The Modern Outpatient: A Collaborative Approach 2017-2020

Annex 5: Home and Mobile Health Monitoring

1. What is HMHM?

Home and mobile health monitoring ( HMHM) describes systems that use technology to support citizens to record and send clinically significant information about their health to an electronic storage system, where it can be accessed by themselves and healthcare professionals to support the management of their care.

2. Why is HMHM important?

As our population gets older, the number of people that will need help from our health and social care services is projected to increase dramatically. We will not have extra health and care professionals to help.

To create the capacity to address this additional demand we need new approaches to service delivery that remove work from care pathways and can, where appropriate:

1. Reduce the contacts required to match patients to professionals.
2. Shorten treatment times.
3. Increase the length of time between episodes of care.

HMHM can help to achieve this by:

1. Collecting clinical data that supports triage, diagnosis and assessment.
2. Encouraging greater adherence to treatments.
3. Supporting citizens to self-manage.

HMHM is not the whole solution but it can make a significant contribution. as part of stepped approach to provision that includes telephone, video and face-to-face consultations.

Example 1 - Diagnosis

A case study by NHS Western Isles documented the use of HMHM in the diagnosis of hypertension. HMHM had been introduced to support a reduction in Primary Care referrals to ambulatory blood pressure monitoring (requiring some 10 additional patient contacts and four patient journeys to complete). The number of referrals were reduced by 50%. Additionally, Primary Care appointments were reduced by an average of 1.6 per patient. A larger scale initiative in Lanarkshire has also demonstrated savings in excess of four appointments per patient. In both studies, patients received treatment faster that they would have under usual practice.

Example 2 - Adherence to treatment

An evaluation carried out on a computerised Cognitive Behavioural Therapy service in NHS Lanarkshire showed the positive impact of HMHM technology on patient adherence to the treatment. HMHM users showed a 46% higher adoption rate (registrations from referral) than the national average and a 30% higher completion rate for the first session. Work to refine the HMHM support component is ongoing.

3. Where can HMHM be used to support improvement?

Traditionally, HMHM has been used to support patients with complex or later stage long-term conditions to stay out of hospital (see Tier 4 above).

The recent introduction of low cost, simple yet flexible technology in Scotland has opened up a wider range opportunity and this includes the ability to support a wider range of services provided in ambulatory and primary care settings (tiers 3 and 2).

This increase in scope means that HMHM now has the potential to support system-wide capacity gains by facilitating simultaneous improvements in each tier.

The challenge for HMHM enabled services is to expand to a degree where system level impacts become tangible and service delivery costs become optimised.

Through the Scottish Government TEC Programme a range of pathways in outpatient and primary care settings are being tested for suitability as scalable services capable of delivering nationally significant impacts.

To date the strongest candidates for national scale are hypertension diagnosis (and early treatment) and blood sugar control for citizens with insulin-dependent diabetes.

Other promising pathways include dietetics and community-based wound care and there are a number of other pathways in early-stage development.