This practice question has been published with the kind permission of the Royal College of Nursing
Assistive technology, for example, telehealth, is designed to support people in their own homes. Telehealth is the remote exchange of data between a patient at home and clinicians to assist in diagnosis and monitoring. Its purpose is to empower individuals in the management of their long-term condition and to support healthcare professionals in their treatment options and care planning.
The deployment of such technology in the community is designed to bring care closer to home and to avoid inappropriate hospital admissions. It allows practitioners to monitor disease progression and put practical measures in place to reduce and/or stop crisis interventions.
Empowering patients
For practitioners, using assistive technology can mean a significant change to working practices. To ensure that it is effective staff will have to modify their working routines. Patients and their carers will have to embrace new ways of receiving care and support. Using remote monitoring has the potential to empower patients, carers and professionals and to enhance integrated working by:
- Having a more productive, flexible workforce ensuring the best and most efficient use of resources.
- Promoting health, choice, independence (self-care) and wellbeing of patients and their carers.
- Preventing acute exacerbations and reducing acute admissions through effective planning and avoidance techniques.
- Supporting and assisting early discharge and maintaining care at home.
- Matching care to needs by creating individual management plans and care pathways.
What does this mean for practitioners, patients and carers? Relying on technology to make care options, including making a diagnosis, prescribing decisions and care planning will mean a change in behaviour. Practitioners are not carrying out the task themselves. They are reliant on the readings sent to them down a telephone line. They have to have confidence in the information given to them to act. This is a significant cultural shift. Making clinical decisions using remote assistive technology without seeing patients is not going to come naturally.
Part of our decision-making process is based on having face-to-face contact with patients. We are told to embrace this change as it will be the only way that we will manage our daily workloads as demand for services increases.
There are areas where this new technology can be used effectively, for example, with patients who:
- Have attended their GP because of an exacerbation.
- Have attended the emergency department because of an exacerbation and have not been admitted.
- Have been discharged from hospital after an exacerbation.
- Are newly diagnosed.
- Require monitoring of newly prescribed medication.
- Are non-concordant with prescribed medication.
- Have any change in their health condition.
- Require reassurance that their condition remains stable as part of routine monitoring and evaluation of their care plan or long-term management plan.
- Require weekly monitoring of blood pressure, pulse, oxygen saturations, weight and/or blood glucose.
Working differently
Patients and carers will have to accept a different approach to care delivery. Some individuals will embrace this change and be empowered. However, there will be others who are not confident with technology and will be fearful. Not all patient groups will be able to participate in isolation and there will potentially be an increased reliance on family and care networks to support them. Working differently is meant to enable patients to manage in their own homes and communities while enabling service providers to deliver flexible, productive and cost-effective care.
This new technology will change the face of the NHS. It will change how practitioners make their clinical and prescribing decisions in the short and long term, and how they support patient compliance and understanding. There will undoubtedly be more changes ahead as technology advances.