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United4Health; Deployment of Telehealth at Scale: Lessons Learned

posted 11 Oct 2017, 03:40 by Hollie O'Connell





11 October 2017


Deployment of Telehealth at Scale: Lessons Learned and Guides for Implementation



Flo has recently been featured in a United4Health report: “Deployment of Telehealth at Scale: Lessons Learned and Guides for Implementation”.  United4Health is a large scale European deployment programme that ran for three years from January 2013.  The purpose of United4Health was to implement and assess the impact of remote monitoring of patients with chronic conditions.  The recently published report aimed to highlight the learning outcomes from the implementation of nine telehealth projects across three of Scotland's Health Boards.  The overall findings demonstrated that the introduction of these telehealth programmes had been successful across the board, creating “transformational change” and “an appetite for at scale solutions”.  You can read more about Flo’s involvement below, but first NHS Lanarkshire’s Morag Hearty has given us an insight into just what being part of the programme meant for herself and her team:

“ Wow!  What a journey, Lanarkshire took Flo on when we agreed to be one of the Scottish partners in the European study known as United4 Health – we even went on
 amazing European and world wide expeditions!  We were excited to have the opportunity of exploring Telehealth options which would provide both a clinically and cost effectiv
e delivery to a potential large cohort of patients.  One attraction to Flo was the minimal time it took to get set up – no complicated web platforms etc.  although in truth, we took th
e opportunity to upgrade laptops, and provide very helpful Smartphones to our specialist nurses thus providing a welcome incentive!

Our first admin training in August 2014 was momentous!  Thanks to the support from Phil and Simple Shared Healthcare team, plus our own enthusiastic specialist nurses, we started developing our protocols in line with the U4H requirements for COPD and Heart Failure monitoring.  Testing and refining always takes more time than you might expect but we all were thrilled when the staff training was completed and our first patient 'opted in'!  Even better was some of the initial feedback from patients – easy to use and lets me manage my condition.  Staff also quickly reported saving travel time and being able to pick up on small but vital changes in a patient’s condition much earlier.

Evaluation and the many “lessons learnt” from U4H certainly gave us a firm basis for scaling up and using Flo across an ever expanding range of conditions, while happily sharing our experience extensively across the U4H European partners and of course with our Scottish TEC programme colleagues.



NHS Lanarkshire’s successful use of Flo with patients with COPD, Congestive Heart Failure (CHF) and Diabetes was discussed in detail in United4Health’s report.  One of Flo’s unique attributes is that she is user friendly and uses simple text messaging, a technology which is easily accessible to the wider population.  Using familiar text messaging means that patients do not need to have a smartphone, nor do they need to have access to broadband - something which NHS Lanarkshire highlighted as a reason for choosing Flo.  Indeed, two key learning points from the report are that: 

 Technology must fit the ‘environment’ within which it is being deployed in terms of availability, infrastructure, accessibility and ability to customise
 
…the newest technology is not always the best for the task

Another benefit of using Flo is that patients are using their own mobile phone: they will be familiar with the device and it also means there is less cost incurred for the provider of Flo.  Simply put, from her early beginnings, Flo was designed to work in a way which this report suggests is the most effective!

The efficiency of setting patients up was also an important reason for choosing Flo:

Once the decision was made to go with a text messaging service, setting up the technology at the patient’s end was straightforward and quick.

Additionally, Flo’s prompt replies were seen as another recommendation for her use, as they “ enabled the patient to assess his/her own condition, send answers into SMS Solution (Simple Telehealth) and get immediate advice. 

Over the three years that the United4Health project ran, there was found to be a “...strong enthusiastic strategic support for at scale adoption and implementation of Home Health Monitoring and Technology enabled care” in Lanarkshire, which is further evidence to add to Flo’s already proven capabilities.

There is a growing recognition of the potential for digital technology, particularly simple, low cost solutions like those adopted in U4H to support and improve many aspects of health and social care provision across the health board. ” 



As part of the United4Health project, NHS Lanarkshire also interviewed some patients to get their perspective on having Flo’s help managing their health; of course, she received glowing reviews!

The first patient interviewed found that Flo’s portability was a great convenience - especially seeing as he took the interview call from Paris en route to a business engagement in Asia!  As the gentleman frequently travelled for work, being able to text Flo his readings from wherever he happened to be was of great importance to him He felt that
 
“ the fact that the text will go to a professional….[gave] him confidence, as he knows that a professional is reviewing his results 

He also felt that Flo’s “ flexibility to work everywhere ” gave him  ...a feeling of safety that enables him to lead a normal life ".

Two other patients were interviewed, both of whom had COPD and found Flo to be of great benefit to them, one going so far as to say 

 [Flo is] part of the family now- just a text away 

 Due to the nature of COPD, patients can often become worried about their symptoms and ended up panicking and rushing to hospital. However, using Flo gave the third patient interviewed the confidence to  differentiate between shortness of breath due to panic as opposed to a lack of oxygen .  The patient now feels that Flo’s help to review their symptoms has “ provided a high level of comfort ” to both them and their carers.  Another benefit of using Flo is that she offers a flexible solution to suit a patient’s needs, again something which those interviewed identified to be of value.

Overall, those interviewed found Flo to be convenient, easy to use and helpful in the management of their condition.  Flo aims to give the patient the confidence to self manage their health by providing that extra link between the patient and their healthcare professional (HCP) to reassure them; this was certainly the case during Flo’s implementation in Lanarkshire: 

“ [Flo] enables an “emergency visit from HCP”, the knowledge that there will be an immediate response when a problem is detected is very important. ”