It was billed as the health service of the future – giving chronically ill patients the technology so they could monitor their own conditions at home or on the move.
In 2011, David Cameron’s Coalition government said that, if delivered properly, telehealth and telecare would substantially reduce mortality, reduce the need for admissions to hospital, lower the number of bed days spent in hospital and reduce the time spent in A&E – saving the NHS £1.2bn a year.
Three years later, the e-health project was quietly axed. Many older people were put off by having to use modern technology to self-monitor, researchers found. GPs complained of being inundated with too much information.
Lars Dahle travelled to the UK to see the new system on trial in London and Kent. He took the idea, brought it back to Norway and improved it.
In early 2014, four boroughs in Oslo began an e-health project, also called Telehealth, sponsored by the Norwegian Department of Health, piloting the use of pill dispensers and remote health care.
Almost 200 patients were given one, or both, services over an 18-month period.
The circular ‘Pilly’ dispensers, which have 28 pouches for pills, have a light and sound alarm alerting the patient when medicine should be taken. If they forget to take their medication, a notification is sent to nurses in a remote office who get in touch to check if everything is ok. The patient’s family can also receive the alerts.
“People get a better service from this than home nurses moving around,” Mr Dahle, the chief executive of Dignio, the company behind this telehealth system, tells i at his office in Fredrikstad, about 55 miles south of Oslo. “Because you cannot be everywhere at 9am when everybody is taking their medicine. With this unit, everyone can take their medicine at that time.
“Home care nurses in Norway typically see 10-11 patients per day, with driving time around 20 minutes between visits. A visit would last about 10 minutes. If that gets up to 14 patients per day, you are left with just a couple of minutes seeing the patient.
“Our nurses now see patients on fewer occasions, but when they do see them they have more time to spend, maybe half an hour.”
Mr Dahle, 55, a former Hewlett Packard executive, quit his high-powered job to create Dignio. It was something of a very personal project, aimed at improving the lives of those closest to him, as well as patients around the country.
“My father-in-law had Parkinson’s and was very dependant on taking medicine at the right time. He had great use of the Pilly and his health improved a lot.”
The nurses currently refill the dispensers, but as they do not feel comfortable doing so Dignio has begun a collaboration with online pharmacies, who can refill the trays at £15 a time.
Under the Telehealth system patients are also given iPads they can self-monitor with.
The aim is to help people with chronic, or long-term, health conditions better manage their illnesses – and stop them from lengthy hospital stays, or even admission at all if possible. Typical users suffer from chronic obstructive pulminory disease (COPD), malnutrition or are recovering from a heart attack.
Patients get different devices based on their needs. Those suffering from COPD have a spirometer and thermometer, those recovering from a heart attack will have a blood pressure monitor, those with diabetes a glucose meter, and so on.
Individuals take readings every day and load the information onto the tablet, complete a daily survey on their wellbeing and send the info to the cloud-based system. All the information is collated onto a dashboard, which has a traffic-light system alerting nurses in the remote care cetre to which patients they need to focus on each day.
The councils buy the devices on behalf of the patient, who are referred via their GPs. They would pay the first £200 of the care, known as “out of pocket” pay, but after that it’s free, regardless of how much medicine they need. The system cost is negotiated with each council, who Dignio invoice, and works out to around £15 to £20 per user per month, including unlimited access for clinicians, support and upgrades.
Mr Dahle’s used his 92-year-old mother, Gudveig, who suffers from hypertension and has had multiple strokes, as a test case for Telehealth.
“She was admitted to hospital multiple times before having rehab so she could stay at home independently. We gave her the tablet in 2012 and used the system with the blood pressure device, so knew what medicine to take based on the average of three readings, as the GP does.
“She was nervous and it took her a couple of months to get used to it, but all of these things she learned and is managing everything on her own. This is where [patients] get to over time, knowing what symptoms to look for related to their disease.
“We used to have take her to the emergency room once a month, which was hugely tiring for her, sitting around for hours waiting to be seen. Why not self-administer?”
“She was the first person we tested the system on. I don’t think I would have my mother today if she was not able to get her blood pressure under control. All her family died from strokes. None of them got close to her age.”
Mrs Dahle’s late-found comfort with technology has led to other benfits. She even has her own Facebook page where she keeps up to speed with what her children and grandchildren are up to.
“Now when she talks to them on the phone, she knows what they have been up to. It all helps for her to feel more included in everything. It’s something she would never have experienced unless she was kind of forced to use this technology.”
Initial results appear to be very impressive. In the first three months of the follow-up period, outpatient visits fell 26.9 per cent, hospital admissions were down 5.1 per cent and days spent in hospital by the patients fell 27 per cent. By six months, those figures had reached 41.8 per cent, 32.3 per cent and 39.1 per cent respectively, according to an official report on the project, seen by i.
“It is about nurses trying to empower patients,” says Laila Hagen, chief nurse at Dignio. “Because it is important to get them in control of their disease.”
At the remote care centre in the company’s office, team nurse Mette Kjørmo is in the middle of writing to one of her patients using the cloud system.
“I usually deal with about 3-4 ‘red’ cases a day,” she says. “I either write or call each one, listen to whether they are breathing heavily. If necessary, I will advise them to go to see their doctor or go through their pill regime to see if there’s an issue.
“Many patients tell me they feel comfortable because they know we are watching over them, especially the diabetics as we can advise on their diet as well as their medicine.”
Ms Hagen says: “Patients can write down what’s on their mind, on the tablet, and the next day Mette is answering it. We have patients who have reduced the number of hospital visits per year from 10-12 down to one or two.”
Mr Dahle hopes the Telehealth system will spread not just around Norway but internationally too.
“Chronic illness is only going to get more and more common as we live longer. At some point we have to decide as a society how best to deal with that.”