With a growing and ageing population the need for new care models such as mobile and telehealth technologies to support long-term healthcare, has never been greater. Yet, there remains an identifiable ‘chasm’ between early adoption and the wider uptake of mobile and telehealth technologies. Dr Jean Challiner, chief medical officer at Clinical Solutions, highlights some of the key barriers and how they can be overcome for wider acceptance.
In recent years we have seen mobile and telehealth innovations provide opportunities to support self-care and deliver services closer to or in people’s homes. We have also seen these services improve quality of life for users and reduce hospital and care admissions.
Healthcare technologies have also demonstrated real cost benefits. An NHS National Mobile Health Worker Project report showed that over an eight-week trial at eleven locations across England in the summer of 2010, semi-ruggedized Panasonic Toughbook laptops saved an average of £462 per clinician, equating to £3,002 annually.
Clinicians also estimated that the devices allowed them to save 507 referrals, equating to a saving of over £21,000, nearly nine per cent. It also enabled clinicians to avoid 49 admissions, resulting in a saving of over £85,000, or approximately 21%.
In the market for home health care technology, experts agree that the current model of care delivery is ill equipped to deal with future challenges, particularly the rapidly increasing demand for care due to an aging population.
The study suggests experts also see the potential value of home health care technologies to relieve pressure on health care systems and to promote a shift in care from high-cost institutions to patients’ homes.
These changes would not only would decrease cost and improve the sustainability of health care systems but would also be consistent with patient preferences for more active aging.
Despite these clear benefits, the national uptake and use of mobile, telehealth and home care technologies remains low. It seems there are a number of challenges to widespread service adoption and it is imperative these are overcome through concerted efforts from all stakeholders, if we are to transform healthcare delivery in the UK.
Overcoming the barriers
There is an impression that mobile and telehealth innovations have yet to provide significant evidence of cost-effectiveness. There are also concerns that health organisations must present their own business case to adopt the technology, rather than accept recognised findings from elsewhere.
Mobileand telehealth innovations have been proven to provide evidence of cost-effectiveness, with some results being so outstanding that I believe it is imperative that these recognised findings be taken seriously when considering introducing change within an organisation.
This was the experience for an end of life care service provided by Healthcare at Home Ltd (HaH) in partnership with NHS Birmingham East and North (NHS BEN). The service resulted in fewer unnecessary admissions into acute care, shorter bed stays and better end of life choices for patients, and in addition saved the PCT more than £1m in its first year. The year-long pilot exceeded expected referral numbers by 12% and exceeded targeted savings by 51%.
In light of these results, it is clear that overcoming barriers to adoption starts with highlighting the practical benefits of mobile health technology more effectively. We need to help front line nurses see the benefits technology introduces to their work environment, such as enabling them to treat more patients in a shorter time span.
As well as highlighting the practical benefits, it is also important that we encourage organisations to analyse their current systems, carry out audits, evaluations and obtain stakeholder feedback on where processes can be improved.
We can start this process by providing information from examples such as the NHS BEN end of life service. These findings showed that across England, savings from home-based end of life healthcare for approximately 88,000 such patients could total in the region of £160 million.
NHS BEN also worked with HaH 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. These statistics cast doubt on the suggestion that mobile and telehealth innovations have yet to provide significant evidence of cost-effectiveness.
Evolving the paper trail
In our experience change has proven to be another barrier to the adoption of new technology. It takes real commitment to break from systems that have been in place for many years, even if these are sometimes unreliable or cumbersome.
Paper-based systems are an example of outdated procedures which are still favoured by many health organisations. 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.
When paper records are stored in different locations, collating them to a single location for review by a health care professional is time consuming and complicated. These complications mean organisations using paper-based systems have difficulty reporting performance levels and therefore justifying their existence.
Paper based records can also increase administrative costs; research from the National Association for Home Health Care & Hospice revealed that Care UK’s administrative expenses increased by 10.7%, from £12.2 million in June 2010 to £13.5 million by June 2011.
Homehealth care nurses spend a great deal of time on paperwork and dealing with reimbursement issues. One study revealed that 60% of their time is spent handling administration during the first visit, while further research stated that 25% of their time is spent on administration during follow up day visits. A recent study conducted by Outcome Concept Systems(OCS) 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.
While paper-based systems may seem outdated, in our experience the move to digital records has still presented concerns, with some health organisations worried about the risk of data loss if the system fails, or potential security incidents such as breaches, theft or criminal attacks.
The introduction of technology may present risks, but it can also be used as a vital tool to monitor the quality of care delivered. Many organisations may resist the transformation from paper-based processes over concern that implementing new systems may disrupt existing services. While there may be some initial disruption when bringing any change into an organisation, this should not in itself be used as an excuse for ignoring innovation. Those that can accurately view how much time is wasted through current 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, as well as improving the productivity of staff and providing the right care in the right place at the right time.
The use of technology can also reduce the cost of, and improve healthcare in the home. According to results of recent research, a specialist nurse-led telephone call can improve the home services and reduce hospital re-admission by 33%, cost associated with in-patient hospitalisation 42%, and cost of health care in the home services by 40%.
It is imperative that businesses plan ahead to the future requirements of the organisation. 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
Change within organisations almost always introduces challenges, and employees that are resistant to this can present a major barrier to the wide-spread adoption of technology.
To overcome these challenges, I believe all stakeholders, from carers to patients, should be consulted and involved in the transition process. Key professionals need to be engaged and motivated by the prospect of a system that is easy to use, helps improve care services and reduces administrative burdens.
There may also be an impression that healthcare solutions may lead to professionals becoming ‘de-skilled’. This is certainly not the case. For example, in the case of frontline nurses, it improves their ability to carry out high quality assessments, by prompting what questions 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. In the UK the latest data (September 2011) 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 healthier, 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, which if unfamiliar, or if there has been no prior training, may add to the time it takes to complete their task – increasing the cost to the organisation. I believe providers should work with front line staff to introduce them to, help them understand, and communicate the benefits of mobile and telehealth technologies.
Looking to the future
Technology-enabled care provides a wealth of benefits; from software which helps us to manage patient interactions, to supporting decision-making or leading the change to a more cost effective but high quality model of care that patients can benefit from.
While we continue to see changes throughout the NHS, the need to think and act strategically is now more imperative than ever. 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.