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Guest blog: Telehealth and "channel shift"

 

Guest blog: Telehealth and "channel shift"

Richard Stubbs, ex Newham WSD Programme Manager, currently Transformation Manager East London NHS Foundation Trust discusses channel shift and the use of tariffs to incentivise change.

The BMJ recently carried a Whole System Demonstrator research research report on the impact of telehealth on quality of life.

The conclusions are that “Telehealth did not improve quality of life or psychological outcomes for patients with chronic obstructive pulmonary disease, diabetes, or heart failure over 12 months. The findings suggest that concerns about potentially deleterious effect of telehealth are unfounded for most patients.”

Many people have seen this as a negative result and yet I built East London NHS Foundation Trust’s business case for mainstreaming telehealth around this (then unpublished) WSD research result many months ago because I viewed it as a positive finding.  It is important to note that many peoples' expectation of remote care, as distinct from face to face care, was that it would reduce a patient’s quality of life but now it is quite clear that it doesn't.

Channel shift

I see telehealth as both a means of educating and supporting people in self care and a classic instance of “channel shift”.  Our telehealth work shifts transactions from the NHS “default” channel of providing face to face support, to remote support over the phone and internet, then to self support using these same technologies.  Supporting patients with visits to their home, even in the relatively small area of Newham, requires a great deal of time spent in travel and finding a parking space. When a patient comes into a clinic, she or he will spend a great deal of time travelling and waiting to be seen.  A lot of these face-to-face meetings are entirely unneccesary if the patient can measure their own vital signs, understand their import and seek advice when needed.  

It is possible to use our most valuable resource, ie our medical staff, far more efficiently with telehealth than it is without, so we can look after many more people with the same staff and not decrease quality of life.  There is nothing new about using IT to increase efficiency, and given we now know that people won’t suffer harm as a result, there is no reason at all why it should not be used to do so in health.

Year of Care

I am hoping that a year of care tariff is introduced locally as this would bring real value to the Trust for introducing such efficiencies in the delivery of care with telehealth. I am far less keen on a telehealth tariff as I see this as likely to create a perverse incentive to keep people on a monitored telehealth service for longer than they need to be, thereby promoting a culture of dependency rather than self help.

Large savings possible

I’ve been working closely with Newham Council who can tell me the percentage of contacts for each of their services by Face to Face, Phone, Web forms, Web (self service) eMail, Fax and SMS.  They are having  huge success with their channel shift strategy and have already achieved a strong downward trend in face to face transactions and have increased online self service to over 40% of contacts, resulting in large savings in transaction costs.

One problem of building a business case on this basis within the NHS is the fact that we just don’t appear to have channel use and channel cost data in any form that is even vaguely accessible or perhaps we simply don’t even have it at all.  I have enquired as to the availability of high-level data that would show the channel split for health services in the NHS in general and also by locality, GP practices and Community Services but so far without any success.  If you can point me to relevent data please get in touch.

Given a lack of national data we will need to review the data captured in our own Community and Practice based systems and build the case from here, which I doubt will be easy and in any event will not help us benchmark ourselves against other providers.  Again if you have carried out an exercise like this in your area, please get in touch.

NHS

I am sure that the NHS will take on board the benefits of a channel shift strategy for reasons of efficiency, patient convenience (38% of the use of Newham Council’s online service is outside of office hours) and the capability of providing improved services for more people at lower cost. Obviously face to face meetings will continue to be an essential channel within the NHS and it is highly unlikely that the channel shift to self service will be anywhere as great as with the Council’s service, however within the NHS services such as Motiva (TV & Internet) and Simple Telehealth (SMS text) will certainly have a major role to play in increasing the effectiveness of our clinical staff in delivering care.

March 7th, Richard Stubbs.