The Commissioning Assembly has published this new toolkit to support commissioners to plan, procure and evaluate technology-enabled care services. The toolkit is an electronic web-based resource with a number of links to useful resources including case studies, research and policy links. The toolkit will be added to over the coming year with additional resources: procurement contract templates; project and change management tools and templates; continuous improvement good practice.
The value of technology-based care services (TECS)
TECS incorporates telehealth, telecare, telemedicine/teleconsultations, telecoaching and self-care apps and are designed to complement other technology services such as integrated care records and unified communications. The toolkit provides a range of examples of TECS in action, such as telecoaching to support smoking cessation and apps to support self management of long term conditions. A COPD pathway is used to demonstrate how TECS can support commissioning priorities such as reducing hospital admissions and where technology can be used at different points in the pathway involving primary care, secondary care and emergency services. For example: alerts can be set up to remind patients to take medication; falls detectors and bed sensors to activate night lights can help with falls prevention; telecare can be used to support early discharge; and telerehabilitation can be used to deliver pulmonary rehabilitation programmes. The example of the pathway highlights the importance of care planning to ensure the use of TECS matches individual patients’ needs and preferences.
A key message of the resource is that planning, implementation and evaluation benefits from a health economy wide approach. This will help to ensure technology is embedded and aligned with other key initiatives to support self management, coordination, prevention and personalisation as technology alone can’t deliver the necessary change. A health economy wide approach will also enable greater collaboration and partnerships with academic and clinical networks, patient groups and suppliers.
Helping commissioners to plan, procure and evaluate
The toolkit includes helpful “know-how” organised around the commissioning cycle. Helpfully, a number of checklists are included to encourage reflection and a systematic approach. Here’s a flavour of the learning and guidance:
- Planning: A useful map of TECS services is included, which can be added to and has the potential to develop into a useful real-time source of information. There are also numerous links to case studies and evidence relating to mental health, urgent care, prison health, social care, community care, primary care and acute care, which will help commissioners writing business cases. There’s also a helpful list of potential sources of investment and funding.
- Procurement: There’s a link to the Integrated Digital Care Fund (IDCF) toolkit which includes guidance, a standard contract, open-source solutions and signposting. A number of links are provided to tools and resources which will help commissioners select appropriate TECS, along with guidance on information governance considerations.
- Implementation: The toolkit guides commissioners through the following steps: establishing buy-in, workforce requirements, service design, implementation and evaluation design. Processes such as patient recruitment/referral, managing a directory of TECS services, communication planning, installation and maintenance are covered with links to further detail.
- Evaluation: Commissioners are encouraged to plan for evaluation from the outset to measure value and plan for scaling up/disinvestment. The current evidence base is mixed and of varying quality therefore it’s critical that commissioners evaluate implantation and build on the evidence base. There is advice on different types of evaluation and how to manage issues such as sample size and drop out rates. An Evaluation Framework is provided, which details a range of metrics (including utilisation, patient goals, patient experience, socioeconomic impact).
- continuous improvement: There are further case studies, for example, the Florence text system in Stoke on Trent to enable interactions between patients and clinicians and the use of Medvivo HomePods in NHS Ayrshire and Arran to support COPD care. The guidance covers important considerations including: alignment with organisational priorities; sustainability; involvement; workforce development; and processes and policies for service refinement.
The toolkit will be a useful resource for commissioners and is timely given policy drivers towards more patient-centred and coordinated care and new models of care. Although at first glance it seems quite a lot of information to digest, it’s relatively easy to navigate and the various sections are concise and easy to read. The toolkit suggests a range of questions to consider but initially, commissioners may want to reflect on:
- Who will take a lead on TECS strategy and implementation?
- Who are the key stakeholders who need to be involved?
- What governance structures are in place (or need to be put in place) to support health economy-wide discussions and decision making?
- What TECS are already in use and what do you know of their impact? How can existing TECS be integrated into an overall approach?
- Which patient groups are most likely to benefit from TECS?
- What opportunities might exist to introduce TECS e.g. high utilisation rates?
- What information requirements need to be built in to support evaluation and integration/coordination? Are data sharing agreements in place?
NHS Commissioning Assembly, Technology enabled-care services: resource for commissioners, NHS Commissioning Assembly, 2015.