Telehealth is very good but it needs a human face. Our practice started a management scheme for patients with dementia using telemonitoring which we expanded to other clinical areas when it was found to be successful.
We hired what we call ‘primary care liaison officers’, local people, often volunteers, from the community who we paid to befriend the patient, be their advocate and help them use the telehealth technology. This meant patients had a single point of contact and weren’t isolated.
They collected all the data we needed about the patient and brought it back to the outreach centre where a psychiatrist or the GP creates a treatment plan, which the liaison explains to the patients.
We gave patients a tablet pad which worked on a mobile or a wifi network. When a district nurse or a carer comes in they touch the pad with their blackberry, and the pad informs them of the tasks we think they should be doing in a ticklist.
If that doesn’t happen, the doctors and family gets notified. If you have a parent who’s vulnerable, you’d want to know if they weren’t getting cared for.
Similarly, with patients who were on the brink of an unelected hospital admission for different problems, we created treatment plans, then decided who between the GP and the family were responsible for each part of the care.
The treatment plan gave advice such as ‘this ulcer should clear up in so many days’. The family would monitor this, and if they or the patient deemed the plan wasn’t working, we’d get notified electronically and we’d bring them in and change it, which we didn’t need to do if it was working.
It made a saving of 1.5 million out of a budget of 8 million. This was by rationalising care through following the patient journey; asking whether patients really did need to go to all these outpatient appointments; asking whether the family valued them.
The clinical system is useful and the technology enables it. It’s not going to be a panacea, and you need to give people help in using telehealth. Even if patient can’t use the technology, if someone in their family can it can work well. In that way it improves social cohesion.
Telehealth on its own doesn’t work, but telehealth with a workforce that’s going to support it can help people take responsibility for their own health.
Dr Ian Greaves is a GP in Stafford, whose practice has used telemonitoring technology in a management scheme for patients with dementia