1. Implementation of ICT/Telemedicine:
Experiences of Yorkshire
Rachel Binks
Nurse Consultant, Critical and Acute Care
Airedale NHS Foundation Trust

2. Tele care

3. Tele monitoring

4. Tele coaching
tele medicine
tele coaching

5. Tele medicine
tele medicine

6. The Airedale journey
new ways to deliver early specialist opinion

7. Using technology to work differently

8. Development into the
Mainstream NHS
Market
 Received grant from the Technology Strategy Board
 Development of telemedicine solutions for the home
 Worked with local company to develop video capability for the
patients’ own home
 Pilot for 28 Diabetes patients to receive outpatient appointments via
telemedicine

9. Regional Telehealth
Hub Partners
Airedale NHS
Foundation Trust
-Telemedicine
Regional
Telehealth
Programme and Hub
Hull University and
Barnsley PCT Hull and East
- Telehealth and Yorkshire NHS
telecoaching Trust
- Telemonitoring

10. Home teleconsultation
2008 - ALIP programme
TSB funding, 4 partners
Aims:-
develop product for home use
TV as the display device
standard broadband link
carry out planned
teleconsultations using
diabetes as the exemplar

11. Hub at Airedale
 Dedicated facility opened September 2011
 24/7 telemedicine service
 Acute care nurses
 Consultant physicians

12. Bringing healthcare
home
providing remote consultant opinion to the
English prison service
supporting elderly patients with long term
conditions in their own homes, nursing and
residential care homes via Telehealth HUB
supporting children with diabetes to manage
their condition at home via Telehealth HUB
supporting rural communities with community
based remote outpatient consultations
enhancing recovery for stroke patients through
stroke telemedicine service

13. Telemedicine
Deployments
 Hospice
 1 Hospice
 5 end of life pathway patients
 Integrated Pilot
 6 GP surgeries
 7 residential home
 2 COPD patient

14. Telemedicine
Deployments
 Patients’ own homes
 42 COPD patients
 30 Heart Failure
patients
 25 Diabetes patients
 Nursing and Residential
Homes
 29 Care Homes + 33
this month

15. Evidence Base to
December 2012
578 Clinical Consultations
 357 primary consultations
 221 follow up consultations
 198 admissions avoided
 52 admissions

16. The big question
Does it Work?
Feedback
• from patients in their own
homes
• Nursing and residential
home patients
• And carers
• And clinicians
• And nurses

17. Patient feedback
“…there is no expensive journey to and from hospital.
No re-organising of work commitments to then
spend time sitting around in waiting rooms…
…simply a live link up where I can talk freely and we
can swap ideas as to how to improve my life…”
Gillian, Diabetes Patient,
talking about her home based telemedicine service
http://www.airedaledigitalhealthcarecentre.nhs.uk/Videos/

18. Care Home feedback
“Very good service, made me feel confidant within my job
role so I could do the best I can for our residents. So
often we are left in confusion whether we should call a
doctor or an ambulance. This service takes the pressure
off us as we have access quickly to a health professional
who can advise us the best route to follow. Dr Pope was
fantastic when one of our dementia patients fell and
bashed her nose. I would have called an ambulance and
she would have endured an A&E visit which would have
terrified her. Dr Pope saved her from this and reassured
me that the cut was superficial, which was true - and she
was fine.”
Residential Home Care Worker

19. Nursing Home staff
• ‘made me feel confident in my job role’
• ‘quick, helpful and much easier than going
through telephone triage as (I was)
recognised as a professional, with
knowledge, rather than a complete lay
person as often occurs via telephone’

20. Does it work?
“It’s a brilliant concept”
“ [the telemedicine system]…has been a Godsend to me. Thank you
for getting me one”
“came into its own 4th Feb when snow and ice brought traffic to a halt.
Geoff’s condition deteriorated suddenly and having visual, instant
contact with the team was very reassuring. A wonderful service”
“I’m only sorry it wasn’t out years ago”
“All the people in my block came round for coffee and saw it working –
they are all quite envious of it now!”
“The best thing about it is knowing I am not alone”
“the picture is faint and the sound keeps coming and going”
http://www.airedaledigitalhealthcarecentre.nhs.uk/Videos/

21. Overall level of
satisfaction
95% patients and 90% of clinicians described themselves as being “very satisfied”
or “satisfied”.

22. Level of satisfaction –
ability to communicate issues and
concerns during the Teleconsultation
• Several patients have mentioned the positive benefit of including
family members in the consultation:-
“It was good how we can all have input; Dr. Pope, Jackie [DSN],
myself and my wife all round the TV”

23. numerous potential use
cases:
When to use?
• long term conditions
• outpatients
• nursing homes
• employee health & well
being
• early supported discharge
• admission avoidance
• dementia – carer support
• social care
• purely social calling
• specialist networks

24. Deploying at scale
Just imagine….
…the number of patients lives
that could be enhanced
…the number of carers and
families that could be
supported
…the amount of time released
to care
…the resources released for
better utilisation/reinvestment
..if we maximised the potential of telehealth at scale

25. Future Developments
 3 year end of life project
- Telephone and telemedicine
 North Yorkshire commissioners developing
business case for 40 care homes
 Enable telemedicine site wide across Airedale

26. Does it work?
Patient survey – on going
How satisfied were you with:- Ave Score (0-10 scale)
(a) the teleconsultation 8.7
(b) the video quality 8.5
(c) your ability to use the link to
communicate your issues and
concerns 9.0
(d) the advice you received 8.7

27. Useful data
• A&E admissions/attendances
• How many admitted
• Length of stay
• Reasons for admission
• Examples of TH Hub support
• Any change in attendance/admission
since Telemedicine enabled

28. 12
: 00
01 -12:
0
10
20
30
40
50
60
70
80
90
: 00 59
02 -01: AM
: 00 59
03 -02: AM
: 00 59
04 -03: AM
: 00 59
05 -04: AM
: 00 59
06 -05 AM
: 00 :59
07 -06 AM
: 00 :59
08 -07: AM
: 00 59
09 -08: AM
: 00 59
10 -09: AM
: 00 59
11 -10: AM
:0 59
12 0-11 AM
: 00 :59
01 -12: AM
: 00 59
02 -01: PM
: 00 59
03 -02: PM
: 00 59
04 -03: PM
: 00 59
05 -04: PM
: 00 59
06 -05 PM
: 00 :59
07 -06: PM
: 00 59
Time of Attendance in ED
08 -07: PM
Admissions from September 2011 – August 2012
: 00 59
09 -08: PM
: 00 59
10 -09 PM
.00 :59
11 -10: PM
: 00 59
-11 PM
:59
PM
No of Patients

29. Numbers of admissions
1400 Admissions from September 2011 – August 2012
1200 1144
1000
800 612
(53.5%)
600
400
200
6
(0.98%)
0
Emergency Department Attendances for Number Admitted Number Deceased within 24 Hours
Nursing/Residential Home Residents

30. LENGTH OF STAY
Admissions from September 2011 – August 2012
>
59
55
54
53
52
50
49
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
Number of Days
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
0 10 20 30 40 50 60 70 80 90 100
Number of Patients

31. Admissions from September 2011 – August 2012
Top 10 Admission Reasons
Pertrochanteric fracture Closed
Fracture of neck of femur Closed
Syncope and collapse
Urinary tract infection, site not specified
Constipation
Chronic obstruct pulmonary dis with acute lower resp infec
Unspecified acute lower respiratory infection
Pneumonia, unspecified
Lobar pneumonia, unspecified
Cerebral infarction, unspecified
0 10 20 30 40 50 60

32. Admissions from Non
Telemedicine Enabled
Homes
• 43 Homes with data from 2011 and 2012
• 34 had a reduction in admissions in 2012
• Overall the reduction in admissions was
31%

33. Admissions from Non TM Homes
18
Overall Reduction in
Admissions = 31%
16
14
2011 - Red
12
Admissions
10
8
6
4
2
2012 - Blue
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
Home

34. Admissions from
Telemedicine Enabled
Homes
• 14 Homes with data from 2011 and 2012
• 12 had a reduction in admissions in 2012
• Overall the reduction was 46%

35. Admissions in TM Enabled Homes
30
Overall Reduction in
Admissions = 46%
25
2011 - Red
20
Admissions
15
10
5
2012 - Blue
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Home

36. 1 year results – 24 hr
teleconsultations at home
-29.5% -36.5%
Year pre post
Year pre post

37. Quotes from patients
• “The telemed literally brought tomorrow’s technology into my living
room today; without any need to travel I can talk to a specialist!. The
system puts me in control of my diabetes care instead of my illness
governing or interfering with my lifestyle.”
• “There is no expensive journey to and from hospital (2 bus journeys
each way), no reorganising of work commitments to then spend time
sitting around in waiting rooms: simply a live link up where I can talk
freely and we can swap ideas as to how to improve my life”
• “The consultation is an active two way process…it makes a huge
difference to how I feel about my diabetes and therefore about
myself”

38. What more could we want?
Any Questions?