Healthcare Commissioning Forum

Patients

Perceptions of remote monitoring:

-   Remote monitoring is not suitable for all patients. Remote downloads could reinforce the perceptions of patients that they are ‘ill’ and in those who are most anxious conventional follow-up could occur.
-   Patients should have remote monitoring clearly explained to them and give informed consent for remote monitoring. At Sandwell and West Birmingham NHS trust, patients are made aware of remote monitoring at support groups or conventional follow-up appointments and are recommended for remote care by cardiac physiologists.

Staff

Liability concerns about timeliness of dealing with incoming information:

Alert follow-ups:
-   Service design needs to define thresholds for alerts and adapt them according to service provision.
Resistance to change in cultures and behaviours:
-   Commissioners could use active potential to decommission services to allow rapid change.
Lack of clinical champions:
-   When there are no clinical champions within institutions, sharing of practice should occur from other institutions – even from outside the region.

Institutions

Define what proportion of remote care replaces or supplements outpatient activity.

Institutional inertia: slow sign-off of legal documents and contracts with industry:
-   Providers must become more efficient.
-   Industry must standardise paperwork and legal requirements collaboratively – perhaps using the Association of British Healthcare Industries as a catalyst.
Communication with patients and GPs:
-   There is a need to further explore the use of IT to deliver more efficient communication than sending letters.

Recurrent costs

Costs of remote monitoring are hidden: How will costs of continued remote monitoring downloads, server time and transmission be covered recurrently?

Financial

The cost of consultant input for bradycardia and implantable loop recorder follow-up is not stipulated in tariffs and therefore many institutions charge the rate for consultant follow-up if device follow-up is not within a block contract:
-   The majority of these devices currently have no consultant contribution costed into follow-up appointments and therefore tariffs need to be more sophisticated to reflect what actually occurs.
-   There is potential to convert each consultant episode into a traditional follow-up appointment if sophisticated tariffs do not exist and this will incur a cost pressure. If separate tariffs for physiologist- and consultant-led follow-up are produced, the relative utilisation of each tariff and the conversion from physiologist- to consultant-led follow-up can be audited. This will identify any variation between providers and share any learning that improves quality and outcomes as well as demonstrating the extent of standardisation in implementation/approach amongst providers.
-   Coding must be accurate and is a provider responsibility.

The one single significant barrier in the NHS is the inability of current tariffs to incentivise providers to undertake remote monitoring because it reduces income to acute trusts. By adopting innovative mechanisms such as gain sharing, the NHS could save money and improve quality as a whole, with commissioners and providers releasing fiscal and manpower resources, and patients benefiting from improved outcomes.


For further information, please go to : https://arms.evidence.nhs.uk/resources/qipp/617474/attachment