The Long Term Conditions/Telehealth Programme within NHS Yorkshire and the Humber’s Programme for IT aims to improve the experience of patients with Long Term Conditions (LTCs). Working with new and existing technology/systems, the programme includes provision of templates to support personalised care planning and a clinician to clinician advice service. The programme also provides clinical leadership support for telehealth/telemedicine initiatives supporting patients with LTCs across Yorkshire and the Humber.
Personalised Care Planning
The programme has developed a suite of templates for the region’s strategic clinical system that support a personalised care planning approach. Built with an integrated and patient-centred process in mind, the templates follow the flow of a care planning consultation and enable a clinician to record the expressed goals and aspirations of the patient in relation to management of their condition. The approach enables the collection and sharing of both biomedical and care planning information by all those involved in supporting the patient across health care sectors.
Originally developed to support patients with diabetes, a generic Long Term Conditions template has since been developed. Further information is available on the Diabetes Care Planning Template Programme/Projects
Further development has been undertaken to create a variety of specialty specific templates that support patients with multiple LTCs, all accessible through the generic LTC Template.
There is the additional hope that when introduced at scale the resulting data on services needed to meet the needs of patients with LTCs will be of significant benefit to commissioners.
For more information on the Long Term Conditions Programme and templates to support personalised care planning, please contact:
Julia Coletta, LTC/Telehealth Programme Lead
Tel: 07795 603 744
Email: Julia.coletta@yorksandhumber.nhs.uk
Lee hunter, Project Manager
Tel: 07920 138 144
Email: Lee.Hunter@yorksandhumber.nhs.uk
Clinician-to-Clinician Advice Service (E-consultations)
A number of sites across Yorkshire and the Humber are now implementing clinician-to-clinician communication and decision-making support on referrals, tests and medication etc.
Known as E-consultation, the service enables primary care clinicians to seek advice from specialists in secondary care by sending an electronic message through a shared system. For less complex cases this can allow more of the patient care to be managed in the primary care setting and can sometimes remove the need for referral to an outpatient appointment. The shared view of the patient record provides the secondary care clinician with information on interventions, tests and care planning etc undertaken in general practice and/or community services.
The original pilot in Bradford 's Chronic Kidney Disease Service has highlighted significant benefit to patient care and as a result, Wakefield, Kirklees and Sheffield health communities have taken on the innovation for Diabetes care. If proved successful across these localities, the hope is that this approach will be adopted on a wider scale.
For more information on the E-Consultation Project, please contact:
Lee Hunter, Project Manager
Tel: 07920 138 144
Email: lee.hunter@yorksandhumber.nhs.uk
Telehealth and Telemedicine
During 2011/12 the Programme successfully delivered the Telehealth Hub Project, which established a telehealth infrastructure and service for the region. Delivered by a partnership of three health communities (Airedale, Barnsley and Hull) the Telehealth Hub provided services, including telecoaching, telemonitoring and telemedicine, to over 2100 patients across the region. The evaluation is now underway and will be available during the Summer of 2012. There services are still available and further details about how to access them can be provided on request.
For more information on Telehealth and Telemedicine in Yorkshire and the Humber, please contact:
Julia Coletta, LTC/Telehealth Programme Lead
Tel: 07795 603 744
Email: Julia.coletta@yorksandhumber.nhs.uk
Jenny Jackson, Project Manager
Tel: 07889 372 757
Email: Jenny.Jackson@yorksandhumber.nhs.uk
