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Simple Telehealth

6. Minimising risks and concerns

 

6. Minimising risks and concerns

Learning and service outcomes – you will be able to:

  1. Anticipate and minimise any risks in the rollout of Flo telehealth in practice.
  2. Understand gaining informed patient consent.

The main concerns of health professionals about telehealth seem to be the workload, safety and lack of proximity with a patient. You might worry about a patient you sign up becoming obsessed with the regular messaging and contacting you needlessly- but this doesn’t seem to happen; and if you jointly agree your dual management plan the patient will be wise as to what to do if their health condition changes. If you were seeing the patient face to face, you’d interact and engage with a patient in front of you, and note their non-verbal cues and demeanour. But in general with telehealth, care is remote; unless you are using skype you will not visualise the patient. But you won’t regard Flo telehealth as a substitute for face to face consultations - rather it is an adjunct, not a replacement.

Flo is not a medical device. You’ll use it to collect information for any purpose.  Think about Flo as an interactive work book that records patient information in real time from which patients can learn about their condition and note their symptoms or signs. You can't use Flo to autonomously make a diagnosis as you would with a ‘medical device’, this is beyond Flo’s capabilities.  So, if a patient has a dual management plan to follow, which has been agreed with their clinician, Flo just helps the patient to stick to that plan, and keeps the clinician informed. The patient-clinician interaction is mainly automated; but can be enhanced by personalised messages from the clinician via the website to the patient’s mobile phone. Flo also helps to ensure that correct information is available at the time of the remote and/or face to face review e.g. BP readings, without the need for patients to remember to bring data to the consultation.

Flo doesn't:

  • do any ‘clinical’ calculations on the data sent in
  • embellish data presented to the clinician
  • make any clinical measurements
  • monitor the patient as a clinician would
  • do anything that replaces or de-skills a clinical decision

 

Patient consent: this is assured by:

  • verbal explanation of Flo and the agreed dual management plan
  • consent form that captures (see page 51 Flo resource pack) (click here):
    • affirmed understanding that Flo is an automated machine, not a human being
    • affirmed understanding that the responsible clinician will view the patient’s texted in readings infrequently e.g. weekly (depends on protocol), so that responsibility for acting on bodily measures to seek medical help as appropriate remains with the patient as it would if they were not signed up to Flo
    • personally written sentence describing their understanding of the agreement as well as their signature
  • patient volunteers current mobile number for Flo connection
  • patient positively texts response ‘yes’ to texted invite to sign up to Flo

Workload: it will probably take around five minutes to sign up a patient and explain the Flo system. Explaining and agreeing the dual management plan should be a normal component of best practice in clinical management; as should checking inhaler technique or training the patient to take their blood pressure or check and record their weight. Overseeing texted-in responses once a week should take around one minute per patient. There may be an action such as sending a personalised text message to change medication. You’ll save avoidable consultations; and will need to book the oversight of Flo readings in clinicians’ diaries so they operate in booked time slots.

Safety & privacy:  aside from the AIM for Health operator (who does not extract patient identifiable information), only the CCG facilitator and designated practice team members who are enrolled on Flo can access texted-in records of the practice patients – which ensures privacy. The SMS service partner Mediaburst uses the highest security tier 4 data centres and ensures appropriate data security and data segregation.

Practice clinical management protocols: any AIM for Health clinical protocols that your practices adopt or adapt are your own protocols. All the clinical protocols provided are those adopted by Stoke-on-Trent CCG for use in association with Flo telehealth service. Healthcare professionals and practice teams should compare the proposed clinical protocols with their own practice protocols and make amendments (to the clinical protocol and any associated messages or clinical parameters set in the text messaging) where these differ from the example protocols shared here. Practices must insert specific systolic and diastolic BP readings in their own hypertension dual management plans - the examples shared from the AIM for Health project are locally agreed protocols that can be adapted by clinicians elsewhere. In receiving and interpreting text messages and the use of example dual management plans, health professionals should use their clinical judgement in individual cases and arrive upon a shared care management plan with their patients. This resource is based on current best evidence at the time of compilation and other national guidelines. The authors recognise that new evidence can come into existence rapidly, and clinicians should follow current best evidence at the particular time of applying their knowledge and skills in patient care for individual patients e.g. in line with NICE guidelines.

Consent & confidentiality: keep up to date with GMC guidance for best practice www.gmc-uk.org/guidance/ethical_guidance/confidentiality.asp

Question1So can you now anticipate possible risks in adopting remote telehealth technology in general; and understand how you have minimised those risks via the recommended ways to set up Flo in your practice?

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