CASE STUDY
London Borough of Bexley deploys Docobo’s DOC@HOME remote patient monitoring technology across care and residential homes
The London Borough of Bexley has successfully deployed Docobo’s DOC@HOME remote patient monitoring technology across the majority of its care and residential homes to manage residents’ health and wellbeing, reduce emergency hospital admissions and enhance contact with GPs. The borough has also started to use Docobo’s ARTEMUS system to identify cohorts of patients and to carry out population health analytics activities and monitoring.
Background
London Borough of Bexley wanted to support resident wellbeing and help residents to be cared for in their homes, while reducing and delaying the need for a move to higher levels of care. The team also wanted to support the diagnosis and monitoring of health conditions, to help staff to be able to quantify and record when a resident becomes unwell and to help rule out health conditions – if and when people need support, advice and interventions around mental health. Bexley chose to work with Docobo, which provides remote monitoring technology and population health analytics across the UK and has an excellent track record in delivering digital health successfully.
Successful remote monitoring pilot
The Bexley team started a pilot in October 2018 at Northbourne Court, a large 120 bed care home. While the care home had a good CQC rating, there was quite a high usage of ambulance services and also a prevalence of falls, which were a challenge for both carers and residents. Bexley used the pilot to bid for funding, which was successful, and started to roll out the Docobo system across the care home.
Talking about the decision to work with Docobo, Rebecca Watson-Morse, Commissioning Programme Lead, at the London Borough of Bexley says: ‘It was a question of working with staff – and to see how we could support them to manage the wellbeing of their residents. Docobo had a good reputation for collaborating with clients and providing excellent results, which was important to us.’
What is remote monitoring and how does it work?
Remote monitoring uses the DOC@HOME platform to do the following:
• Care home staff record vital signs and symptoms onto the DOC@HOME tablet (using thermometer, blood pressure monitor, pulse oximeter etc).
• Information is transferred to the GP clinical system.
• Care home staff can track information on the DOC@HOME system.
• GPs respond to any requests or alerts within two hours and the alert is triaged.
• Baseline readings can also be recorded monthly with a ‘Resident of the Day’ process, to help monitor a person’s wellbeing over time.
Remote monitoring enables users to update personal healthcare data using different kinds of question sets, which are then recorded and submitted to clinicians using a secure web interface. This pilot involved two types of question sets.
The first was for cases where a resident themselves or a staff member felt that the resident required a consultation with a GP. By answering the questions on the DOC@HOME tablet and submitting the observation, the GP is able to review comprehensive information and quickly determine the course of action and whether or not a visit is necessary. The GP will then respond within 2 hours with a call to the home, which avoids wasted time for care staff waiting for a call to get through or waiting for a return call. The question sets were developed in consultation with the surgery and the care home.
The second type of question set is the ‘Routine wellness check’ which is used to carry out monthly wellness checks on residents. During these wellness checks, care plans are reviewed, and residents’ health needs are discussed both with residents and their families. Readings are taken, which go on to the resident’s record which is then submitted to the GP. Once submitted, if there are any observations which exceed agreed parameters, the GP or pharmacist will automatically be alerted.
Rebecca explains: ‘We find this method really helps us build a picture of residents’ health and it is really helpful to refer back to – other professionals have access to data, which is also really useful. We are looking to inform GP intervention and support their visits to care homes, by building a picture of the wellbeing of residents, which – prevents increased acuity and supports residents to stay in their home where possible.’
”The system works really well, as when a care home staff member want to contact their GP for advice about a resident, they can use the Docobo device to run through a series of question sets which then goes straight through to the GP system (which is integrated with Docobo). This avoids ‘telephone tennis’ which is often recounted by care homes who are constantly trying to get hold of a doctor, and missing a string of phone calls, which can be very frustrating for both sides.’
Rebecca Watson-MorseCommissioning Programme Lead, London Borough of Bexley
Successful results following implementation
Since implementing DOC@HOME at Northbourne Court and other care homes, there have been fewer transfers to more intensive care settings. Care home residents have benefitted from more timely prescription of medicines by the community pharmacist. When comparing the period April to June 2018 (pre-implementation) with April to June 2019 (post-implementation), there were:
36% fewer visits by residents to A&E
The feedback from the care homes and GPs has been fantastic, as was the evaluation with the Health Innovation Network (HIN) South London’s Academic Health Science Network (AHSN). There was also feedback about an increase in staff confidence in supporting residents.
One Senior Care Home Lead says: ‘Sometimes you can spend all day on the phone trying to get through to the surgery, as they’re very busy, but with this, it goes straight to the GP and then I get a response, so it’s much quicker.’
Another Senior Care Home lead says: ‘I’ve been working in care for 35 years and I’ve seen lots of changes over the years, but this equipment is great, it really is, and it saves us time, as you can do it on the move and then get a call back from the GP.’
Next steps
Since the successful implementation at Northbourne Court, DOC@HOME has been rolled out across 15 homes, with two more on track to be onboarded by the end of 2021. In addition, Bexley Clinical Commissioning Group (CCG) is working with Docobo to implement its ARTEMUS risk stratification platform to support population health analytics. This will include predicting residents’ needs and provide a more rounded approach to wellbeing – by providing a better understanding of the healthcare needs of residents.
ARTEMUS currently takes data from GP practices and DOC@HOME to provide relevant information and will soon be incorporating Secondary Uses Service (SUS) healthcare data, adult social services data and other council data.
Going forward, Bexley will be developing new care home question sets including:
• Post falls neuro observations
• Virtual ward rounds and MDT meetings
• Mental Health questionnaires
• Long term condition monitoring
• Wound care
• ECG screening
Rebecca concludes: ‘We have now implemented remote monitoring into 11 care homes and have already supported over 900 individuals using the system. We’ve been able to look at question sets and adjust where we need to. We’re really pleased with the project so far and the success achieved in enhancing care home residents’ care and supporting care home staff and their GP surgeries.’
