT in conjunction with HomMed weighing scales, thermometers, pulse oximeters and blood pressure cuffs. Unlike other PCTs, however, Sheffield has given the task of implementing the technology to its teams of specialist physiotherapy assistants.
“We believe we have a unique arrangement in Sheffield relating to the deployment and installation of our telehealth monitors, in that the community nurses work in close partnership with our specialist physiotherapy assistants,” said Sheffield PCT locality service manager, Helen Chapman.
“Once a community matron or case manager has ‘prescribed’ the use of telehealth, the specialist physiotherapy assistant is responsible for the installation of the equipment and ensuring both the patient and their carer clearly understand how to use the equipment. They will also carry out a detailed environmental assessment which may result in physiotherapy follow-up.”
To qualify for consideration, patients must be deemed motivated enough to take an active role in the monitoring of their condition, be over 18 years of age and frequently experience a worsening of symptoms or be undergoing a change in treatment that requires monitoring or education, such as insulin titration. Patients that are being managed by the community nursing team, to avoid deterioration of their condition leading to hospital admission, are also considered.
“This system is working very well because it benefits the patient, allows quick deployment of equipment - within 24 hours of referral - and has fostered more integrated working practices across the two specialisms,” said Chapman.
Adapting to the monitors
Before the technology is installed in a patient’s home, the relevant healthcare professionals are provided with the patients’ diagnosis, past medical history and current medication. A monitor is then allocated to the patient and their personal monitoring information is downloaded onto it.
The HomMed device has the functionality to measure vital signs including heartrate, blood pressure and weight and asks subjective disease-related questions to provide a more complete picture of the individual’s health.
Each morning at a pre-agreed time, the patient records a number of vital signs. They are also asked a series of simple ‘yes’ or ‘no’ questions relating to their condition. Once vital signs and answers have been inputted, the data is transmitted down the patient’s phone line to a secure server.
Initially, Chapman reports that a few issues arose surrounding the interpretation of questions by patients and said that some patients recorded low oxygen saturation levels, which she believes occurred because when the system alerted them to undertake their observations; they would rush to the machine rather than taking their time and relaxing first.
My job is to help prevent patient exacerbations and hospital admissions and watch out for early signs of changes in conditions. Telehealth better enables me to do this
“Another challenge is the change for clinicians with the introduction of telehealth, initially some nurses viewed this as an added burden to their busy workload,” she added.
“This has now been overcome and they can now see the real benefits for patients and themselves of using the equipment.”
Keeping track of any changes in symptoms is essential for the healthcare teams to help them prevent a worsening of conditions. “Many of the patients on my case load have multiple long-term conditions, in particular COPD and heart failure,” said Sheffield PCT community matron, Sarah McCarthy.
“Having the telehealth monitors enables me to keep a close watch on them and indicates if their condition changes. One of my patients with heart failure, for instance, regularly forgets to take her medication. The first sign of this is that her ankles may swell and her weight might increase. The telehealth monitor enables me to monitor these fluctuations in her symptoms.”
Growing in confidence
Overall, Chapman reports that patient feedback on the technology has been positive;
“Thanks to the repetitive process, even those with very little technology knowledge soon find they can easily complete the daily monitoring routine,” she said. “It gives them a sense of security about their condition to know that someone will be alerted if they are feeling unwell.
“The use of telehealth has also allowed the nurses to become more pro-active in visiting patients and intervening when a patient’s status changes to avoid a hospital admission. In turn, this releases clinical time to care for other patients. I’m aware of at least one instance where, as a result of telehealth, the number of times a patient has been asked to attend a hospital outpatient appointment has been reduced by their consultant.”
McCarthy added: “Telehealth has definitely cut down on the amount of visits that we have to do and better enabled us to plan our workload. This also helps to reduce associated costs such as our time and mileage.
“During the recent snow the technology really came into its own as we were still able to closely monitor patients even when it was hard to get to them.
Thanks to the repetitive process, even those with very little technology knowledge soon find they can easily complete the daily monitoring routine
“My job is to help prevent patient exacerbations and hospital admissions and watch out for early signs of changes in conditions. Telehealth better enables me to do this. Most importantly, I think that the technology reassures patients, gives them a sense of independence and is helping to reduce clinical appointments and home visits.
“Often, when there is a change in condition, the patients themselves do not recognise it until they are really quite unwell, especially those with heart conditions. So if there is a sudden change in a patient’s blood pressure, temperature or weight readings, or if they alert me to a problem when they answer one of the questions, it enables me to get to them quickly – before their condition worsens.”
Wider deployment
In January 2011 the telehealth technology became available citywide. According to Chapman, the PCT also intends to investigate the use of telehealth within the heart failure nurse specialist team as a further development and an addition to the care pathway.
“The technology is advancing all the time and patients are becoming more receptive to it,” she said. “In my view it should now be considered when developing any patient pathway or service.”
“Preventing avoidable hospital admissions is a key driver for the NHS in the current economic climate, added McCarthy. “I believe that using HomMed monitors is really helping to achieve this important goal.”