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Podcast Transcript
Ewan: Hello and welcome to the inaugural Technology Enabled Care podcast. My name is Ewan Summers, and I have been fascinated by the massive growth in the use of Technology Enabled Care – or TEC for short – as it enables everything from Near Me video consultations to remote monitoring using text messages and much more.
So the aim of this series is fairly simple:
- I intend to shine a light on what TEC is and how it works.
- I plan to meet the people driving its increasing use.
- And crucially, I’m keen to find out the benefit it’s having, in real human terms, for the people of Lanarkshire.
And I look forward to taking you, our listeners, on my journey of discovery.
In this first episode, I speak to Morag Hearty who is Lanarkshire’s programme leader for TEC. In our conversation, we cover a range of issues, including the person-centred, human benefits of Technology Enabled Care such as mental health nursing and remote blood pressure monitoring. And in broader terms, I explore how Morag and her award-winning team have rapidly scaled up the use of TEC in Lanarkshire during the last year, enabling health and care to continue safely despite the many challenges Covid has posed.
So please, sit back, and enjoy our conversation.
Without further ado I give you Morag Hearty.
Morag: Technology enabled care, or TEC, really aims to help people be as independent and safe and looked after but giving them the options on how to do that. The team’s extended quite a lot, and we now support services to use digital technology in their day to day work. That can be mainly for the Near Me, which is the Attend Anywhere video consultation platform, or remote monitoring.
E: And would you be able to tell us a wee bit more about them, starting with Near Me?
M: I know that many people in the last 12 months particularly have found all sorts of different ways of keeping in touch with friends, family, work colleagues and so on. In Lanarkshire, in the health and care sector, we’ve also been looking at how we can make things easier for people to keep in touch with their health and social care providers. So, for example, many people using video conferencing, video calls, your Skype, your face time, your zoom calls, to link in with your family, both locally and abroad, seeing your grandchildren, meeting up with your pals. This is a way that we can bring that into our health care and provide you with a way of connecting with people without having to come in-person to our site.
E: And is it as simple as being sent a meeting request from your doctor or clinician?
M: They will send you that with your usual appointment letter with all the instructions, or if it was something urgent, or something just in the spur of the moment, then they can actually send you a link via text or an email straight to your phone and say “just click on that” and it takes you into a virtual waiting area and a doctor or nurse or whoever brings you in, but it’ll just be on a screen.
E: And which devices can you access Near Me on?
M: So you can access Near Me on most reasonable devices, so it can be on our phone, not necessarily an iPhone but a smartphone, as long as it’s got a camera and some way of connecting in with your audio as well, so whether you have a headset or your earplugs in. But just exactly the same way as many, many people are using to link in with, as I say, their family and friends.
E: And what about blood pressure monitoring?
M: Blood pressure monitoring, huge success in Lanarkshire. So, blood pressure is one of the most common appointments in Scotland, across Scotland, for people to go to their doctor, and usually, up until last year, people went to the doctor, got their blood pressure checked and then might be asked to come back because their blood pressure was a little bit high. This way, we can give someone a very simple one touch monitor that they put on their arm maybe twice a day to start with, and they send in a text reading with what that monitor tells them. It’s much, much easier for the patient to do that, they find it very easy. We’ve had thousands and thousands of people across Lanarkshire using it, and of all ages.
E: And are they sending it directly to the doctor or nurse?
M: It goes into a report that the doctor then sees in your medical notes, it goes into the medical notes, and the doctor or the nurse can see that everything’s as it should be. So the test goes to an automated reply that you get a wee remainder saying, “Hi, can you send in your blood pressure, please?” You start with twice a day and then it might be once a week or even once a month. Send in your blood pressure making sure that you’re sitting quietly and then you get some instructions. But it’s a very simple one-touch with a great big screen, so it’s very difficult to get it wrong, really, and at the moment you’re keeping it, because we don’t want you going back and forward into surgeries and things. At the other end, we’ve also got citizens who would find it difficult digitally so the new platforms are able to accommodate an automated telephone call option, so we’re not only moving with the times, we’re also making sure that we’re not disadvantaging people who could be excluded.
E: Is that a part of your everyday thinking, to not be digitally exclusive?
M: Absolutely, I think we we’ve always said, as part of the sort of theme from the team, that this is not for everyone and we don’t try and mandate this, this is an option, it’s an option for communication with patients, and for many of our patients that’s absolutely the way that they embrace this, they actually take it on board. We know for example that if people are able to relax at home or in a comfortable place privately then they might respond better to treatments. So blood pressures taken at home are normally lower more often than if they’re in a clinic setting. We have evidence from our mental health colleagues where actually not having the stigma of coming into a clinic, for example, can be helpful. I think that’s something else that the team do, and we recognize can help with either the remote monitoring or the Near Me, is that we include carers. So if an older person or someone who’s got less ability in some way can’t manage it themselves then the carers can help them. And we find family and carers really appreciate the fact that this is helping them to look after their person as well.
E: How exactly do they help them through Near Me?
M: The beauty of Near Me can be that you can have up to four people on the call, so you’d have the nurse and the doctor and we’ve had family members as far away as Saudi Arabian and Canada coming in, Australia, you know. They want to know what’s happening, particularly in this last year with the pandemic, you’ve got families that are remote, but even before then, and I think hearing the same story at the same time can be really helpful and then supports the patient. Even people at work could come in on a call and hear what the physio’s telling their mother or their partner or hear what’s happening with their child. We’ve had children with asthma, for example. And it means that they don’t have to take time off school, but the father and the mother can both hear what is happening and what the condition is. So I think there’s lots of communication there we can do. Quite often it was the husband and wife team – you know, “my wife’s the one that does the texting, I don’t go near the mobile phone,” or vice versa. But it’s not for everyone and we’re always very clear that there’s very few of our services that are wholly digital. Only where that’s absolutely essential. And I think it’s an option, but it’s an option that we would be promoting as we show people what the benefits can be. And usually once people have used it once or twice then they’re really comfortable with it and want to use it again.
E: It’s interesting what you say about the blood pressure monitoring; have you actually seen a health benefit as opposed to it just being convenient as well?
M: Absolutely. There’s actually been really good research carried out by our partners in Lothian where they were actually able to show that patients and people who were monitoring their blood pressure remotely actually maintain their correct blood pressure levels longer than if they were just given monitor and they only come in once or twice a year to have their blood pressure checked. And in between that, they forget about exercise, reducing their salt and so on and indeed taking their medication. So that sort of continuous monitoring, maybe once a month sending in their blood pressure actually helps them maintain that blood pressure, and the health benefits of a healthy blood pressure is immeasurable and we are hoping that we will show, longer term, a reduction in the people having stroke or heart disease, because a high blood pressure carries a very, very high risk of those, and there are certain categories of patients with diseases like diabetes, where it’s even more important, that they’re at even greater risk.
E: That’s really interesting. Are there any other examples of something along those lines?
M: For COPD – Chronic obstructive pulmonary disease – and asthma patients, they’re usually given their rescue medications and it’s really important that they use these effectively and safely at the right time. So actually, making sure people with a new diagnosis, for example, of COPD or asthma are actually encouraged to take their inhalers at the right time and recognize any symptoms worsening. And indeed, the most recent one, obviously, was the remote monitoring we’re testing, and I’ll make very clear this is a test, it’s a pilot for COVID monitoring, and that’s where we are wanting to detect or try and help patients to detect if their condition is worsening. And that can happen quite often within the 14 days of their first symptoms appearing; they appear quite well but very suddenly deteriorate and they need to look at their oxygen level. They’re given a small device called a pulse oximeter that measures their oxygen, but in addition to that, it’s their symptoms and how they’re feeling. And all of these will give them an automated response saying, “Please phone 999 or phone 111 for further advice.” I think the other point we always make is that remote monitoring is not continuous 24-hour monitoring, it is not somebody sitting at the end of the system looking at everything coming in in real time. Yes, it is coming in in real time, but we make it quite clear this is self-management, this is helping the patient take responsibility for getting in touch, or what to do, take some actions. But there can be alerts sent to a clinician, for example, for asthma or COPD where they might follow this up or arrange to see you. But a GP with a blood pressure that’s running too high may message the patient to say, “Can you make an appointment please? We need to discuss this,” or, “We want you to change your medication,” so it’s a bit of two-way, but it’s not 24-hour, someone sitting at the end – it’s not an emergency service.
E: We’ll go on to talk about how much it’s blown up after COVID, but how prominent was the TEC team pre-COVID as well?
M: I think we had a good reputation, we started from very, very small beginnings as they say. We took part in a European project and literally there was myself and a band three part time person at that point. So we’ve extended the team quite significantly because it’s become more and more prevalent, and thanks to some Scottish Government funding as well, we were able to extend this. And the support from NHS Lanarkshire and the health and social care partnerships, they recognized this was something that was good to do. And I have to give credit to the clinical staff in Lanarkshire who tell their neighbours or their friends and their colleagues, “Why are you not doing that because this makes a big difference saving time and so on.” We’ve been all over Lanarkshire, explaining to the public what we’re doing and how this can help them. And it is an option for them. And we’ve also seen patients going to their doctors and saying, “Why do I have to do it this way?” And one of the most frequently asked questions I got it, not so much recently we’ve not been out and about the same but previously if I went to an event, the most frequently asked question I got was, “Does my doctor do that? Why does my doctor not do that?” So, you know, patient power.
E: And how do you reply to them.
M: I usually said, “ask”. It’s up to your own clinician, again it depends on the clinician, the service and the timing has to be right for them so we would never mandate something because we always recognize that circumstances can be different for different services. We’ve been, I think, very fortunate in Lanarkshire that most of our clinicians have been very much on board, and, in actual fact, it’s shown that at the moment we’re providing 30% of the target recruitment in Scotland, we’re actually 33%, a third, we’re smashing the recruitment targets at the moment in Lanarkshire. But there’s still some things to do, still some things to take forward. But yeah, we’re doing well.
E: Did you feel when COVID and all the lockdowns started happening, did you feel that the nature of TEC meant that you were more prepared for what was to come?
M: I think we would have been in a very sticky place altogether had we not had the background and we had something there in place. Now, we had to absolutely change everything very quickly, respond very quickly, within a couple of weeks we had every GP practice set up with their Near Me accounts. They weren’t all in a place to start using them And there was a wee bit of… we had to sort of do what we could quickly, but we had superb help from our e-health colleagues in providing equipment quite quickly out to the GPs and we linked in with them. And when we set it up, we had to change waiting areas, get accounts set up very, very quickly and we couldn’t have done that had we not been quite confident in the skills of the team to set up accounts and get them going and what had to be done, and how we could work it and how we can support them and we did lots and lots of one-to-one calls, checking round-a-bout, left the door open, worked extended hours so that we weren’t leaving people too long without access, particularly when it was out of hours and other people were working extended hours as well so we tried to support that. So it was a massive impact but we couldn’t have done that without the team having been expanded and the expertise that was in the team.
E: How important has technology enabled care been in providing safe patient care in the pandemic?
M: I think it’s been recognized as for many of the services that have used it, in particular. They have recognized this was the only way they could have safely delivered a service, and I’m thinking particularly about mental health. I mean we have literally… we had hundreds, I did not appreciate how many mental health staff or staff working in mental health, psychology, CAMHS, psychiatry, and all the sort of associated services around mental health. I had no idea we had as many staff in Lanarkshire working in that, many of them working from home, many of them working part-time, quite a lot of staff shielding. And the only way they could have provided any service was remotely, and it actually let them still respond to their patients, and they were one of the biggest ones that came on, but I think there was many other services as well where they were able to utilize staff working remotely shielding effectively.
E: Can you give us some examples of some of the other services?
M: So tissue variability kind of jumps up, tissue viability nurses, they’re a very small resource, tiny resource in Lanarkshire, and they were able to use Near Me with care homes so they didn’t want any more footfall going in than required, but they were able to support care homes, looking after sort of tissue viability pressure areas issues, sort of things like that and give the advice to the care homes. Physiotherapy, they were actually able to see what a patient’s doing and do some interventions there, so our musculoskeletal colleagues there. Occupational therapists, the nursing teams, linking in with patients. Anywhere where they didn’t have to put hands on the patient, then they were able to have a Near Me call that they liked the idea that they could actually see what was going on, they could see someone from that point of view. So, lots of things like that that people have come back to us and said this was really, really good. As I say, I’ve already picked out a few of the services.
E: And is that something you consult with your patients?
M: So we’re going to put our on survey on Near Me for patients to get some feedback from them directly because the national team weren’t able to drill it down to the level we wanted, so we’re working with Helen Alexander from Lanarkshire to put a survey on that we’ll get our own information back. In addition to that, we’ve just set up ‘patient opinion’ on the webpage to encourage people to let us know there, because we want to know good and bad. We want to know if something’s not working and how can we improve. I think that’s really important; it’s nice getting all the, “oh this is great, this is wonderful, and we like it,” but we also want to know when it doesn’t go right.
E: How important do you think it’s going to be in the future, post-pandemic.
M: I think it’s very important because I think that we’ve changed a culture and I think there’s a general sort of ethos across the country that we’re not going to go back to normal. You might settle down a little bit and there’s some services that will absolutely prefer and would have good clinical reason to go back to face-to-face seeing somebody, there’s lots of positives to that and I wouldn’t deny that. So that’s important.
E: Just finally, are there any personal highlights or stories or anecdotes that you’ve got that you’d like to share?
M: Yeah, I think they keep coming. You know, I still remember, it still strikes in my head and it goes back to our very first patients we had on when we did the United for Health study and we had never done anything like this before. The patient looked as if she was going to be charged for the text messaging. Now text messaging is free, there’s no charge to the patient for any of this. I had to call the patient to sort of say, because this was very early days, and I called the patient to say, “Look, I’m really sorry about this,” and she said, “oh no, hen, it was well worth it. See even if I do you get charged for my text, it’s well worth it, not having to trail up to the hospital. She was so enthusiastic, and I think the highlights for me are always when we get that unexpected, sort of, this is really good, and this has made a difference. I think to me that’s the bit.
E: Perfect. Morag, thanks a lot for joining me today.
M: Thanks, you take care.
E: And I’d also like to thank you, our listeners, for joining me on the beginning of what I’m sure will be an insightful and engaging navigation through the workings of Technology Enabled Care. Be sure to look out for our next episode on this journey of discovery, but for now, thank you.
