Last week, David Cameron unveiled a Department of Health campaign to extend telehealth to 3m homes over five years.
The launch came at the end of the Whole System Demonstrator pilots, which apparently showed that the correct use of telehealth could reduce deaths by up to 50%, while bringing down the number of emergency hospital admissions, GP appointments and A&E visits.
The government hopes that the NHS could save around £1.2 billion a year by caring for people in their own homes.
There are 15.4m people living with long-term conditions in England who could benefit from this kind of technology. So with a growing and ageing population, the need for new care models has never been greater.
However, the uptake and use of mobile, telehealth and home care technologies nationally remains low. There are a number of challenges to widespread service adoption and it is imperative that these are overcome through concerted efforts from all stakeholders.
Finding evidence of cost-effectiveness
One barrier that we have seen is a perception that mobile and telehealth innovations have yet to provide significant evidence of cost-effectiveness.
Even last week, the DH was unable to publish the results of the WSD pilots in full, prompting speculation that they have not delivered the savings that were hoped for.
There are also concerns that health organisations must present their own business case to adopt the technology, rather than accept recognised findings from elsewhere.
However, mobile and telehealth innovations have provided evidence of cost-effectiveness. An end of life care service provided by Healthcare at Home in partnership with NHS Birmingham East and North resulted in fewer unnecessary admissions into acute care, shorter bed stays and better end of life choices.
In addition, the primary care trust saved more than £1m in its first year. The year-long pilot exceeded expected referral numbers by 12% and exceeded targeted savings by 51%.
These findings were used to evaluate what the savings to the NHS would be if the service was provided to the same number of patients within every primary care trust at a national level.
The analysis showed that, across England, savings from home-based end of life healthcare for approximately 88,000 patients could total in the region of £160m.
NHS Birmingham North and East also worked with Healthcare at Home to deliver home healthcare services for patients with long term conditions.
Results from all four pilots show that adopting these models nationally could generate savings in excess of £1 billion, benefiting 550,000 patients.
Overcoming the barriers
In the light of these results, it’s clear that overcoming barriers to adoption must start with highlighting the practical benefits of mobile health technology more effectively.
It is important to encourage organisations to analyse their current systems, carry out audits, evaluations and obtain stakeholder feedback on where processes can be improved.
We also need to help frontline nurses to see the benefits that technology can introduce to their work environment, such as enabling them to treat more patients in a shorter time span.
Evolving the paper trail
In our experience, change has proven to be another barrier to the adoption of new technology. Paper-based systems are an example of outdated procedures that are still favoured by many health organisations.
Yet we have seen these manual processes lead to confusion, as records can be lost, or mistakes made and not easily traced. Paper-based systems also require a significant amount of storage space compared to digital records. And collating them into a single view is time-consuming and complicated.
This process can be simplified with electronic records; and this can also deliver significant cost savings, since home health care nurses currently spend a great deal of time on paperwork and dealing with reimbursement issues.
One recent study conducted by Outcome Concept Systems found that agencies without automated documentation have reported 48 minutes of paperwork for every hour of care, which doesn’t include calls and travel time.
Many organisations resist the transformation from paper-based processes to electronic ones because of concerns about availability and security, or worries that new systems may disrupt existing services.
It takes real commitment to break from systems that have been in place for many years, even if these are sometimes unreliable or cumbersome.
However, while there may be some initial disruption, organisations that can accurately view how much time is wasted through using ineffective systems may well be more compelled to introduce and benefit from mobile and telehealth services.
Taking advantage of cost efficiencies
Another major barrier we’ve seen to the wider acceptance of technology-based care is the initial level of investment.
In this financial climate many health organisations have budget constraints and are looking to reduce costs wherever possible. Because of this, the focus may be on short-term cost savings and limiting expenditure where possible.
This may explain why many are resistant to invest outlay on solutions which may disrupt the organisation in the short-term.
These concerns are understandable, but the model behind mobile and telehealth services is designed to save costs, while improving the productivity of staff and providing the right care in the right place at the right time to the patient.
It’s worth considering not only the cost of implementation but the long-term potential savings and benefits, and whether these will offset the initial investment.
New ways of working
There may also be an impression that healthcare solutions may lead to professionals becoming ‘de-skilled’. This is certainly not the case.
In the case of frontline nurses, technology can improve their ability to carry out high quality assessments, by prompting the questions that patients should be asked, and the actions arising from these. As providers, we need to convey the message that systems can support and improve healthcare skills.
An important problem for the home health care sector is the shortage of registered nurses and home health aides, as well as a high turnover rate; UK data from September last year puts homecare at a turnover rate of 16.4%.
Attracting qualified workers and retaining them is therefore a high priority for many home healthcare structures. The assistance offered by telehealth technology can provide a more healthful, less stressful work climate which is an important part of any retention strategy.
There are other areas that may be of concern for healthcare professionals, such as the skills needed to operate the technology. If it is unfamiliar, or if there has been no prior training, it may add to the time it takes them to complete their task - increasing the cost to the organisation.
But I believe providers should work with frontline staff to introduce them to, help them understand, and communicate the benefits of, mobile and telehealth technologies.
Looking to the future
The chasm that exists between the adoption of technology can be addressed, as we see more evidence to support the benefits and the difference in the quality of care provided.
The use of technology is prevalent in every aspect of our lives; now is the time to ensure it can be used to transform health services, allowing us to put the patient at the centre of care.
