Transforming lives through technology

On page 11 of the May 2012 issue of RCN Bulletin, Kim Bell reports on RCN support for a campaign to improve the lives of people with long-term conditions through the use of telehealth. Tracy Hitchens, Lead Telehealth Nurse for Peninsula Community Health, answers some common questions about the technology.

What exactly is telehealth?

Telehealth is often referred to as remote patient monitoring and involves the use of various technologies to monitor the physiological status and health conditions of patients. When combined with personalised health education within a chronic disease management programme, it can significantly improve the quality of life of people with long-term conditions.

What does it involve?

Typically, telehealth involves the use of electronic sensors or equipment that monitors vital health signs remotely from a patient's home. Readings are automatically transmitted to an appropriately trained person who can monitor the health vital signs and make decisions about potential interventions in real time, without the patient needing to attend a clinic.

How does it help improve lives?

The aim of telehealth is to support patients through a self management approach. It aims to avoid a patient’s condition reaching crisis point by providing education and support. It enables people to understand more about their complaints and to realise the impact of their behaviours on their health. Using the technology has empowered some people to make positive choices in terms of giving up smoking, doing more exercise and having an improved diet. Those using telehealth tell us it has helped reduce their anxiety and made them feel more in control of their conditions.

How are the readings monitored?

The readings are automatically transmitted to a central clinical team which, at Peninsula Community Health, includes five registered nurses working at band 5. It is our job to monitor readings and look for irregularities. If we see something of concern, we get in touch with the patient, assess the situation and either provide advice over the phone or refer the patient on to their GP or community matron. We currently monitor the health vital signs of 780 people across Cornwall. The service runs from 9am-5pm Monday to Friday.

When do alarm bells ring?

Readings that concern us about one patient may not necessarily concern us about another. Parameters are set in the system that are tailored to each individual so we know when to escalate things dependent on whether a reading is unusual for that patient and their condition. We do this in consultation with the patient’s GP and the relevant clinicians involved from both primary and secondary care.

How do you decide who is eligible for telehealth?

There are certain clinical indicators that we look out for when deciding who the equipment would be appropriate for. Patients are referred from their consultant, GP, community matron or specialist nurse, but the most important thing is that they are happy to have the equipment in their homes and that they engage with it. When we first started the Whole Systems Demonstrator (WSD) programme we only worked with patients who had a diagnosis of chronic heart failure, diabetes types 1 and 2 or chronic obstructive pulmonary disease. Now it has been extended to help people with the diagnosis of postural hypotension as well as those experiencing recurring urinary tract infections (UTIs). Both are proving popular and effective.

How long do patients use the telehealth service for?

It really depends on their condition and the extent of their problems but it usually ranges from three to nine months for people with postural hypotension and up to 18 months for those with frequent UTIs. It is even longer for those with a more severe long-term condition.     

How much does it cost?

The equipment originally cost around £1,000 per system and this was funded by the Department of Health as part of the WSD programme. The headline results from that programme demonstrate that the use of telehealth can accrue considerable potential savings, in terms of avoided visits to hospital and improved general health, to recoup the system cost several times over. Our equipment is reusable and can be cleaned and ready for installation for the next patient referred. Each system bought is likely to be used for several years to come.