June 2009: WSD Pilot Update: Cornwall
Andrew Forrest
Situated in the South West of England, Cornwall has a population of around 500,000 people that doubles during the summer months with holiday-makers. You can learn more about Cornwall on special resources such as https://exclusivepapers.net/buy-a-literary-analysis-paper.php where you can buy analysis essay or read about the relevant points. Although there are pockets of wealth, it is generally a poor county. Some 21 per cent of the population has long-term conditions. Services need to be properly organised across such a large geographical area that is mostly rural.
Project Management
Cornwall adopted the Managing Successful Programmes approach to ensure that the demonstrator programme was well organised and managed.
The telecare and telehealth programme in Cornwall is based in one single office to ensure there is good communication and that problems can be identified early. All of the main processes are mapped out, so if something is not working it can be picked up quickly.
A tracking database was put in place at the start of the programme so that everyone can keep up to date. A lot of time has been spent sharing information across all organisations and with service users. Consent has to be given for sharing data as well as for putting equipment into people’s homes.
Finding the right patients to take part in the programme has not been easy. Even with good systems, data has to be analysed and cross-checked. Coding has to be accurate and information up to date.
Implementing Assistive Technology
Cornwall has had a lot of experience with choosing equipment, particularly following the recent recall of some devices, so staff knew exactly what they were looking for when they prepared the specification and tender for the equipment. It is important that the software can be updated, that the system is secure and that there is a full audit trail for the processes of managing long-term conditions. It was important that the equipment was ready for installation. Because of cost and the difficulties with broadband coverage across rural areas, Cornwall has chosen a telephone-based system. Touch screens or soft buttons and variable sound level have proved important requirements for users.
Results can be sent back to clinicians from connected home devices such as pulse oximeters, blood pressure monitors and weight scales. The devices have programme prompts and questions based on NICE guidelines and local protocols. As with many of the systems, the results can be coded on a ‘traffic light’ system, allowing clinicians to view them on an internet browser and take appropriate action. For instance, results in red require a prompt telephone call or visit.
Cornwall considered carefully how to set up the monitoring and response processes; the role and expertise of the community matron was key.
A small telehealth centre provides support for community matrons; staff in the centre ensure that alerts are not missed. They can call up patients and ensure all the details in the system are up to date. They provide essential support for the whole process, using detailed scripts for dealing with individual situations. To the patient, the process must appear seamless. Staff training is very important and they are highly motivated.
Patients also get training in their home on using the equipment and are offered support, particularly at the start when everything is new. There is a freephone number they can use to answer queries.
It is important to fully document the process and understand all of the key points at which there could be drop-outs. With a randomised controlled trial, drop-outs may be more likely as people have to give consent before knowing the details of the equipment and monitoring arrangements.
The system must be easy for clinicians to use must make it possible to print off detailed histories for people to take to outpatient appointments when necessary. As the numbers of people involved in the trial increase, monitoring and response processes are being fully tested, eg prioritisation of alerts.
As with any new system, there are unexpected gains, for instance, a number of smokers who have seen the measured impact on their blood oxygen levels have asked about smoking cessation options.
Andrew Forrest is WSD Programme Manager in Cornwall
Note
This update is based on a presentation provided by Andrew Forrest at the Managing Long Term Conditions conference in Harrogate on 7 April 2009.