Lessons from Richard Pope, Video Consulting Diabetes Consultant

At the Healthcare Innovation Expo in London I met with Dr Richard Pope, Consultant Diabetologist, who is reporting some great success with the use of Video Conferencing with home based patients:

Key take aways of the talk:

> There are currently 150 home based patients being telemonitored. Set against registry data service is saving ~0.1 all cause admissions, per patient, per month

> Between July 2009 and December 2010 it has saved 202 all-cause admissions

> Based on these reduced admissions alone it’s saved >£93k in 18 months

> Identified a popular new feature: That patients like to keep a recording of the consultation so that they can replay it later

> 5 year programme is running across 20 prisons delivering A&E urgent care service + 21 outpatient specialities offering elective services via telemedicine. 1000 video consults handled over 18 months and in 66% of cases these prevented the need for expensive patient transfers

> Patients Perspective:

…There is no expensive journey to and from hospital. No re-organising of work commitments to then spend time sitting around in waiting rooms… simply a live link up where I can talk freely and we can swap ideas as to how to improve my life…

> Consultants opinion on the value of video connectivity:

…First of all it allows you to deal with comorbidities much more straightforwardly, we’re doing what we’re doing in clinic but we just happen to be remote from the patient. And the visual dimension gives you a lot more confidence in your decision making. So you’ve got a data stream coming in oxygen saturations are low and you’re going to admit somebody because thye’ve dipped but you can actually see them in their own house and they’re not breathless and you just make decisions that you make day in day out and I also think there is an ability to engage in a different way with the family so i’ll give you an example, I was doing a call to a guy with diabetes at home and he’s telling me how he’s sticking rigidly to his diet and then i hear a shout from the kitchen “oh no you’re not you lying bugger!” and his wife comes around the corner joins in the call and we have a much more engaging conversation. So obviously he’s given permission to have his wife in the room so confidentiality isn’t an issue in this case but there are lots of examples like that were another patient who was hospital phobic and wouldn’t come to clinic, and her (blood sugar) control was awful and she felt really bad about herself. But she engaged through this modality in a way that allowed her to have really quite complex clinical discussions, six or seven sessions later and her HbA1c levels are back down and have stayed down. so i think it allows you to do what you do day in day out but actually do it in a much more efficient way

If they’re achieving this with set top boxes can you image how this market is going to take off with the arrival of easy to use tablets?

I’m also excited by the potential that this successful video consulting intervention in the prison service could offer as a stepping stone towards justice reinvestment (eg. an explicit attempt to disinvest from prison services and invest in more efficient health and social welfare services).

UPDATE: 15 MARCH

David Barrett (Lecturer in TeleHealth) commented to suggest that the service deals only with the monitoring of data (e.g. weight; pulse; BP) with no face-to-face consultation. I can only assume there must be some major communication errors at the Yorkshire and Humber Telehealth Hub project.

1) In his slide deck Richard outlined the “patient’s perspective” as:

“…There is no expensive journey to and from hospital. No re-organising of work commitments to then spend time sitting around in waiting rooms… simply a live link up where I can talk freely and we can swap ideas as to how to improve my life…”

Now the only telemedical examples he talked about were the “Hull Heart Failure Experience” and the “Prison Telemedicine” experience at “Airedale NHS” so are you suggesting that this is the patient perspective of a prisoner?

2) On the trade show exhibition stand (that I made a video recording of) there was only Video Conferencing equipment on display. Was there a reason why we saw none of the weight, pulse, BP monitoring technology that you mention are delivering you these great outcomes/savings?

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7 Responses to Lessons from Richard Pope, Video Consulting Diabetes Consultant

  1. Pingback: Lessons from Richard Pope, Video Consulting Diabetes Consultant

  2. chris says:

    David, I felt the ipad 2 last night. Lighter and some things faster some seem slower. Most important after facetime is HDMI dongle to show the Mirror of the
    screen of all content screens and programs, but not demoed at the store. I bought
    one and it works with the other iPod and iPhone, but only for video and pics.

    no programs or screen shots. Can’t use any of the others for presentations ppt
    or other demos.

    Chris Bickford MD

    I will be trying to do a live Q&A with Ganapathy at the Hyderabad meeting
    April 22 23

  3. Many thanks for the interesting summary of Dr Pope’s presentation. As one of his co-presenters, I just wanted to clarify some of the figures in the article. The first three ‘key take aways’ (150 patients; 202 admissions saved; £93k in net savings) relate to the Hull Heart Failure telemonitoring service, rather than the Video Conferencing (‘Telemedicine’) service. The Hull service deals only with the monitoring of data (e.g. weight; pulse; BP) with no face-to-face consultation. However, we are working closely with Dr Pope’s team as part of the Yorkshire and Humber Telehealth Hub project to identify which patient groups benefit most from video conferencing and which just require ‘standard’ telemonitoring.

    David Barrett – Lecturer in Telehealth

    • Hi David,

      Thanks for your interesting comment but as you can see in the upddate I’ve made to the post above it really has got me confused.

      What’s really happening? eg. is anyone saving money as a result of avoiding patients having to make the “expensive journey to and from hospital”

  4. Hi David,

    Thanks for this. Firstly, there’s certainly no communication problems within the hub, and I’d be grateful if that suggestion was removed.

    The hub project is a unique piece of work designed to demonstrate that three successful elements of telehealth provision can be delivered at scale on a regional basis. The presentation at the Expo was an opportunity to discuss each of the offerings individually – telemonitoring, telemedicine and telecoaching – and then describe how these will all be available within the hub service to allow for end-to-end care, commensurate with the level of need.

    The telemedicine service described by Richard has already proven itself in the prison sector but has not – as yet – been delivered at scale for people in the their own homes. Once the Airedale telemedicine service is scaled up as part of the hub then it will bring demonstrable clinical, financial and quality of life benefits.

    Finally, in relation to why the SHA stand only had telemedicine kit on show, the telemonitoring offering does not use a specific technology product. Hull happens to use Philips Motiva, but the service can also be (and is) delivered elsewhere in the region using equipment from Tunstall, Honeywell, Bosch and many others. These technologies were well represented elsewhere at the Expo, so there seemed little need to populate the SHA stand with a range of telemonitoring technologies! In addition, the SHA representatives were giving out impact cards and DVDs that gave more detail about a whole range of telehealth and telecare projects in the region.

    Hope that clarifies the situation a little – happy to post a more detailed briefing of what the hub is and how it will work if you think that your readers would be interested.

    Many thanks

    David

  5. Hi David,

    “there’s certainly no communication problems within the hub, and I’d be grateful if that suggestion was removed”

    I think either there must be a communication problem OR I’m just plain stupid. Could you please clarify if Richards quote is from a “prisoner” or “at home patient”.

    “Hope that clarifies the situation a little – happy to post a more detailed briefing of what the hub is and how it will work if you think that your readers would be interested”

    Please don’t be shy about sharing anything that’s relevant. Could you point us to your slide decks?

  6. Hi David,

    The perspectives that Richard quoted are from the early users of the home-based telemedicine services. Once the presentation slides are available online, I’ll forward on the link.

    Many thanks,

    David B

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