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Telehealth Across the Alps: Supporting Clinical Care Networks

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Dr Michael Sullivan …

Dr Michael Sullivan
Associate Professor of Paediatric Oncology, University of Otago; Consultant Paediatric Haematologist/Oncologist in the Children’s Haematology Oncology Centre, Christchurch Hospital

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  • 1. Telehealth Across the Alps:Supporting Clinical Care NetworksThe WCDHB and CDHB initiative Associate Professor Michael Sullivan FRACP PhD Clinical Leader WCDHB and CDHB Telehealth Initiative HINZ and Telehealth Forum February 22 2012
  • 2. Telehealth SymposiumTelehealth Across the Alps; Supporting clinical networks and sharedcare by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 3. Telehealth Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 4. Telehealth Telehealth The delivery of health care at a distanceby the remote transmission of audio and video and clinical data Telehealth Clinical Networks An enabling technology to ensure equity of access to quality health care services, regardless of where people live; by supporting clinical care, professional development and continuing education
  • 5. Telehealth• “is an enabling technology”• “to support health care across geographic regions”• “for clinical care collaboration ”• “to foster clinical network development• “for planned, prospective and anticipatory care ”• “planned and scheduled clinical meetings and care”• “enhance equity of access to health care”
  • 6. Telehealth• “is not about the technology”• “only succeeds on when human factors are addressed”• “always fails when it’s unsupported”• “does not replace services that don‟t exist”• “Telehealth is an enabling technology”
  • 7. Telehealth Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 8. Principles of child healthcare: “Through the eyes of a child”National Review of Specialist Services for Children (1998-1999) 1. Needs of a child and the family are paramount 2. Equitable of access to specialist care where ever a family might live 3. Specialist care should be as close to home as possible; where safe and of appropriate standard BUT 1. Specialist Skills are inequitably distributed • “Critical mass” • “Centres of excellence” • “Multidisciplinary teams” 2. Enhancing support to regions needed 3. Development of national and regional health care capacity 4. Enhanced national and regional health care capability
  • 9. TelePaediatrics; a brief historyNational Review of Specialist Services for Children (1998-1999)1. Telehealth – need to develop a national network as an “enabling technology” • To support the care of children and families in their home centre • To support the local health care Professionals who provide specialist care • To develop new collaborative networks for professional development, education and research2. Develop “Communities of Interest”3. Building Capability and Capacity for care across health care sectors4. Support education and training for staff recruitment and retention
  • 10. TelePaediatrics; a brief history 1997-2009• Founding partners 1999-2003 • Starship Foundation - sponsorship and funding • Paediatric Society of NZ • 10 District Health Boards• NZ TelePaediatrics Service - a Non Profit independent incorporated society • Governance Board of child health sector representation • Membership; Eric Hienemann (Chair 1999-2000), Michael Sullivan Chair (2000-2009), Tosh Stanley, Phil Weston, Barry Taylor, Pam Jackson, David Montgomery, Jeff Brown, Nick Baker, Karyn Bycroft, Chris Moyes, Roger Tuck, John Garrett, Rosemary Marks, Mollie Wilson, Peter Ross, Brian McMath; Pat Wright (Starship Foundation), Simon Hayden (NZTPS)• Initial launch May 2003 • 10 locations in 10 District Health Boards • Dedicated to Paediatrics and Child Health• “Growth and Development 2005-2009” • completion of a national telemedicine network connecting all DHBs and small centres • multiple parallel non paediatric networks • uniform technology platform • Fully managed service
  • 11. TelePaediatrics; a history 1999-2007 Health and Disability Award for Innovation 2004
  • 12. TelePaediatrics; a brief history 2009-2010 NZTP Trust: Trustee Board established 2009Associate Professor Michael Sullivan( Chair NZTPS 2001-2009), DrRosemary Marks, Karyn Bycroft, Dr Nick Baker, Dr John Garrett, DrRoger Tuck, Mollie Wilson, Peter Ross (Current Chair) and BrianMacMath Vivid Solutions: Board of Directors established 2009 Board: Patricia Wright (Chair), Mark O‟Donnell, Michael Boersen, Simon Hayden (MD), Peter Ross
  • 13. TelePaeds and the Vivid Network• Single integrated IP network• 220 sites• Multiple sub-networks
  • 14. TelePaeds/Vivid - usage• National telemedicine network >3000 hours month• Direct clinical care <20%• Multiple user groups and communities• National medical and nursing workshops• Clinical Grand Rounds• Specialist training • Paediatrics, Mental Health • Surgery • ENT, Plastic Surgery • Microbiology, Pathology • Nursing, Allied Health,• Team-to-team clinical care and outreach• Research and special interest groups• Hospital to home palliative care• Mental Health clinical network• Rural health, GP and education• Northland Specialist Renal network• Administration and human resources• Ministry of Health – all MOH offices across country
  • 15. Current usage• Clinical; Paediatric Oncology, Child and Adolescent Psych consults, Diabetes insulin pump patient/family assessment, Child abuse consults, Specialist nurse advice (tracheostomy, renal care, respiratory, Cystic Fibrosis), Rheumatology Clinics, Immunology Consults, Clinical Consults (Renal, Haem, Oncology, Rheumatology, Immunology, Diabetes etc) Northland Breast Screening• National Broadcasts; Starship Hospital Paediatric Grand Round and Paediatric Update, Paediatric Nurses Grand Round, Infectious Diseases Grand Round, Child and Adolescent Psych Grand Round, Adolescent Health Seminars, Hospital Play Specialists Inservice Training, Visiting Specialists‟ Lectures• Specialist Groups; Paediatric Oncology Group, Genetics, Cardiology, ENT, Audiology, Play Specialists, Paeds Pharmacists, Radiation Technologists, Paedsleep, Physio Special Interest Group, Probiotics Committee, Eating Disorders, Social Workers, RACP and RACS management and special interest groups, Child Protection, DHB Management Groups, HIV Workgroup, Breast Care, Paedsleep, Family Options, Neonatal Physiotherapists, DSAC (Doctors for Sexual Abuse Care), PREDICT (Emergency Management), HIV network• Education; FRACP Training (Paeds & Adult), Specialist Nurse Study Days, Plastic Surgery teaching, Laproscopic Surgery Training, Gynaecology Surgery Training, Community Paediatrics Training, Diploma of Child Health Training, Cardiothoracic Surgery Training, „Brain School‟, Child and Adolescent Psychiatry Advanced Training, Midwifery Training and Continuing Education• Telehealth Solutions; Hospital to Home, Breast Screening, Echo-Cardiography.• Other; District Health Board Management Meetings, International and National Recruitment Interviews, Medical Legal consultations, Safe Kids NZ National launch, Parent to Parent National Launch, Live link to North Pole (Santa). Ministry of Health
  • 16. Telehealth: Supporting Child Cancer ServicesChildren’s Haematology Oncology Centre; Christchurch• One of only two Tertiary Paediatric Haematology Oncology Services in New Zealand • Diagnosis and Treatment for all children of South Island., Wellington and Wairarapa • Population 1.5m • Distance: >1500 km (Christchurch to Invercargill > Wgtn to Ackl, Edinburgh to London)• Centralised specialist service • Critical mass of specialists and associated services • Centralised clinical care centre • Distributed Outreach model • 60% or patients from outside Christchurch metropolitan region • Clinical Outreach: 42 visiting outreach clinics per year• Routine clinical videoconferencing: • Weekly VC to Dunedin, Nelson, Invercargill • 3x weekly VC to Wellington • Multidisciplinary Team-to-team clinical network based care • Discharge planning, ongoing clinical support to home centre, treatment planning, • Hospital to home palliative care • Direct clinical consultation • Nursing education and updates
  • 17. HINZ and Telehealth Forum Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 18. The WCDHB and CDHB Telehealth Initiative Supporting Clinical Networks and shared care by Telehealth Progress Report 2012
  • 19. West Coast Health ServicesPopulation – approx 38 000 • Greymouth 12 000 Grey Base Hospital and GP practices • Westport/Buller 7-8000 Buller Health Centre/GP practice • Reefton 2000 Reefton Health Centre/GP practice • Hokitika 3000 Hokitika Health Centre and GP practices • Haast 300, South Westland Health Centres and rural practices • Fox 900, • Franz 2000, • Whataroa, Hari Hari • Kumara and NgakawauBuller Health and rural practices• Dispersed over 400 km• Geographic barriers within the Coast and across Alps• Unique community related health care needs – occupation based• High participation in physical occupations; farming, mining, adventure tourism
  • 20. West Coast Health ServicesHealth Services – key issues • Fragile and vulnerable specialist services • Paediatrics, O&G, Specialist Medical and Surgical Services, Palliative care, Cancer Care, Primary Care and Emergency Care • Critical mass – for existing specialist services • General and Specialist Surgery • Limited access to external specialist services • Palliative Care, Cancer Care, Specialist Surgical Services, Medical Specialties • Internal geographic barriers – South Westland • Recruitment and retention issues • Access to continuing education – medical, nursing and allied healthHealth Services – key strengths • Highly committed and resourceful • Broad generalist skills – nursing, medical, allied health • Collaborative and willing approach to care • Many unique West Coast solutions
  • 21. Supporting West Coast Health ServicesWCDHB and CDHB Collaboration• Long and established clinical and administrative relationship• Many health services to West Coast provided in part or completely by provided by CDHB based specialists or Christchurch private sector specialists• Need for increased collaboration and support recognised by both DHBs• Joint CEO and shared services agreementClinical collaboration• Clinical networks Strengthen existing networks Develop new clinical care networks• Shared Care develop structured and formalised shared care processes• Support clinical network development by Telehealth
  • 22. WCDHB CDHB Clinical networks and telehealthReference Group – established 2010 Associate Professor Michael Sullivan, Project Leader Bronwyn Petrie, Project Manager, Canterbury Initiative Nigel Millar, CMO, CDHB Mary Gordon, Chief Nurse, CDHB Chris Dever, CIO, CDHB Miles Roper, CIO, WCDHB Wayne Champion, GM Corporate Services WCDHB Vicki Robertson, CMO, WCDHB Carole Atmore, Chief Medical Advisor, WCDHBReporting to: Boards of WCDHB and CDHB David Meates, CEO, CDHB/WCDHB EMT for WCDHB
  • 23. WCDHB CDHB Clinical networks and TelehealthProject Group – established 2010 Associate Professor Michael Sullivan; Project Leader and Clinical Leader Telehealth Bronwyn Petrie; Project Manager, Canterbury Initiative Nicole Redfern; Telehealth Facilitator Bob Ashford; Director, Medical IllustrationsReporting to: GM Medical and Surgical Services Pauline Clark GM Diagnostic and Support Services Trevor English Chief Medical Officer Dr Nigel Millar Chief Nursing Officer Mary Gordon Chief Allied Services Stella Ward CIO Chris Dever and Miles Roper CEO David Meates
  • 24. WCDHB CDHB Clinical Networks and Telehealth Initiative 2010• Feb-March 2010: Evaluation and review of services and needs WCDHB and CDHB• April 2010: Sullivan and Petrie Telehealth Report to CDHB and WCDHB• May 2010: Recommendations reported to WCDHB Board• July 2010: Phased implementation of enhanced telehealth network endorsed Haast meeting Whataroa Clinic
  • 25. WCDHB and CDHB; what’s the problemWCDHB: issues and challenges• Different Clinical Information System to CDHB; CIS, PACS, Laboratory Systems• Very limited network capacity and legacy videoconferencing equipment• Paediatrics: no resident Paediatrican and fragile after hours support• Palliative Care: no dedicated palliative care service• Medical Oncology: improved support needed for cancer care and chemotherapy• O&G and midwifery: fragile clinical service and need for midwifery education• Rural Health: long distances and limited access to specialist advice• Health Care of Elderly: no specific service• Emergency services: limited support• Limited access to many Specialist Medical and Surgical Services• Limited access to medical and nursing professional development and CME
  • 26. Telehealth Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 27. WCDHB CDHB Telehealth Initiative 2010-2012 Progress Report1. Clinical Information systems and Network Capacity • Harmonisation of Clinical Information Systems (CIS) commenced • Universal secure access to Clinical Information Systems across both WCDHB and CDHB • Increased Network Capacity increased across Alps 50 x • Enhanced Network capacity to specific locations – Buller, Haast, and other South Westland sites
  • 28. WCDHB CDHB TeleHealth Initiative 2010-12 Progress Report2. Upgrading and installation of additional Telehealth equipment • New and multiple additional high definition systems installed • Grey base Hospital - 8 locations • Buller Hospital Westport – 3 locations, • Reefton Hospital • Hokitika Health Care • South Westland: Haast, Franz, Fox, Whataroa, Hari Hari • North Westland: Karamea, Ngakawua
  • 29. WCDHB CDHB TeleHealth Initiative 2010-2012 Progress Report3. TeleHealth Facilitator proposal July 2010 (appointed 2011 Nicole Redfern) • Identified need for Telehealth Facilitator role in Evaluation report • Proposal submitted to Health Work Force New Zealand July 2010 • Support Clinical Care • Support and co-ordinate ongoing education • Technical interface • CDHB and WCDHB
  • 30. WCDHB CDHB TeleHealth Initiative 2011 Progress Report4. Paediatrics and Child Health Network (Dr John Garrett) Desktop VC Christchurch Paediatrican Office • Clinical Network proposal completed • Clinical Network meeting for Sept 2010 • New High Definition videoconference unit installed and commissioned August 2010 • Mobile Telehealth Cart deployed in Grey Hospital (wireless Polycom) • Virtual Daily Ward Rounds commenced with Christchurch based Liaison Paediatrican Sept 2010 • Semi-urgent distant consultations and clinical advice • Virtual Specialist Clinics; Christchurch to West Coast commended October 2010 • Acute Neonatal assessments and advice – planned equipment upgrade • Continuing professional support for nursing and junior medical staff • Nursing and junior medical education
  • 31. WCDHB CDHB TeleHealth Initiative Progress Report 2010-20125. Obstetrics and Midwifery Network (Dr Mary Oliver and team) • Clinical Network proposal completed 2010 • Clinical Governance processes commenced 2010 and continues • Completed evaluation of technical requirements 2010 • High definition telepresence units for Christchurch Women‟s Hospital installed Feb 2011 • Midwifery education workshops from Christchurch Women‟s Hospital commenced August 2010 • Virtual whole day education workshops from Christchurch attended by Grey Base and Buller Midwives • Routine broadcast of further whole day workshops 2011 -2012 • Semi-urgent distant consultations and clinical advice for high risk obstetrics • Continuing professional support • Nursing and junior medical education
  • 32. WCDHB CDHB TeleHealth Initiative Progress Report 2010-126. Cancer Care Medical and Paediatric Oncology Services CDHB/WCDHB, Network (Dr Mark Jeffery) • No Cancer Specialists resident of West Coast • Paediatric Oncology – fortnightly videoconferencing to support care of child cancer patients and families • CDHB Medical Oncology services provide fortnightly visiting clinics in Medical and Radiation Oncology • Medical Oncology participated in Buller/Greymouth Telepresence evaluation • Clinical Network proposal completed and technical specifications identified 2010 • Installation of additional videoconferencing equipment into Christchurch Cancer Centre; clinical office , meeting room, and family room 2011. • Commenced direct clinical consultations and on therapy assessments from Christchurch to West Coast, commenced 2011 • Routine Clinical are, team-to-team care, continuing medical and nursing education • Christchurch Oncology Conference centre and installation of dual high definition real time videoconferencing of radiology and histopathology for multidisciplinary cancer case:Southern Cancer Network
  • 33. WCDHB CDHB TeleHealth Initiative Progress Report 2010-20127. Palliative Care WCDHB, CDHB, Nurse Maude Community Services Network (Dr Amanda Landers) • No palliative care Specialist resident of West Coast • Nurse Maude has MOH contract to support community palliative care to WCDHB • Community Care Palliative care Physician appointed early 2011 • Meeting Nurse Maude August 2010 – Jim Magee (CEO), Dr Sandy Macleod and Dr Amanda Landers • Clinical Network proposal completed and shared care agreement planned • Nurse Maude installation of videoconference facility in Christchurch linked via CDHB fast network • Direct clinical consultation, support and advice to commence following installation commenced 2011 • Enhanced network capacity to Nurse Maude to enable access to CIS CDHB And WCDHB completed
  • 34. WCDHB CDHB TeleHealth Initiative Progress Report 2010-20128. South Westland Rural Health Network (Dr Martin London) • Evaluation of needs for Rural Health Clinics: Haast, Fox, Franz, Whataroa, Hari Hari August 2010 • Network proposal completed and installed • Real time videoconferencing into each rural health clinic in South Westland completed (Haast, Fox, Whataroa, Hari Hari heath clinics; Real time High definition videoconferencing with content sharing installation completed June 2011) • Support for direct clinical care of rural health nurse specialists and rural GP to Greymouth and Christchurch • Enhance access to continuing education • Support professional supervision and development • Direct clinical consultation, support and advice to commence following installation • Shared videoconference installation into new Franz Health Clinic commissioned 2011 • Haast rural health clinic; satellite network tested, QoS video/audio and Citrix network access to WCDHB Information systems
  • 35. WCDHB CDHB TeleHealth Initiative 2011 Progress Report9. Emergency and Acute Medical Care (WCDHB AND CDHB ED departments) • Proposal completed • Recommend installation of wireless mobile Practitioner Cart into Grey Base completed 2011 • Use for ED, Newborn, ICU/CCU, Children‟s Ward • Direct Buller to Grey Base emergency assessments possible • Recommend development of enhanced clinical network with ED CDHB; staff resourcing needed • Commenced broadcast ED education meetings to WCDHB, Timaru, Ashburton 2012 • Direct clinical consultation, support and advice no possible • Professional support and education
  • 36. WCDHB CDHB TeleHealth Initiative Progress Report 2010-201210. Continuing Medical Nursing and Allied Health Education (Nicole Redfern) • Telehealth Facilitator co-ordinates access to CDHB continuing education • Access to CDHB Grand Rounds and Winter Lectures Series commenced 2011 • Access for West Coast Physicians, Surgical, Mental health CME from Christchurch • Support RMO staff for ongoing PGY1/2 education • Real time videoconferencing and Store and Forward for recoding of education sessions and later webcasting (medical Illustration) • Recommend complete evaluation of clinical use • Phase out CSICO technology and switch over to existing enhanced VSL platform • Develop specific clinical protocols for direct clinical care.
  • 37. WCDHB CDHB TeleHealth Initiative Progress Report 2010-201211. RuFUS (Rural Focused Urban Specialists Dr Martin London) • Designated clinicians in specific urban services providing clinical leadership and links to rural centre • Understand resources and skills in rural regions • Support direct clinical care • Support continuing professional development and education • Co-ordinate urban service provision for rural patients • Supported by TeleHealth • Dr John Garrett; Paediatrics • Dr Mark Jeffery; Medical Oncology • Dr Amadna Landers; Palliative care • Dr Jackie Broadbent; Health Care of Elderly
  • 38. WCDHB CDHB TeleHealth Initiative Progress Report 2010-201212. New Initiatives for 2012 • Health Care of Elderly; clinical network supported by telehealth • Telehealth clinical consultation rooms; Christchurch, Greymouth and Westport • Specific clinically appropriate room for specialist consultation • HD VC, PSCS, Clinical Information systems • Planned and booked clinics • Medical Specialties; respiratory, cardiac, renal, neurology, • Surgical specialties • Mental health • Discharge planning and follow up • Burwood, Ashburton, PMH units installed for clinical care ad administrative support • IDFs!
  • 39. Telehealth Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 40. Clinical Networks• Clinical Management Network• Clinical Care Network• Shared Care Network
  • 41. Clinical Management NetworksClinical Management Networks • Support Specific Health Services across geographic regions • Paediatrics, Obstetrics, Rural Health, Specialist services, Surgical Services • Collaborative service development and management • Collaborative clinical governance • Clinical care agreements • Professional supervision and support
  • 42. Clinical Care NetworksClinical Care Networks • Collaborative clinical care across geographic regions • Service specific; Paediatrics, Palliative care, Medical Oncology, etc • Peer-to-peer consultation and collaboration • Specialist to specialist, nurse to nurse, allied health • Clinical care for patients across a region regardless of where they live • Clinical Conferences and Multidisciplinary Team meeting • Clinical education and audit • Clinical Network Agreements
  • 43. Shared Care NetworkShared Care Networks • Shared clinical collaboration for patients across a region • Differential clinical scope and responsibilities • Collaborative clinical care across geographic regions • Specialist to Generalist, Physician to nurse etc • Christchurch Paediatrician to Grey Base RMO and Nursing • Delegated levels of care • Support Clinical education • Shared Care Agreement
  • 44. Telehealth Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 45. Some Principles of TelehealthSome Principles: clinical networks and telehealth 1. Quality of Care: not a replacement for non existent service 2. Capability development: enhance local care skills 3. Capacity development: develop the capacity of local service 4. Communities of interest: fosters development of health care networks 5. Symmetry of need and purpose: shared responsibility is crucial 6. Isolation barriers: overcome isolation for patients and health professionals 7. Enhanced professional development and education 8. Human factors fill gaps and enhance quality • Even where data, audio and video quality are suboptimal, • Human factors; clinical experience, data interpolation and fuzzy logic • Compensate for the limits of technology • Otherwise known as good clinical judgment
  • 46. Telehealth Symposium Supporting clinical networks and shared care by telehealth1. What’s Telehealth and why2. TelePaediatrics: a brief history of a national telehealth network3. The West Coast; what’s the problem4. Defining Clinical care networks and telehealth5. The West Coast and Canterbury Telehealth Initiative; solutions6. Some Principles of telehealth7. Putting telehealth into Practice
  • 47. Telehealth PracticePutting Telehealth into your practiceDo you? • Provide or participate in specialist care at a distance • Provide or participate in “shared care” • Provide a specialist or subspecialist service to patients at a distanceNetwork and Shared Clinical Care • Shared care - a single clinical care environment across geographic locations • Care beyond the “consultative” - ie traditional “phone consultation to single specialist led service” • Multidisciplinary care and multi-location care • Sustain and supporting longitudinal care for serious chronic and complex health needs • Notion of collective care; active and transparent networks beyond informal care
  • 48. Putting it into telehealth into PracticeIn practice: telehealth and clinical network• Use simple, robust and reliable technology; Vivid and Poltycom• Proximity to the clinical work environment is crucial - 50 m rule• Remove cost barriers and incentivize• Actively manage the telehealth service and the clinical network• Co-ordination of clinical care essential for sustained telehealth networks• Co-ordination of the content and delivery of education enhances capacity building• Integration within existing specialist services; part of routine clinical care• Identify classes of clinical encounter suitable for Telehealth• Security of technology and data important but is not a barrier to use• Medicolegalnot a barrier; but responsibility for clinical care must be clear.
  • 49. Putting it into telehealth into PracticePutting Telemedicine into your clinical networkPersonnel and work practice for successful telemedicine and network support • Integrate distance care and shared care into your specific clinical service • Develop acute and non acute telemedicine networks • Clinical network agreements • Shared Care agreements • Multi-disciplinary meetings • Team-to-team consultation for regional patient practice groups • Develop designated virtual telehealth clinics • Nurse led telehealth clinics - ie diabetes, cancer care, renal medicine, wound care, burns, palliative care • Allied health support; dietetics, physiotherapy, rehabilitative therapists
  • 50. Supporting clinical networks by TelehealthClinical care networks and telehealth • Quality of Care; quality needs support and active management • Communities of interest; develop and build professional networks • Continuing medical and nursing workforce development • Asymmetry of need; integration of telehealth into specific services • and “bottom up” clinical networks • Identify “clinical leaders and early adopters” • Pragmatic outcomes - just do it • Beware of “adopter fatigue” • Quality of service - video, audio, easy of use • PilotitisEvidence suggests “clinical leadership” is the defining component for the adoption of telemedicine and the successful development of sustained clinical networks
  • 51. Putting it into telehealth into Practice The Practice: clinical networks and telehealth Telehealth is about “human interaction” and “the content” It is NOT about “the technology” Telehealth only succeeds when barriers are addressed and overcome human factors service barriersFailure to address barriers = telehealth failure (technology gets the blame!)
  • 52. Clinical Networks and TelehealthTelehealthSynchronous: Real time videoconferencingAsynchronous: Store and ForwardTelemedicine services: • Formal managed clinical service focused • Informal unmanaged, • Informal networking
  • 53. Telehealth - real time videoconferencingSimultaneous transmission of video, audio and or data • Synchronous • Dedicated videoconferencing systems • Point-to-point • Multipoint • preplanned and scheduled clinical encounters • Fixed locations • Collaborative; team-to-team • “unlike the phone - person-to-person • Non verbal cues and body language • Standard definition = Videoconferencing • High definition = Telepresence
  • 54. Telemedicine - real time videoconferencingDirect clinical care • Acute clinical care - ED, Paediatrics, Newborn • Consultative clinical care - palliative care, cancer care • Medical surgical specialties, allied healthClinical network and shared careShared care: team-to-teamDiagnostics; real time diagnosis, tele-echocardiographyEducation • Continuing medical and nursing education • Postgraduate education • Specialist education - intra-operativeAdministration and governance, professional supervision and support
  • 55. Telehealth - Store and ForwardAsynchronous or delayed transmission of data, video • None acute clinical care and specialist consultation • Data acquired at the distant site • Uploaded to secure clinical information system • Elective data review/interpretation and opinion at referral centre • Clinical diagnoses and opinions ENT and Eyes • Pathology review and opinions • Radiology - distant consultation and review
  • 56. Telehealth - Real time vs Store and ForwardReal-time Store and Forward• Simultaneous transmission of video, audio and or • Asynchronous delayed transmission of data, video data -synchronous • Anytime - no scheduled meetings• Dedicated videoconferencing equipment • Narrow bandwidth, requires broadband internet• Minimum broad bandwidth for effective access only communication - 512k - 1Meg • Network infrastructure not required• Scheduled meeting times • Specific web interface preferred• Direct and immediate personal communication • No direct clinical contact possible between health care providers • No immediate emergency assessment possible• Direct patient contact • Minimal interpersonal contact between health• Direct clinical assessment care providers• Collaborative • Person-to-person• Supports multidisciplinary care • Non collaborative• Team-to-team