NHS budgets are increasingly restricted. So strategies and linked implementation plans for Technology Enabled Care Services (TECs) must be focused on service developments and improvements that should generate cost savings as well as improved patient satisfaction and enhanced clinical outcomes.1,2
Some top tips for commissioning
- Communication, communication, communication - as they say! Commissioners, providers, patients – all need to be talking the same language and seeking equivalent goals.
- Patient and public engagement is vital, so patients co-drive the design of digital delivery of care.
- Use a range of telehealth or other digital modalities such as skype, telecare (assistive technology), teleconsultations or telediagnostics to drive integrated care and not as standalone solutions.
- Focus on hot spots in patient pathways, across primary/community/secondary care interfaces.
- Anticipate consequence costs – better/quicker care may increase costs of supporting clinical teams.
- Consider what workforce competences and capabilities are vital for smooth rollout of TECs and prepare before you expect them to use digital modes of delivery. Build their confidence, provide experienced mentors.
- Focus the kinds of digital delivery of care on particular patient groups; e.g. teenagers are likely to embrace skype consultations.
- Evaluate usage of TECs; what were the benefits shown and what did not go well. Then learn from the evaluation in your next redesign of services.
- Improvement tools are not just for development days at update workshops; they should underpin your commissioning and service improvement – leadership, transformational change, service redesign.
- Your stakeholders are your allies – spot challenges and counteract in constructive ways before progress with rollout is stalled.
Take a look at the Case Studies in the clinicians’ learning resource section and associated videos of how clinicians and managers have applied Flo Simple Telehealth in a range of healthcare settings.
You will need to
- Underpin integrated care with the use of easily accessed technology enabled care services (TECs), synchronised along the patient pathway between the NHS, social care and other local provider organisations.
- Create the right environment to support the uptake of TECs in your NHS organisation and local health economy.
- Develop your workforce’s capacity & capability for digital delivery of healthcare and remove barriers to its provision. Look at a video describing how Flo mobile phone texting was used in Newham as part of a skype consultation – see Diabetes, Flo and Skype video below.
- Simplify the procurement and commissioning processes for deploying TECs at scale in the local health economy.
- Promote the benefits that TECs can provide to local people, in managing their health and care.
All videos are available on our Videos page.
Diabetes, Flo and Skype by East London NHS Foundation Trust
Theresa O'Shea - Diabetes Nurse Specialist of the East London NHS Foundation Trust and patient Yvonne, explain how they use a combination of Florence and Skype to increase the quality of care and convenience.
So base your strategy and implementation plan for digital delivery of healthcare on
- Best practice in commissioning delivery of digital health care throughout the commissioning cycle e.g. procurement, service specifications, monitoring of contracts with action on underperformance, patient & public feedback.
- Priority population groups to focus on: using risk stratification; optimising productivity/efficiency; oversight of cost effectiveness of comparable digital modalities applied to different patient groups for different purposes; getting buy in of stakeholders/clinicians/managers/patients/public; clinical governance across patient pathways; digital modalities & applications most likely to generate cost benefits, evaluation of cost benefits and consequence costs.
- Overcoming potential challenges to commissioning digital delivery of healthcare e.g. telehealth and telecare.
- Cost benefits – how measured and by whom? Synchronise strategies and implementation of digital delivery of care across NHS/Local Authorities [LAs]/social care. Aim to work with providers of digital modalities in constructive ways to optimise benefits; shared patient records to underpin digital delivery of care across patient pathways spanning various NHS & LA settings.
- Integrated care pathways: assurance that digital delivery of healthcare is not implemented as a standalone solution.
- Agreement across the local health economy/LA with a culture of digital development to ensure rollout at scale.
- Leadership, transformation capability planning (e.g. how to design pathways) and technical skills and expertise (e.g. business cases, planning etc).
- Right workforce competence & capability (clinician & manager): choose right digital modality for right patient for what purpose/length of time/expected clinical outcomes; clinical governance, informed patient consent, oversight of remote bodily measurements/response to alerts, writing of clinical protocols for digital delivery, teamworking re remote access, enhancing patient behavioural change.
- The IM&T infrastructure (hardware, wiring, and clinical systems that all support connectivity and sharing of data).
- Digital health interface (anything that requires an interface between health and social care settings, and connections with service users and their families/carers).
- Derived from NHS England’s Rapid Design 3millionlives initiative, 2014.