COMMENT
living and who were at risk of be- ing placed in a nursing home), and individuals who needed long-term condition case management. Tel- ehealth allowed the care services to be brought to the patients. This programme assisted with the or- ganisation and continuity of care as well as reducing clinic visits and hospital admissions, and resulted in a reduction in costs associated with chronic condition manage- ment and an improvement in pa- tient outcomes. Telehealth also al- lowed the patients to take control of their own health and changed the relationship between the pa- tient and the healthcare system, putting the patient at the centre.
Referral system
When the programme first com- menced, the recruitment of pa- tients for the telehealth programme was completed using risk stratifica- tion. The first individuals recruited were patients who had health costs that exceeded $100,000 in the pre- vious year and/or had contact with the care service multiple times or for an extended period of time. Currently, telehealth patients are recruited via referrals from physi- cians; however, some patients may refer themselves or are referred by other patients in the programme.
The VHA has been highlighted for its excellent delivery of healthcare. Even in the early years of Dr Kizer’s tenure, a 2004 RAND corporation study noted that the VHA was su- perior when compared to the other division of American healthcare in 294 measures of quality. The Brit- ish Medical Journal mentioned in 2007, “the VHA has recently emerged as widely recognised in quality improvement and informa- tion technology. At present, the VHA offers more equitable care, of higher quality at comparable or lower cost than private sector alter- natives”.
Due to the success of the programme, the VHA provides numerous lessons that the ‘3 million lives’ (3ML) NHS programme needs to learn as it cre- ates a new telehealth service.
It’s good news that the Department of Health has indicated it is work- ing on a new ‘year of care’ tariff that will at least provide a currency
for future commissioning of tel- ehealth, but there are further steps that are vital to success.
Business case
With investment into central pro- grammes on the whole a thing of the past, the key now lies with persuading commissioners of the business case for new telehealth- enabled services. The Whole Sys- tems Demonstrator results (the large trial of telehealth that pre- ceded the 3ML announcement) – and other relevant evidence – will need interpreting to help commis- sioners frame new services and de- commission others; in particular, of course, for diverting acute re- sources into community care.
Added to this, while commission- ing at the local level remains in flux, the National Commissioning Board will need to show leadership and consider what will really drive large-scale uptake – in addition to the requirement of the use of tech- nology as directed in the Innova- tion Strategy. Clinical leadership will also be essential. We need to turn enthusiasm at the national level and in organisations such as the RCGP into clear endorsement for local GPs to refer patients, pro- vided telehealth-enabled services meet key clinical standards, and possibly also have central accredi- tation. There is a lot to learn from telecare too, which is well estab- lished in many local authorities, and there could well be opportuni- ties to converge systems and costs. Personal health budgets could be an additional driver here.
The story of the VHA tells us that this is an exciting opportunity, one that could transform the lives of a huge number of people liv- ing with long-term conditions. Government mustn’t let the waste and embarrassment of the NHS IT programme mean that they neglect to provide the central support that is vital to the success of the 3ML telehealth programme.
Julia Manning
FOR MORE INFORMATION The report can be found at
www.2020health.org
national health executive Jan/Feb 12 | 21
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