Implementing Telecare
Planning to implement

Many Partnerships are now beginning to consider the introduction of telehomemonitoring as a development of their local Telecare programme, so this chapter is intended to offer a brief overview of the key considerations when setting up a local project. Further guidance will be developed as the learning emerges from the Partnerships that are implementing telehomemonitoring during 2009/10.

The process and tools for effective implementation of telecare outlined in previous chapters within this guide are equally applicable to the introduction of telehomemonitoring.

Establishing project outcomes

When considering the outcomes that the Partnership wishes to achieve through the introduction of telehomemonitoring, it is important to consider whether the Partnership wishes to:

  • Improve clinical outcomes - e.g. reduction in emergency admissions and re-admissions, etc;
  • Increase operational and / or clinical effectiveness – e.g. reducing clinicians home visits, etc;
  • Increase patients’ ability to self-manage their condition – e.g. improved education with home testing.

Getting to know the products

As with telecare implementation, in order to effectively identify the components of a project / implementation plan for telehomemonitoring, it is essential that the project team first takes time to learn about the range of products available, their features and functionality and how these could deliver the outcomes the Partnership wishes to achieve through the introduction of telehomemonitoring.

It is a good idea to include the key stakeholders who are likely to become involved in the implementation of telehomemonitoring (i.e. clinicians, nursing staff, patient / carer groups) in the technology demonstrations / selection process as this will increase the likelihood of “buy-in” for the concept of home monitoring.

Patient selection

It is essential to develop a clear definition of the patient selection criteria for inclusion and exclusion from the project at an early stage. Once developed, they should be communicated to all key stakeholders in the project (primary care teams, consultants, discharge planners, etc) to ensure that the correct type of patients are selected for inclusion in the project. Careful patient selection is essential if the project outcomes are to be effectively evaluated.

Examples of patient selection models include:

  • Exclusion criteria model – include all of group of patients (e.g. COPD) minus those that don’t meet certain criteria (e.g. don’t have a telephone or broadband connection at home, lack cognitive ability to complete homemonitoring session, etc);
  • Inclusion criteria model – include all patients if they meet certain criteria (e.g. have had x number of hospital admissions in y time, etc);
  • Disease state model – include all patients with a specific disease (e.g. all chronic obstructive airways disease / diabetes / chronic heart failure patients, etc).

Project team selection

As with any telecare project, the project team selection is a critical element of successful project planning. When identifying which staff will be involved in a telehomemonitoring project, think about the following things:

  • Will existing staff be used and the new work associated with the project be integrated into their existing workflow?
  • Will any new staff be required?
  • Who will manage the telehomemonitoring stock (e.g. stock control, storage, cleaning, repairs, etc)?
  • Who will co-ordinate the installations and any additional preparation components for the installation (e.g. broadband, telephone line, consent)?
  • Who will be the system administrator (i.e. to issue usernames / passwords)?
  • Who will be the internal technical service / technical experts?
  • Who will install the telehomemonitoring device and teach the patient (i.e. will this be a clinician)?
  • Who will conduct the daily clinical monitoring?
  • What level of monitoring will be conducted and what level of expertise is required?
  • Will these staff have additional project roles or be solely dedicated to monitoring?
  • What communication (type and frequency) will monitoring staff have with other project staff, consultants, primary care teams?
  • Who will remove the monitor from the patient’s home?

Outcomes data / data integration

The management of the data received from the telehomemonitoring system is critical to the success of the project. The project team needs to decide:

  • How it will track the clinical outcomes and associated data;
  • Where will the data be stored – i.e. will existing systems be used, do they need to be changed or is a new system required?
  • How will important clinical data be merged / integrated with the telehealth system data?
  • Where are the synergies with the local telecare programme?

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