Spritely: Nurse Maude trialing telehealth support and monitoring service
Nurse Maude is trialing a remote health support and monitoring service – Hauora Tūhono – that also aims to reduce isolation for older people living in Canterbury. Nurse Maude provides a range of services, including district and specialist nursing, home support services, hospice and community palliative care and allied support.
The initiative has received funding from the Ministry of Health’s Digital Enablement Programme, which provides support for innovation in digital health care. The programme has a particular focus on co-investing in projects that improve access or participation for people who do not access health services and need to. It’s all about improving equity.
The Ministry is working closely with project teams, sharing learning between participating organisations as a community of practice and looking for opportunities to help others learn from these initiatives as they adopt and promote these or similar services elsewhere. The projects are examples of the types of innovation that will be supported by the better access to information enabled by the Hira programme.
Hira will be an ‘ecosystem’ of data and digital services that will enable consumers to access and control their health information through their choice of website or application using a digital device such as a smartphone, tablet or computer. New Zealanders will be more empowered to manage their health, wellbeing and independence. Organisations can work together to share information so that people don’t have to repeat personal details multiple times. Clinicians can harness digital technologies to improve services. The sector and digital innovators can design and contribute innovative data and digital services, making Hira more powerful.
Photo of the Spritely tablet and blood pressure monitor. Hauora Tūhono is based around a simple tablet that connects people to a range of health support and monitoring, in partnership with family and whānau. The tablet uses ‘Spritely’ software, a monitoring and communication package for older people. The pilot will involve 30 older people, who are experiencing isolation and have higher health needs. Each will be involved for six months. The pilot will run for about 18 months in total, including participant recruitment, data collection, evaluation and reporting.
Nurse Maude is partnering with the Te Puawaitanga ki Ōtautahi Trust and the Tangata Atumotu Trust on the project. Each provider will support about 10 people who use their services, to take part.
‘The people we really want to try and connect with are Māori and Pasifika who are disengaged from their primary health provider and have chronic health conditions that are not being addressed,’ says Nurse Maude’s service development manager Karen Jackson.
‘That disengagement could be for a number of reasons which we are hoping to discover more about through this project.’
Annette Finlay, Kaihautū Māori, (Tainui/Te Arawa) noho mātāpono/kaunga (privacy/quality) for Nurse Maude says people who are part of the pilot will be provided with a tablet to help monitor their health conditions, and possibly other bluetooth devices, depending on what those conditions are.
‘For example, they could be a blood pressure monitor or weighing scales. There will be benchmarks for the readings either from their last interaction with their health care provider, such as their GP, or the project nurse will collect baseline information for that person and their condition. The nurse monitors the readings and will also be alerted by the Spritely programme if the readings go outside what is expected. They will contact the person to see how they are doing, discuss whether they need to go and see their GP, or whether they’d like the nurse to visit them.’
The nurse who provides the tablet will ‘walk alongside’ the person, to assess if the tablet is an effective tool for them. The project has ensured the nurse will have sufficient time to spend with people. ‘It will take the time that it takes.’
Project coordinator Gill Coe says Nurse Maude wants to capture participant’s stories, to understand their journey. ‘We want to know why they’re engaging really well, or why they might be pulling out of the project. We are very keen to have this rich background information, rather than just the numbers.’
The tablet will also enable face-time video calls, with the participants able to talk to their whānau / aiga. Initially the nurse may sit with the person while they are on the call.
Karen says they are hoping that in the future these kind of non-face-to-face health check-ins will encourage people to stay well and begin to engage with primary telehealth care services.
‘Another aim is to keep people out of hospital. At the moment we know some people present at emergency departments rather than having an ongoing relationship with a GP to better manage their chronic health conditions.
‘People can be reluctant to leave their home to get appropriate health care as well. This way, they can receive care in the privacy and sanctuary of their own homes, removing barriers related to money and mobility. Or some people may feel intimidated going to the GP because they don’t like it there or it doesn’t feel safe for them.’
If people do not have a GP, efforts will be made to find them one. Where they do have a GP, the project will work closely with them and communicate what is happening for the person.
As part of the pilot, WIFI will be funded for people who do not have access to it.
Karen, Annette and Gill see keeping people engaged and motivated as the biggest challenge ahead.
‘We expect to be constantly tweaking the project as it is rolled out. For example, how can we get this person to stay in the programme, what is it that they don’t like about it? The nurse will get to know all the participants personally, and can give them individual support,’ says Annette.
‘We are aware that for some people, their health will not have been their priority – and that can be confronting. They may have to face facts about their own health for the first time, so they will need support around this.’
Reducing people’s sense of isolation is an important part of the project.
‘As well as connecting people with health services, it’s about giving them another way to connect with their whānau,’ says Gill. ‘The whānau app being developed will enable family to be more involved in the person’s health – for example, a daughter could check in with her mum about her blood pressure readings or check that she’s taken her medication.’
They say the most exciting thing about the project for Nurse Maude is being able to support populations the agency has not always worked closely with in the past.
‘This is enabling us to form stronger alliances with groups like Te Puawaitanga ki Ōtautahi Trust and the Tangata Atumotu Trust, relationships we hope will continue and grow into the future,’ says Karen.
‘The potential is huge. If we get this right it could change a lot of peoples’ lives, but also the way health care is provided in the future. It is really exciting to be involved in something like that.’
The project evaluation will consider:
whether there has been an improvement in quality of life for participants, reduced social isolation, increased confidence in the health system
what participants have used the devices for, and the frequency of use
health outcomes, including reduced hospital admissions, improved engagement with primary care, improved medication compliance, stabilised blood pressure, etc
the resource needed to set up and support users for any ongoing service.