Special Report: Remote Monitoring
Enshrined in healthcare policy across the UK, this is an exciting time for remote monitoring. But is its potential being held back by ‘pilot-itis’ and short-term funding? Jennifer Trueland reports.
It is probably fair to say that remote monitoring has been having a “moment”. With the growing focus on looking after people in their own homes, plus developments in technology, the acceptability of using technology to support care is at an all-time high among patients and clinical staff.
Remote monitoring has become a key element of central policy across the UK – including England’s NHS @home approach, and the focus on hospital at home services in the Scottish Government’s Digital Health and Care Strategy delivery plan, published in November.
But even with this high-level policy support, has remote monitoring really become embedded in health and care services? Or does it remain patchy, still beset by the “pilot-itis” that has seen initiatives come – often with great flourish – then disappear when the short-term money vanishes?
Adrian Flowerday is a chartered engineer by background, and has been a close observer of NHS attempts to mainstream remote monitoring for a number of years. He is CEO and founder of Docobo, which has been developing and deploying remote patient monitoring since 2001, with the original intention of helping people manage their long-term conditions at home. As he recalls how it came about, it’s a scenario that still sounds familiar today. “We saw that a big proportion of hospital admissions were caused by people whose hospital admissions were not managed properly,” he explains. “And so, when we saw this concept, and got involved with it, and started to run with it, we thought we were really going to help the NHS to be able to manage this and try to reduce that constant winter noise of ambulances stacked up outside A&E. But we also had the aim of improving the quality of life of both the patient and their family, and staff. It was a natural thing for an engineer to think ‘how do we solve this?’.”
There has been progress over the last two decades, he says – but not nearly enough. When we speak, he has just been watching a BBC Morning Live segment showing work on virtual wards in Liverpool, which he finds hugely positive. Unfortunately, the uptake of remote monitoring is far from universal.
“A few entrepreneurial NHS organisations over the years have used it, but then funds disappear, and you’re at the same point as you were before,” says Flowerday. “You could take all the current headlines about ambulances and waiting lists, and you could put it in the news 20 years ago; it doesn’t change.”
Battle for funding
The fragmented nature of health services is partly to blame for its slow uptake of remote monitoring, he says. “I learned very quickly that ‘The NHS’ doesn’t actually exist. It’s a load of little empires all fighting for funding. It’s a battle every day.”
Another challenge, is that remote monitoring is a disruptive technology, in that it changes the way that people work, he adds.
Remote monitoring is demonstrably working well where it has been properly deployed and maintained, he says, but in England, the current procurement landscape makes that challenging. He deplores the system where NHS organisations compete for test bed funding – and then the money runs out. ‘It’s a continuous competition for ‘prizes’ – bits of funding from government – and the funding is only for one or two years. So everyone is constantly spending time writing proposals.”
Procurement must change
Covid has changed mindsets around remote monitoring, and given new impetus to virtual wards, Flowerday says. He is also optimistic that integrated care boards – with an eye to whole geographies rather than just one organisation’s needs – will help, provided they are visionary and well-coordinated. But procurement must change. “My biggest call to the NHS would be to stop giving out one-year or two-year ‘prizes’. Just continually fund every provider arm with a million pounds a year for remote monitoring and stop all the prizes.” Reliable funding would “give providers a chunk of money to do what they should be doing, and use technology to help their staff manage more patients”.
As CEO and clinical director of an organisation that delivers hospital at home services to NHS patients, Jill Ireland has also been a close observer of the evolution of remote monitoring, and has personally seen the benefits for patients, staff, and health services. Since her organisation – HomeLink Healthcare – was founded in 2017, she says the landscape of remote monitoring has transformed.
“There’s been an interest in how we support patients at home, and how we maintain their safety in models of hospital at home care for a number of years, decades probably,” says Ireland, a former director of nursing. “But I think what we’ve seen over the last two or three years, particularly with the advent of Covid, is how we can use remote monitoring more widely for patients at home. In many ways, the pandemic was a catalyst for change in the uptake of home monitoring and remote monitoring, and there’s been a real uptick in the interest in the way that it can be used.’
Exciting devices and software
She is excited by the range of devices and software that now form part of the toolbox of clinicians working in the community – and of patients and their families too, who are increasingly monitoring their own health and conditions. “There’s a whole range of ways in which different devices and the software are being deployed and used. In many ways, the boundaries are unlimited in terms of where this could go.”
While there has been substantial progress in the use and functionality of remote monitoring, Ireland believes there is more to be done to embed it in the everyday lives of patients, staff and organisations. Part of that is cultural – not everyone wants or is able to use technology to monitor their own care, or that of their loved ones, and issues with connectivity (and, particularly at the moment, fears about running costs) remain.
“From a clinical perspective, many patients do still struggle with the application of the tech,” she says. “Some patients feel that they’ve been discharged from hospital, for example, but they’re also being told that they need to be monitored, so they might feel ‘Am I really safe at home?’. Other patients will think ‘Great, so the team can monitor me 24/7, they know exactly what’s happening with my blood pressure and temperature and so on, and that makes me feel very safe at home.’ So, some patients feel it’s almost an intrusion, and struggle with it at times, while others find it extremely reassuring.”
Brian Murray, UKI regional sales director with Orion Health, says remote monitoring has always promised a lot, but that it hasn’t always delivered for those most in need. Big tech companies are ploughing a lot of money into “lifestyle” devices, which can help people stay healthier longer, but people are still receiving most of their health care in the last few years of life, and they need earlier engagement. “Lifestyle devices have a part to play, but in terms of proper monitoring, it’s still very patchy,” he says. “What’s out there is still very much based on solutions for particular conditions, whether respiratory, diabetes or anything else.”
These types of targeted solutions do make a difference, he says, but also potentially create silos of data that don’t tell us much about the patient’s overall health, or the health of a population as a whole or the cohorts within them. It’s crucial that any data collected feeds back into the shared care record and is discoverable for end-to-end patient and population health management – rather than out in another silo.
A shift to population health management
“At the moment we’re seeing an explosion of these point-to-point patient monitoring solutions, that don’t connect with the shared care record or other health and care systems and that will never scale,” he says.
He is, however, optimistic about the future, and a shift to a population health management mindset. Remote monitoring will be just one part of a larger cohort management programme to effectively manage the care of these patients. “When a stroke patient is asked to monitor blood pressure and records a reading outside of the normal range, it should trigger a chain of coordinated and recorded actions for the health and care team to ensure that another stroke is avoided.
“It’s an evolution, not a revolution. But you’ve got to look at this at a system-wide level, not at the individual technologies to monitor this and monitor that. We need to be able to manage cohorts of patients and know whether they should step up or step down within each pathway. Remote monitoring has a place in that, but the bigger, more important thing is managing the whole cohort.”
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