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       #Post#: 178--------------------------------------------------
       Barriers to implementation of Remote Monitoring of cardiac devic
       es service?
       By: admini5 Date: May 13, 2015, 6:10 am
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       Patients
       Perceptions of remote monitoring:
       -
       downloads could reinforce the perceptions of patients that they
       are ‘ill’ and in those who are most anxious
       conventional follow-up could occur.
       -
       them and give informed consent for remote monitoring. At
       Sandwell and West Birmingham NHS trust, patients are made aware
       of remote monitoring at support groups or conventional follow-up
       appointments and are recommended for remote care by cardiac
       physiologists.
       Staff
       Liability concerns about timeliness of dealing with incoming
       information:
       Alert follow-ups:
       -
       them according to service provision.
       Resistance to change in cultures and behaviours:
       -
       services to allow rapid change.
       Lack of clinical champions:
       -
       sharing of practice should occur from other institutions –
       even from outside the region.
       Institutions
       Define what proportion of remote care replaces or supplements
       outpatient activity.
       Institutional inertia: slow sign-off of legal documents and
       contracts with industry:
       -
       -
       collaboratively – perhaps using the Association of British
       Healthcare Industries as a catalyst.
       Communication with patients and GPs:
       -
       more efficient communication than sending letters.
       Recurrent costs
       Costs of remote monitoring are hidden: How will costs of
       continued remote monitoring downloads, server time and
       transmission be covered recurrently?
       Financial
       The cost of consultant input for bradycardia and implantable
       loop recorder follow-up is not stipulated in tariffs and
       therefore many institutions charge the rate for consultant
       follow-up if device follow-up is not within a block contract:
       -
       contribution costed into follow-up appointments and therefore
       tariffs need to be more sophisticated to reflect what actually
       occurs.
       -
       traditional follow-up appointment if sophisticated tariffs do
       not exist and this will incur a cost pressure. If separate
       tariffs for physiologist- and consultant-led follow-up are
       produced, the relative utilisation of each tariff and the
       conversion from physiologist- to consultant-led follow-up can be
       audited. This will identify any variation between providers and
       share any learning that improves quality and outcomes as well as
       demonstrating the extent of standardisation in
       implementation/approach amongst providers.
       -
       The one single significant barrier in the NHS is the inability
       of current tariffs to incentivise providers to undertake remote
       monitoring because it reduces income to acute trusts. By
       adopting innovative mechanisms such as gain sharing, the NHS
       could save money and improve quality as a whole, with
       commissioners and providers releasing fiscal and manpower
       resources, and patients benefiting from improved outcomes.
       For further information, please go to :
  HTML https://arms.evidence.nhs.uk/resources/qipp/617474/attachment
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