The evidence is mounting on the impact of digital home care solutions. These include hospital-equivalent care at home for acute conditions that is tech enabled and ongoing remote monitoring solutions for long term conditions. These are being advanced by health systems across the globe with fascinating results.
Digital Home Care solutions are scaling around the world and I have been fortunate to be able to share thoughts with many leaders of this work globally and to visit a wide number of centres, most recently in Singapore. It is terrific to see the evidence mounting for them across the world and there is so much activity underway that this doesn’t attempt to be a comprehensive summary but are some interesting recent examples that have caught my eye.
First a word or two on me. Having spent my career in leadership roles in healthcare, I came to digital home care when I was Chief Digital Officer for the NHS in England, during the Covid pandemic. I am proud of the advances we were able to achieve together, in establishing a national network of tech-enabled Virtual Wards. Initially, as part of the Covid response and then later covering a much wider range of clinical conditions, with an emphasis on keeping people at home and out of hospital as far as possible.
The growth in England was from a standing start as four years ago there was effectively no digital home care within the NHS in England. Today, around 10,000 people will have woken up in their own bed receiving hospital level care at home, delivered by the NHS. Those beds roughly equate to building 20 new hospitals or a 10% increase in bed stock, so it is significant.
It’s been a huge shift for the NHS and now every part of the country, we call them Integrated Care Systems or ICSs, has their own Virtual Ward provision. The clinical conditions supported at home now cover a broad range including respiratory and cardiac conditions, such as acute respiratory conditions, COPD and heart failure, frailty, acute issues such as cellulitis or needing IV antibiotics, services for children and young people such as supporting children post brain tumour surgery at home, maternity with conditions such as pre-eclampsia managed at home with remote monitoring, and post surgery enabling earlier discharge for major operations such as knee replacement.
But we have done this on the shoulders of other countries.
Denmark has been a pioneer in this area and is currently going further than any other country in its commitment to provide remote monitoring to every citizen with severe COPD. Having piloted the service in 11 municipalities it began rolling out to all 98 in 2024, and is a model for other countries to follow, in my view.
France has been undertaking remote monitoring at some scale in a range of conditions for many years, with some sites beginning as early as 2007. It has also put in place the clearest reimbursement system in Europe for digital home care.
At a conference In Nantes, France, recently I heard impressive results of a very large real world study that looked at the outcomes across almost 200k patients on providing remote monitoring (RM) to those with Heart Failure compared to standard care. Alongside many benefits in the cohort receiving RM support, the one that stood out most starkly were the significant survival benefits. There was a 35% lower risk of death in the home monitored cohort. At the link is a video with the lead investigator Prof Nicolas Girerd explaining the findings -
To see that those participating in the RM programme survived longer than those in the control group - the control group receiving what is current standard of care - is a new result. Interestingly, compliance clearly matters, while all in the RM programme had survival benefits, in Nantes we heard that these were strongest of all in the “heavy users of RM”.
Singapore has modelled their virtual ward service known as Mobile Inpatient Care at Home or MIC@Home on the UK’s approach and now has provision across the country. Beginning in 2022, MIC@Home is now available to patients across the three health clusters in Singapore using an innovative chat bot to remind patients to track their vital signs when at home.
Ireland opened its first tech enabled virtual wards in July 2024 in Dublin and Limerick and has ambitious plans to reach all significant clinical settings with the model within 18 months. If successful, that would be the most rapid scale we have seen across a country ever.
Their strapline is “the care of hospital, the comfort of home”
I visited Riyadh last year to learn more about what they were advancing and to speak at their major conference dedicated to Telecare. Within the Kingdom they have the Seha Virtual Hospital which has recently been officially recognised by the Guinness World Records as the largest virtual healthcare provider in the world.
Launched in February 2022 as the first of its kind in the Middle East, the SEHA service supports 130 hospitals around the Kingdomit has supported 58,000 patients so far. With 75 physicians, over 30 specialised services are provided, such as emergency consultations including strokes, daily critical care tours; specialist clinics for blood diseases, psychiatry, kidney disease, endocrinology and diabetes, genetic and metabolic diseases, geriatric diseases, medical rehabilitation, and heart disease; medical support services on virtual rays, pathology, pharmacy services and home care services. It is building capacity to treat over 400k patients a year.
“Seha Virtual Hospital is part of a broader trend towards digital health and telemedicine services in the Middle East, which is driven by the need to address challenges such as chronic diseases, aging populations, and limited healthcare resources,” Nacer Mami, the MENASA Regional Lead for the Jameel Clinic AI Hospital Network at the MIT Jameel Clinic.
New Zealand has undertaken extensive work in telehealth for many years, in particular to better reach remote communities. They also have some interesting economic modelling of the impact of scaling up RM across Long Term Conditions with savings at the 20 million dollars mark estimated for full rollout.
There are many examples across America and here are a few interesting ones.
I visited Intermountain healthcare some years ago as part of a study tour we led for South London health leader colleagues. The organisation is renowned for providing services that achieve some of the best results in the country, in a very cost effective manner, by systematising best practice and reducing unwarranted variation. I left impressed, so it is great to see it now has a very significant virtual hospital provision.
The Virtual Hospital at Intermountain has a comprehensive offer of over 50 individual clinical services spanning neonatal through adult, and direct-to-consumer through critical care. Intermountain Telecritical Care which covers 280 ICU beds across 18 hospitals.
One of the challenges of a shift to digital home care is ensuring our clinical staff feel clinically confident in the new model and I feel the Chief Medical Officer at Intermountain puts this really well -
“When patients come to one of our services with a clinical challenge, we want to meet that challenge with the right capability. We want all clinical leaders to be so capable and fluent in telehealth that when they're solving clinical problems, it's part of their toolkit."
Dr. Bill Beninati CMO Virtual Hospital Intermountain Healthcare
From an initial pilot of 50 patients in 2015 to today, Mercy Virtual care remote patient monitoring programme has grown significantly. Mercy Virtual has a large medical team with over 300 clinicians who use technologies to “see” and treat 600,000 patients wherever they are; which could be a hospital, a doctor’s office, or at home, across a large geography including the states of Arkansas, Kansas, Missouri, North Carolina, Oklahoma, Pennsylvania, and South Carolina. Of this population, 60.5% is between the ages of 70-89 and 84% is between the ages of 60-89, which represents the largest number of enrollees; and overall, 56% are female and 42% are male.
Mercy has also done a good job of tracking benefits including
● Doubling patients served without increasing clinical headcount
● Reduced cost per patient - from $750/pmpm to $300/pmpm
● Established a high patient satisfaction score NPS 86%
● Major reduction in hospitalisations of 50%
For more detail see this article in Health Care IT News
Work in Michigan reporting just last month demonstrates improved hypertension scores in a rural cohort provided with RM:
“The outcomes McKenzie providers saw were also impactful. For all patients enrolled in the pilot for six months, those who were monitoring their blood pressure and were uncontrolled at the start of the pilot saw a meaningful average reduction of systolic blood pressure of 27 mmHg and a diastolic reduction of 11 mmHg. For those managing their own blood glucose, the pilot saw a similar positive trend with an average reduction in blood glucose readings of 25 mg/dL.McKenzie Health System will continue to offer a remote monitoring program to patients expanding beyond the Medicare population that the pilot targeted.” Michigan US Nov 24
Across the world, health systems have their differences but are all facing the same challenges: rising ageing populations, challenges in finding the clinical workforce, changing patterns of disease meaning LTCs are the principle conditions, shifts in public expectations alongside increasing costs.
In this context tech-enabled care at home seems to be an idea whose time really has come, and has huge potential to scale as the mainstream way of delivering care to those with LTCs and acute health care needs, from the comfort of home.
I hope that this summary of some of the latest developments and results on digital home care across the globe helps you in the work you are doing and encourages greater scale of the model.
Highlights:
https://www.regioner.dk/services/nyheder/2023/november/foerste-landsdaekkende-telemedicinloesning-forbedrer-livet-med-kol/
https://www.cfrjournal.com/video-index/hfa-24-remote-patient-monitoring-patients-heart-failure-telesat
https://moht.com.sg/mic-home/
https://www.hse.ie/eng/about/who/strategic-programmes-office-overview/national-virtual-ward-programme/virtual-ward-service.pdf
https://www.moh.gov.sa/en/Ministry/Projects/Documents/Seha-Virtual-Hospital.pdf
https://www.linkedin.com/pulse/what-holding-us-back-from-realising-benefits-remote-nz-braatvedt-lc9pe?utm_source=share&utm_medium=member_ios&utm_campaign=share_via
https://www.ey.com/en_cn/insights/health/how-virtual-and-in-person-care-merge-for-a-healthier-and-more-sustainable-future
https://www.healthcareitnews.com/news/mercy-virtual-care-center-deep-dive-virtual-hospital
https://www.mercy.net/service/virtual-care/
https://www.secondwavemedia.com/rural-innovation-exchange/features/remotepatientmonitoring.aspx
Tara is an authority on tech enabled home health care models, and their potential to transform care globally, having worked as Chief Digital Officer for the NHS and undertaking two Chief Executive roles in health care in London. She now runs Digital Care supporting health systems and tech innovators to scale this model.
