A report on Lessons from the US: Using technology and homecare to improve chronic disease management
This report is based on the observations of a US study tour of NHS and Healthcare at Home representatives (the UK’s leading home health care provider) who visited colleagues at Kaiser Permanente and HealthTech in California to look at how they use remote technology to manage chronic disease.
One of the group’s key observations was the lack of consolidation in US health care. The effects of this are felt in a number of areas: large numbers of ‘competing health plans’; the separation of hospital and outpatient care; the absence of a single, accountable regulator; and IT operations which are billing-led, rather than focusing on, for example, co-ordinated care. 
The potential of an electronic patient record (EPR) like Kaiser Permanente’s was viewed positively by the study group. These centralised registers of service users’ details facilitate access to and sharing of patient information. The NHS’s forthcoming summary care record programme should deliver similar benefits.
Email, yet to be adopted in the UK as a regular communication tool between patients and health professionals, has reduced Kaiser physician visits by as much as a quarter in some areas.  Confidentiality and security issues have so far impeded development of this telehealth method in the UK.
The group found that the effectiveness of homecare technologies did not rely on how ‘hi-tech’ they were. The use of existing technology, notably televisions and mobile phones, reduces the need to install new equipment in homes, and, potentially, facilitates sign-up by patients who are already familiar with the kit.
Management skills were identified as an important factor in carrying forward new modes of care. High-calibre US graduates enter the field of hospital administration, where they use analytical and strategic skills. Such skills need to be honed in the UK as care delivery takes new directions, which require managers to negotiate with clinicians.
The study concluded that EPRs were hugely important for chronic disease management. Also, commissioning in the UK has to take a broader view than previously, and likewise, NHS ‘capital investment’ needs a more circumspect approach to meet future requirements.
Best use of existing resources, both human and material – combined with innovative future planning and purchasing – represents a way forward for chronic disease management with technology and homecare.
Susan Royer is WSDAN Network Manager, The King’s Fund
 Garside P (2010). Lessons from the US: Using technology and homecare to improve chronic disease management, p 5. Newhealth and Judge Business School,
University of Cambridge. Available at:
www.hah.co.uk/HaH%20lessons%20from%20the%20US.pdf (accessed on 27 May 2010).
 Chen C, Garrido T, Chock D, Okawa G, Liang L (2009). ‘The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care’.
Health Affairs, vol 28, no 2, pp 323–33.