Health Transformation

The Department of Health for England’s (DH) current investment in their Whole Systems Demonstrator programme, active development of the field by groups such as Continua, and lobbying from the groups representing those with Long Term Conditions are all helping raise the profile. For too long it’s been perceived as a technology solution focused on capturing and recording data to drive treatment through dose management in isolation. The “whole system” part of the DH programme title gives the real game away. It’s about providing a cross setting, coordinated response that leads to an improvement in the wellbeing of the patient, enabled through the use of assistive technology.

What makes this whole area interesting is the potential breadth of clinical scenarios and conditions where it can be adopted, the apparent breadth of benefits and who receives them (it’s not just the patients!). It’s also particularly relevant as an approach when considered against the backdrop of an increasing and ageing population, with forecast rises in both chronic conditions and risk factors such as obesity which bring an increased likelihood of developing some form of Long Term Condition. Take a look at the recently updated LTC compendium (from the Department of Health for England) for the latest projections. So who can benefit?

Patient self monitoring is less time consuming due to the increased automation of the process. They are happier in the knowledge that their condition is being actively monitored and managed (though there are questions about a dependency shift and responsibilities here). Case management and individual “just in time” intervention reduce the likelihood of an episode. In the case of an episode arising, early intervention reduces the likelihood of an admission.

Clinicians and care providers are able to rely on data that’s free from notational errors, but most importantly they can have this information in near real time. The timeliness of the delivery of the data can be tuned to the condition or the severity of an individual patient’s case. That allows interventions to be taken early, improving the patient’s quality of life through the better management of their condition. The increased volume of reliable data being captured also helps to drive forward research on the condition and the efficacy of particular treatments.

Commissioners and “payers” are happy as well. If we intervene early we can reduce the likelihood of a face to face encounter, whether with the GP or MD, or as an admission or in-patient stay. An intervention to achieve this isn’t necessarily clinical. It can range from a reminder to take a dose of a prescribed drug, advice and guidance from a case manager in response to the collected data or pro-actively using the collected data to drive the decision support to undertake a clinical intervention.

It’s ultimately about helping a patient to better manage their condition and improve their quality of life. This in turn reduces need for access to more costly and scarce resources in primary / community and acute care settings, with a reduction in admission days.

In itself it’s not a magic bullet, but as a means of health and care provision it offers benefits for everyone in the health and social care ecosystem. Its applicability to address the challenges from a future ageing population and forecast growth in Long Term Conditions makes it relevant globally. Behind all this is a pretty compelling business case, and there’s already plenty of evidence out there. The US Veterans Health Administration case study presented by The Kings Fund presents strong evidence for Telecare and Telehealth. It will be fascinating to read the findings from the WSD trial when it concludes to see whether it upholds these findings and can deliver the benefits. So what do you think? What’s stopping the growth of this aspect of care delivery? Why aren’t we seeing more integrated care solutions supported by Telecare and Telehealth? What’s the blocker, what’s the catch?