• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Tele-GESCHN_submission_2003-2004.doc
 

Tele-GESCHN_submission_2003-2004.doc

on

  • 850 views

 

Statistics

Views

Total Views
850
Views on SlideShare
850
Embed Views
0

Actions

Likes
0
Downloads
1
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft Word

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Tele-GESCHN_submission_2003-2004.doc Tele-GESCHN_submission_2003-2004.doc Document Transcript

    • SEH – TeleHealth Submission 2003/04 South Eastern Sydney Area Health Service Supporting Rural Child Health Services in the Greater Eastern & Southern NSW Child Health Network Submission for NSW Health Innovations Fund TeleHealth 2003-2004 telegeschnsubmission20032004doc382.doc Page 1
    • SEH – TeleHealth Submission 2003/04 1. PROJECT DETAILS Project title and aim: SUPPORTING RURAL CHILD HEALTH SERVICES IN THE GREATER EASTERN & SOUTHERN NSW CHILD HEALTH NETWORK: DEVELOPING A MODEL FOR CLINICAL NETWORKING IN PAEDIATRIC SHARED CARE AND PAEDIATRIC EMERGENCY The Greater Eastern & Southern NSW Child Health Network (GESCHN) is an alliance of 8 NSW Area Health Services and the ACT with the Sydney Children’s Hospital. It’s objective is to provide equity of access and a standardised quality of care to consumers of child health services in NSW, ie to children and their families. The primary focus in achieving this objective is the support of the providers of child health services, both clinically and educationally. Aim This project aims to improve access and quality of paediatric health service delivery to consumers through the support of clinicians and by strengthening partnerships between Network hospitals. Priority will be given to supporting shared care arrangements in Oncology, HIV and Spina Bifida, and to improving paediatric care in Emergency Departments throughout the GESCHN. The project will also develop and expand on existing Telemedicine services in Cardiology, Medical Genetics and Brain Injury Rehabilitation. Objectives The objectives of this program are to: • Provide a service to the local communities in rural and remote areas by improving access to a large network of healthcare services including tertiary paediatric care, with specific emphasis on Paediatric Oncology, HIV and Spina Bifida. • Develop and expand on existing Telemedicine services to local communities in rural and remote areas in Paediatric Cardiology, Medical Genetics and Brain Injury Rehabilitation. • Support the family unit by decreasing the need for separation through transfer to metropolitan services and through early discharge to local health care services, so that patients can be managed closer to home. • Establish appropriate links between health care providers to improve consumer access to appropriate healthcare services, with minimal distress to the child and family, both emotionally and financially. • Facilitate Sydney Children’s Hospital’s role in the GESCHN as being the support institution for paediatric services in 8 Area Health Services and over more than one third of NSW. • Support rural and remote medical, nursing and allied health care professionals through the provision of case discussions and interactive workshops that will improve the standard of care provided to their local community and decrease practitioner isolation. • Enhance partnerships between Network hospitals and standardise the quality of paediatric health care in emergency departments by facilitating the implementation of locally adapted Clinical Practice Guidelines for paediatric emergency presentations. • Exchange clinical information and evaluate current practices in order to maximize best practice in paediatric shared care, with particular emphasis on oncology, HIV, spina bifida, cardiology and medical genetics. • Enhance the quality and content of education, training and support for rural and regional centres, with particular emphasis on paediatric emergency care. It is proposed that a model for clinical care and networking using Telehealth be established and integrated with existing usage and evaluated using both qualitative and telegeschnsubmission20032004doc382.doc Page 2
    • SEH – TeleHealth Submission 2003/04 quantitative research methods, and that this model could be replicated by other Paediatric or Statewide Services. The project would require the employment of a designated Project Officer to ensure the facility is utilised appropriately, to it’s fullest potential and in a timely manner, and to be responsible for the documentation and evaluation of the project. Identify the proposed service and specify the type of proposed service. Type of Service Specify Expansion of an established TeleHealth service? Yes Enhancement of an established clinical network? Yes Development of an innovative TeleHealth model or service? For example seeking funding to research and pilot an original Yes TeleHealth service Other TeleHealth application? Please specify Yes / No Submission Author/s: Clinical Sponsor the senior clinician responsible for overseeing the proposed service Name of Clinical Sponsor Dr Richard Cohn Position Chair, Telehealth Steering Committee, Sydney Children’s Hospital Unit / Ward / Department Centre for Children’s Cancer and Blood Disorders Hospital / Health Facility Sydney Children’s Hospital Address High St, Randwick NSW 2031 Telephone 02 9382 1730 Fax 02 9382 1789 Email Cohnr@sesahs.nsw.gov.au Project Manager the person responsible for the management and coordination of the project Name of Project Manager Judith Lissing Position Coordinator, Greater Eastern & Southern Child Health Network Unit / Ward / Department Executive Unit Hospital / Health Facility Sydney Children’s Hospital Address High St, Randwick NSW 2031 Telephone 02 9382 1686 Fax 02 9382 1777 Email Lissingj@sesahs.nsw.gov.au Provide proposed site details in order of priority. If there are more than three proposed sites, please add details. The on-site coordinator is the person responsible for the day-to-day management of that TeleHealth site. Service Provider/s: Name of facility Sydney Children’s Hospital Postal Address High St, Randwick NSW 2031 Street Address As above Name of on-site coordinator Andrew Gadow Position of on-site coordinator Audio-visual technician (part-time) telegeschnsubmission20032004doc382.doc Page 3
    • SEH – TeleHealth Submission 2003/04 Telephone 9382 1640 Fax Email Gadowa@sesahs.nsw.gov.au Existing TeleHealth site Yes yes/no Service Recipients: Name of facility (1) Dubbo Base Hospital Postal Address Street Address Name of on-site coordinator Dr Stephen Pryde Position of on-site coordinator Telephone 6884 1473 Fax Email prydesd@yahoo.com.au Existing TeleHealth site Yes yes/no Name of facility (2) Wagga Wagga Base Hospital Postal Address Street Address Name of on-site coordinator Dr John Preddy Position of on-site coordinator Telephone 69250210 Fax Email jspreddy@tpgi.com.au Existing TeleHealth site Yes yes/no Name of facility (3) The Canberra Hospital Postal Address Street Address Name of on-site coordinator Professor Graham Reynolds Position of on-site coordinator Telephone 6244 3259 Fax Email Graham.Reynolds@act.gov.au Existing TeleHealth site Yes yes/no Name of facility (4) School of Rural Health, University of NSW Postal Address Street Address Albury Name of on-site coordinator Position of on-site coordinator Telephone Fax Email Existing TeleHealth site Yes yes/no Name of facility (5) School of Rural Health, University of NSW telegeschnsubmission20032004doc382.doc Page 4
    • SEH – TeleHealth Submission 2003/04 Postal Address Street Address Griffith Name of on-site coordinator Position of on-site coordinator Telephone Fax Email Existing TeleHealth site Yes yes/no Name of facility (6) Goulburn Hospital Postal Address Street Address Name of on-site coordinator Dr Kerrie MacDonald Position of on-site coordinator Telephone 4822 3544 Fax Email Existing TeleHealth site Yes yes/no Name of facility (7) Shoalhaven Hospital Postal Address Street Address Name of on-site coordinator Position of on-site coordinator Telephone Fax Email Existing TeleHealth site Yes yes/no Name of facility (8) Wollongong Hospital Postal Address Street Address Name of on-site coordinator Dr Allan James Position of on-site coordinator Telephone 02 4229 8993 Fax Email jamesa@iahs.nsw.gov.au Existing TeleHealth site Yes yes/no telegeschnsubmission20032004doc382.doc Page 5
    • SEH – TeleHealth Submission 2003/04 2. PROPOSED TELEHEALTH PROJECT OUTLINE Provide details of: The NSW Child Health Networks emerged from a NSW Health initiative to formalise the informal networks that have long been a part of paediatric care. It is an unfortunate reality that rural and regional families often travel long distances for their paediatric care and there is constant tension between quality and access priorities. Despite a weighted population-based formula for health funding, rural and peripheral metropolitan areas experience health inequities and workforce limitations. Even within metropolitan Sydney parents may drive past local hospitals to take their children to a tertiary facility. As part of the process of establishing and consolidating professional relationships and ascertaining needs of clinicians in the GESCHN, a needs analysis in the form of a Network-wide workshop was held in May 2002, and the following priorities were identified: - Workforce issues, including recruitment/retention, paediatric credentialling, skills & experience - Continuing education and training, especially in rural areas - Communication - inadequate IT in some facilities, email inaccessible to many clinicians - Quality & Safety - minimum standards of care, Clinical Practice Guidelines - Resources, equity of access to quality care Most of these priorities relate to the providers, not the consumers of child health services. In other words, GESCHN partners identified that by appropriately and adequately supporting service providers, consumers would ultimately benefit. These providers require ongoing training and clinical support, particularly in paediatric emergency care. Furthermore, the provision of ongoing training to clinicians in rural regions encourages the retention of quality staff. It is envisaged that there will be 2 major mechanisms of implementation: 1. Clinical Support in Conditions Requiring Ongoing Shared Care: As a tertiary paediatric facility, sub-specialty expertise is centralised at Sydney Children’s Hospital. Appropriate paediatric care away from this facility can only be delivered in certain conditions via a partnership between the specialised tertiary centre and the local facility. This partnership includes continuing communication between the treating clinicians by a variety of means including videoconferencing. In this way local clinicians are empowered and the need for families to travel for continuing treatment of their child’s condition is reduced. In particular, case conferences to optimize shared-care arrangements will be targeted, especially families and clinicians requiring support in the sub-specialities of Oncology, Cardiology, HIV, Spina Bifida and Medical Genetics. Current Clinical Service: The Sydney Children’s Hospital has an extensive outreach program in many subspecialties which includes outreach clinics by staff-specialists and outreach to rural areas by Clinical Nurse Consultants. In fact, in some sub-specialities 60% or more of patients referred to Sydney Children’s Hospital come from outside Greater Metropolitan Sydney. Since 1999 this outreach has been augmented in some sub- specialities (eg Oncology, medical genetics, HIV, and Brain Injury Rehabilitation Program) by Telehealth to improve quality and continuity of care and provide peer support to rural colleagues. • Cohn RJ, Goodenough B. (2001) Quality and continuity of care for paediatric cancer patients: the potential role for Telemedicine. Medical & Pediatric Oncology, 3: 169. telegeschnsubmission20032004doc382.doc Page 6
    • SEH – TeleHealth Submission 2003/04 This has resulted in improved quality of care for rural patients closer to their home. The current submission proposes to enhance and extend this service into other fields, such as Spina Bifida and Cardiology. Proposed Telehealth Service: Building on the framework established in paediatric oncology at Sydney Children’s Hospital with the use of videoconferencing to facilitate shared-care with rural partners, access of rural families and practitioners to specialists and other members of the multidisciplinary team will be provided. This will include pre-transfer interviews, discharge planning and interviews, access to social workers, play therapists, bereavement counselors, palliative-care physicians. Family reunion where appropriate with prolonged separation will be facilitated. This model of shared-care will be made available to other subspecialties (such as diabetic care, HIV, cystic fibrosis, spina bifida, mental health) on an as needed basis. One of the difficulties experienced to date has been the difficulty to arrange for the paediatrician/local medical officer to participate in the patient discharge interviews with the rural receiving team and family members not in Sydney. With the ability to have a telephone call into the conference when using the Tandberg equipment at Sydney Children’s Hospital, it is hoped to improve involvement of medical practitioners. 2. Quality of Care in Pediatric Emergency Medicine: The role of the Child Health Networks includes addressing quality of care in Child Health, with particular emphasis on acute care. It has done this via the development of Clinical Practice Guidelines for the 10 most common paediatric presentations to Emergency Departments, these being Abdominal Pain, Asthma, Bronchiolitis, Croup, Fever, Gastroenteritis, Head Injury, Meningitis, Otitis Media/Sore Throat and Seizures. With rural paediatricians and emergency physicians being in short supply in most localities, much of the work in rural Emergency Departments is done by General Practitioners and nurses with minimal paediatric emergency training. Consequently, GESCHN partners have identified clinical support and ongoing training of emergency department staff as the major priority for 2001-05 and with funding allocated by NSW Health for enhancement of paediatric networking, a Network-wide Paediatric Emergency Support Project (PESP) has been developed. Project nurses with expertise in paediatric emergency and education have been positioned in several rural sites and provide ongoing clinical and educational support to the local hospitals in the field of paediatric emergency. In addition they work with local clinicians to facilitate the local adaptation and implementation of the 10 Paediatric Emergency Clinical Practice Guidelines. Current Clinical Service: Clinical support and training in paediatric emergency skills is currently provided to multidisciplinary groups in rural areas as an outreach service from Sydney Children’s Hospital. A team of professionals including a Clinical Nurse Consultant, a Paediatrician and the local Project Nurse travel to a rural centre and, in consultation with senior local clinicians, provide training in the form of hands-on workshops, seminars and bedside tutorials. These are highly effective but costly, and expenses include travel costs (including airfares), accommodation and salaries. Furthermore, the positions of staff attending these workshops must be backfilled (if possible). Proposed Telehealth Service: Local project nurses would identify particular cases that are of interest to their rural communities either because of their difficult management or because of their infrequent but urgent nature, eg meningitis. Local clinicians would be invited to telegeschnsubmission20032004doc382.doc Page 7
    • SEH – TeleHealth Submission 2003/04 discuss these cases with a panel of experts from Sydney Children’s Hospital using Telemedicine. This would enhance the outreach education currently being provided in the GESCHN Paediatric Emergency Support Project. In-service training relating to performance of newer techniques may be incorporated. With the availability at Sydney Children’s Hospital of the Tandberg equipment, multi- point bridging at lower cost will be available allowing multiple sites to participate in case conferences. Geographic Location: GESCHN partners incorporate 8 NSW Area Health Services and the ACT. The region covers more than one third of NSW and includes the rural AHSs of Macquarie, Greater Murray and Southern. The Illawarra, though classified as metropolitan is far enough away from Sydney to benefit from such a service. The under 16 population of the GESCHN is almost 700,000. Steering Group: A steering group for this project would be formed consisting of • The Chair of the SCH Telehealth Steering Committee • The Telehealth Research Officer (as employed for this project) • The GESCHN Coordinator • The GESCHN Paediatrician • The GESCHN PESP Coordinator • PESP Nurses (one in each Area) • A research psychologist • A local clinician from each site Research: With respect to attitudes to videoconferencing in paediatric health care, studies have been done on both consumers and health service providers at Sydney Children’s Hospital and in the rural GESCHN areas. • Cohn RJ & Goodenough B. (2002) Health professionals' attitudes to videoconferencing in paediatric healthcare Journal of Telemedicine and Telecare, Volume 8, Issue 5: 274-282 (See attachment 1) • Cohn RJ et al (2003) Hidden Financial Costs in Treatment for Childhood Cancer: An Australian Study of Lifestyle Implications for Families Absorbing Out-of-Pocket Expenses Journal of Paediatric Hematology/Oncology (in press) (See attachment 2) • Goodenough B & Cohn RJ (2003) parent Attitudes to Audio/Visual Telecommunications in Childhood Cancer: an Australian Study (submitted to Telemedicine Journal and e-Health, under review) (see attachment 3) It was found that the rural consumers of child health services who access the Sydney Children’s Hospital are receptive to applications of technology, such as audio/visual telecommunications, including Telehealth. In particular, significant hidden financial costs incurred by patients from rural areas referred for treatment at the Sydney Children’s Hospital may be reduced by using this approach. Of particular interest is that Cohn & Goodenough (2002) identified that paediatric health-care professionals gave a higher endorsement of videoconferencing for educational or psychosocial applications than for patient management or treatment planning. This is consistent with the suggested use of this service for continual quality improvement and ongoing training in paediatric emergency care throughout rural GESCHN. It is proposed that a Telehealth Research Officer would be employed to fulfill the following roles: 1. To facilitate, support and oversee all Telehealth activities associated with this project. telegeschnsubmission20032004doc382.doc Page 8
    • SEH – TeleHealth Submission 2003/04 2. To gather relevant data, as determined by the steering group, in order to develop a model for clinical networking in Emergency Paediatrics and in Paediatric Shared-Care that may be replicated by other Paediatric or Statewide Services. 3. To evaluate the project 4. To present the project in a report format that may be used to seek further funding to continue the project, as appropriate according to the evaluation outcome. A job description for the position of project officer is attached. Project evaluation from a user perspective will comprise two stages. The first stage comprises pre-service documentation of baseline attitudes, perceptions and understanding of Telehealth. A survey has been developed for this purpose (attached), which also includes items on time and distance factors in the work setting, as well as communication preferences with colleagues and patients. This survey has been used in previously published research by this team with health professionals caring for children diagnosed with cancer (Cohn & Goodenough, 2002) and will be adapted. The second phase of evaluation will adopt a repeated measures approach to recording Telehealth experience, user appraisals, and charting potential changes in key baseline perceptions (e.g. utility ratings for specific applications). This feedback mechanism will require users to complete a brief standardised assessment at 3, 6 and 12 months. Ethics approval for this research program and associated evaluation methods by survey sampling is current (see attachment). To be completed by the service provider, please describe: Type/Main Use of Service: The primary use of this service will be for multi-disciplinary case-conferencing within the 2 categories described above (ie conditions requiring on-going shared care, and paediatric emergency medicine). The purpose of the case-conference will be 2-fold: • To improve the service to consumers by facilitating the shared-care arrangements between SCH and local clinicians, especially in oncology, cardiology, HIV, Spina Bifida and Medical Genetics • To provide service providers with ongoing training in paediatric sub-specialities, with particular emphasis on paediatric emergency medicine In order to maximise the use of available equipment, other purposes that are compatible with the aims of the project (such as Kids Cancer Update which links Canberra, Dubbo and Wagga to SCH) may be incorporated, as deemed appropriate by the steering group. Process: It is envisaged that a designated time would be made each week for one hour of teleconferencing. The number of sites linking in at any one time would depend on the relevance of the case to each centre. For example, using Telemedicine for discharge planning would involve few sites, whereas discussion of a case in a rural Emergency Department may be of interest to many. As not all 8 sites would link each time, the cost has been calculated for an average of 8 sites per fortnight (rather than per week), although the facility would be available to use for this project on a weekly basis. Furthermore, if the relevant people were present, an urgent discussion over a difficult or rare presentation to ED could potentially take place. For non-urgent presentations • The Project Steering Group would decide in advance on the cases to be discussed • 3-4 cases may be discussed each session, with or without the family present, as is telegeschnsubmission20032004doc382.doc Page 9
    • SEH – TeleHealth Submission 2003/04 appropriate to the condition. • It is proposed that existing equipment be utilised and multiple sites could participate by phoning in to either the Tandberg at SCH, or to one of the bridges located within the GESCHN (if more than 5 sites at a time). To be completed by the service recipient/s, please describe: Expected benefits to consumers include • Continuity of care • Access of patients and parents to expertise of tertiary institution Expected benefits to health professionals include • Participation of rural partners in discharge interviews and planning. • Access for health professionals to expertise not only medical but of full multidisciplinary team for individual patient problems and case conferencing. It is anticipated that the service will be used for • case conferencing as requested by rural partners • quality improvement, education and training as requested by rural partners • clinical consultation prior to referral for procedure – saving additional trip to Sydney • surgical follow-up Frequency and duration of service: • estimate average of one 60 minute case conference per eight specified partner sites per month during initial 12 month pilot period. Case conferences may be multiple sites if topic is of interest • Additional patient specific meetings if need arises and request is made by far site. Some centres have agreed to share or take on fully the cost of calls. For example, Griffith currently links into the SCH Grand Rounds at their own expense. This clearly indicates their belief in the value of this service and signifies their commitment (see attached letters). Impact on current work practices: • Service will be within the agreed GESCHN partnership predominantly and will be inter AHS (see attached letters from clinicians within Illawarra, Southern, Macquarie and Greater Murray AHSs and the ACT). • Decreased travel by outreach medical and nursing professionals • Decreased use of IPTAAS • Improved support of rural practitioners by centrally employed expertise Outline your local technical infrastructure requirements including the proposed telecommunications. Please indicate your current AHS/Statewide Service network capability. The Sydney Children’s Hospital currently has the following Telehealth equipment installed: 1.2x PC-based Galaxy Vtel 2000 with 3 dedicated ISDN lines 2. Tandberg unit with 6 dedicated ISDN lines Use will be made of NSW Health Telehealth Initiative sites in the GESCHN Areas, including a Bridge at Dubbo (if necessary). telegeschnsubmission20032004doc382.doc Page 10
    • SEH – TeleHealth Submission 2003/04 If you would do not want to submit a business case for telehealth funding for 2003/04 but would like to be considered for future projects and receive advice in either of the above (critical care or primary care models) research applications please forward the completed Section 2 of this business case with your contact details to: NSW Telehealth Clinical Policy and Integrated Services Steering Committee c/- NSW Telehealth Initiative, Level 5 Information Management Directorate NSW Health Department Locked Bag 961 North Sydney NSW 2059 telegeschnsubmission20032004doc382.doc Page 11
    • SEH – TeleHealth Submission 2003/04 3. CAPITAL AND RECURRENT REQUIREMENTS Provide details of recurrent/variable costs implications of this project. Item (please provide details) Projected Proposed source of funds additional costs pa. 1st Year 2nd Year 3rd Year Salaries and wages Telehealth * * Mid point HSM1 $ 57,000 Initiative (including on costs) Administration costs $ 10,000 Telehealth * * Initiative Project Management and $ 10,000 Telehealth * * operations management Initiative Other recurrent requirements * * (please specify) Call costs for 8 rural sites @ 1 $ 30,000 Telehealth hour/fortnight Initiative Total $107,000 $107,000 *See section below on Justification (“Our needs in future years…”) telegeschnsubmission20032004doc382.doc Page 12
    • SEH – TeleHealth Submission 2003/04 Justification: Please provide justification for the recurrent requirements and the proposed source of funds for these requirements. Salaries: The Project Manager will • assist with existing projects such as cardiology and BIRP (brain injury rehabilitation), • coordinate the new components of the project • be responsible for planning, undertaking and evaluating the research component of the project • work closely with the GESCHN PESP Coordinator and Network Paediatrician to facilitate meeting the objectives of that project. Equipment, Administration and Call Costs: With the availability of Telehealth equipment at Sydney Children’s Hospital, we are looking at optimising its use. Use of the Tandberg will minimise call costs, but we would require continued funding for the Project Manager and administration costs. To date, all costs have been borne by the Sydney Children’s Hospital Management from donated funds. Our needs in future years would be dependent on the outcomes of the research project. Potential sources of future funds include • Funding from GESCHN’s future Network Enhancement funds • Contributions by participating sites • Other rural funding sources, eg RHSET • Donations sought from sponsors of the Sydney Children’s Hospital Does your service currently receive other funding There is currently a contract between NSW Health and SCH Cardiology, and also with Brain Injury Rehabilitation (BIRP). If this project is approved, it is anticipated that some administration costs may be shared. telegeschnsubmission20032004doc382.doc Page 13
    • SEH – TeleHealth Submission 2003/04 Provide an outline of the telehealth and capital equipment requirements (please contact Department of Health) Equipment type (including No. of DOH office use Item specialised peripherals and medical equipmen only equipment) t required Equipment Videoconferencing equipment: requirements • Room system (5 or more staff) • Desktop system (up to 4 staff) Medical Peripherals (for example audiographic, interactive with still images, store/forward) • Digital camera • Dermascope • Ophthalmic • Other, please specify: • __________________________ __________________________ __________________________ Medical imaging equipment (store / forward) • digitisers • web servers • other Please provide detail of costs on equipment and preferred vendor and justification on a separate page Other equipment, please specify: _____________________________ _____________________________ _____________________________ Utilisation Utilisation Utilisation costs For interactive video please indicate number of hours per week usage by: • Clinical • Training and support • Administration Telecommunication Annual telecommunication costs DOH to s (including rental and call costs) complete DOH to Maintenance Annual Equipment Maintenance complete Total N/A Justification: Please provide a justification for the capital requirements N/A telegeschnsubmission20032004doc382.doc Page 14
    • SEH – TeleHealth Submission 2003/04 4. IDENTIFIED AND ACTUAL RECURRENT SAVINGS Provide details of actual recurrent costs associated with existing services based on previous year’s utilisation rates Site Existing Service Costs Per Annum Delivery Local AHS Other AHS Patient / Other method(s) Client N/A Identify potential savings based on the implementation of TeleHealth services and estimated utilisation rate Area of Savings Identified Savings per annum $ Local AHS Other AHS Patient Other Travel costs Reduced transfers IPTAAS Administration Education and Training Existing services Other Please indicate how the AHS/s will sustain recurrent funding for this TeleHealth service if proven after 12 months: It is hoped that this pilot study will provide a model for networking in clinical care that may be replicated elsewhere. It is also expected that this project will be demonstrate a decreased need for travel by families to Sydney and hence a decreased use of IPTAAS, and may also demonstrate a decreased need for NETS retrieval. Such savings are likely to exceed the recurrent costs of this project. This outcome may allow some flow of funds to teleconferencing within the relevant Areas and the Department of Health. In particular, the following strategies are proposed: • Spread the benefits widely within South East Health so the likelihood of a funding source for continuing support is maximised • Consider future contributions from recipient partners in the service • Seek recognition of the benefits within GESCHN so that the Network may prioritise this activity for future funding • Seek other sources of rural funding, eg RHSET • Seek donations from sponsors of the Sydney Children’s Hospital as part of its commitment to the Network and rural partnership telegeschnsubmission20032004doc382.doc Page 15
    • SEH – TeleHealth Submission 2003/04 5. SERVICE INTEGRATION Identify the Implementation Team involving both service provider and recipient. Name Organisation Role • Dr Richard Cohn Sydney Children’s Hospital Head of Oncology, SCH & Chair, SCH Telehealth Steering Committee • Dr John Ziegler Sydney Children’s Hospital Head of Immunology, SCH & Chair, SCH Education Steering Committee • Judith Lissing Sydney Children’s Hospital GESCHN Coordinator • Dr Jonny Taitz Sydney Children’s Hospital Acting GESCHN Paediatrician • Ella Scott Sydney Children’s Hospital GESCHN PESP Coordinator • Debra Sloane Dubbo Base Hospital PESP Rural Project Nurse • Dr Toni Medcalf Dubbo Base Hospital General Practitioner • Dr John Preddy Wagga Base Hospital Paediatrician • Dr Marion Reeves Griffith General Practitioner • Amanda Little Southern AHS PESP Rural Project Nurse • Prof Graham Reynolds The Canberra Hospital Professor of Paediatrics • Dr Allan James Wollongong Hospital Paediatrician • Dr Maxwell Hopp Griffith Base Hospital Paediatrician • Dr Belinda Goodenough School of Women’s and Research Psychologist Children’s Health, University of NSW Outline the proposed project timeline. Please include major milestones for reporting to the NSW Telehealth Steering Committee. We would anticipate no delay in implementation as the infrastructure is already available and partners are already experienced with the technology. A part-time technician is currently employed by SCH, but full-time hours would be necessary to complete all objectives of the project, including research and evaluation. A system of evaluation will be implemented using published oncology questionnaires, and there will be subsequent 3 monthly follow-up. These parameters will be applied to the Emergency arm of the project and the objectives may be incorporated into the GESCHN Paediatric Emergency Support Project. telegeschnsubmission20032004doc382.doc Page 16
    • SEH – TeleHealth Submission 2003/04 6. EVALUATION Outline the expected outcomes and 5 key performance measure at 3 months, 6 months and 12 months of the project. A Research Psychologist will be on the Steering Committee and this will facilitate the use of appropriate research and evaluation methods. Project evaluation from a user perspective will comprise two stages: • The first stage comprises pre-service documentation of baseline attitudes, perceptions and understanding of Telehealth. A survey has been developed for this purpose (attached), which also includes items on time and distance factors in the work setting, as well as communication preferences with colleagues and patients. This survey has been used in previously published research by this team with health professionals caring for children diagnosed with cancer (Cohn & Goodenough, 2002) and will be adapted. • The second phase of evaluation will adopt a repeated measures approach to record Telehealth experience, user appraisals, and charting potential changes in key baseline perceptions (e.g. utility ratings for specific applications). This feedback mechanism will require users to complete a brief standardised assessment at 3, 6 and 12 months. Current ethics approval for this research program and associated evaluation methods by survey sampling is available (see attachment). Performance Indicators would include • Consumer satisfaction • Health professionals’ satisfaction • Referral patterns and re-presentation to Sydney Children’s Hospital • Frequency of use of IPTAAS • Frequency of need for NETS retrieval • Evaluating the extent to which meeting the objectives of the GESCHN Paediatric Emergency Support Project are facilitated. These objectives include - To enhance the quality of Paediatric care in Emergency Departments - To develop skills and expertise of clinical staff in Paediatric acute care provision - To facilitate the exchange of best practice in providing acute care to Paediatric patients and the dissemination and implementation of clinical guidelines of care for Paediatric practice. - To further clarify the specific needs of each GESCHN hospital to provide quality Paediatric acute care. - Improvement of linkages between Network partners. telegeschnsubmission20032004doc382.doc Page 17
    • SEH – TeleHealth Submission 2003/04 7. ENDORSEMENT The undersigned are committed to: • collaboration on this project between each participating group during the development, implementation and evaluation of the project; • sustaining systems which are demonstrated to be feasible and effective; and • implementing an integrated system of care. Note that prior to approval, a condition of this grant will be that a contract between the Department, Area Health Service(s) and other third parties is signed. Signature of all participants in the project is required: Providing Area Health Service: Area Health Service South East Sydney AHS CEO Area Health Service Signed Date Ms Deborah Green Clinical Sponsor Signed Date Dr Richard Cohn Project Manager Signed Date Ms Judith Lissing IT Manager Signed Date Director Population Health/ Health Signed Date Services Development Ms Elizabeth Koff 1. Receiving Area Health Service or health facility: Area Health Service or health facility Greater Murray AHS CEO Area Health Service or health Signed Date facility Dr Joe McGirr IT Manager Signed Date Mr Richard Howell Director Population Health/ Health Signed Date Services Development Ms Susan Weisser Site Co-ordinator Signed Date Dr John Preddy telegeschnsubmission20032004doc382.doc Page 18
    • SEH – TeleHealth Submission 2003/04 2. Receiving Area Health Service or health facility: Area Health Service or health facility Macquarie AHS CEO Area Health Service or health Signed Date facility Ms Jeannine Biviano IT Manager Signed Date Director Population Health/ Health Signed Date Services Development Site Co-ordinator Signed Date Dr Stephen Pryde/Dr Toni Medcalf 3. Receiving Area Health Service or health facility: Area Health Service or health facility Southern AHS CEO Area Health Service or health Signed Date facility Mr Bill Dargaville IT Manager Signed Date Ms Ivonne Buckley Director Population Health/ Health Signed Date Services Development Site Co-ordinator Signed Date Dr Kerrie MacDonald 4. Receiving Area Health Service or health facility (if provider and receiver service is in same AHS): Area Health Service or health facility Illawarra AHS CEO Area Health Service or health Signed Date facility Mr John Blackwell IT Manager Signed Date Director Population Health/ Health Signed Date Services Development Ms Tineke Robinson Site Co-ordinator Signed Date Dr Allan James telegeschnsubmission20032004doc382.doc Page 19
    • SEH – TeleHealth Submission 2003/04 APPENDIX 1 - Cost / Budget Spreadsheet South Eastern Sydney Area Health Service Project Name Detailed Summary Resourcing, Software & Hardware - Costs RESOURCING 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $107,000 $0 $0 $0 $0 $107,000 ISD Resource S&W $0 $0 $0 $0 $0 $0 Business Resources S&W $77,000 $0 $0 $0 $0 $77,000 Other Resources (Internal) S&W $0 $0 $0 $0 $0 $0 Vendor Resources G&S $0 $0 $0 $0 $0 $0 Other Resources (External) G&S $30,000 $0 $0 $0 $0 $30,000 SOFTWARE TOTAL $0 $0 $0 $0 $0 $0 Purchase(s) G&S $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 HARDWARE TOTAL $0 $0 $0 $0 $0 $0 Purchase(s) / Lease(s) (Including Warranty) G&S $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 RESOURCING, SOFTWARE & HARDWARE TOTAL $107,000 $0 $0 $0 $0 $107,000 Recurrent - Costs N/A RESOURCING 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $0 $0 $0 $0 $0 $0 ISD Resource S&W $0 $0 $0 $0 $0 $0 Business Resources S&W $0 $0 $0 $0 $0 $0 Other Resources (Internal) S&W $0 $0 $0 $0 $0 $0 Vendor Resources G&S $0 $0 $0 $0 $0 $0 Other Resources (External) G&S $0 $0 $0 $0 $0 $0 SOFTWARE TOTAL $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 HARDWARE TOTAL $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 RECURRENT TOTAL $0 $0 $0 $0 $0 $0 Cost Reduction Considerations N/A RESOURCING 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $0 $0 $0 $0 $0 $0 ISD Resource S&W $0 $0 $0 $0 $0 $0 Business Resources S&W $0 $0 $0 $0 $0 $0 Other Resources (Internal) S&W $0 $0 $0 $0 $0 $0 Vendor Resources G&S $0 $0 $0 $0 $0 $0 Other Resources (External) G&S $0 $0 $0 $0 $0 $0 SOFTWARE TOTAL $0 $0 $0 $0 $0 $0 Purchase(s) G&S $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 HARDWARE TOTAL $0 $0 $0 $0 $0 $0 Purchase(s) / Lease(s) (Including Warranty) G&S $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 RESOURCING, SOFTWARE & HARDWARE TOTAL $0 $0 $0 $0 $0 $0 Cost Reduction Considerations - Recurrent N/A RESOURCING 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $0 $0 $0 $0 $0 $0 ISD Resource S&W $0 $0 $0 $0 $0 $0 Business Resources S&W $0 $0 $0 $0 $0 $0 Other Resources (Internal) S&W $0 $0 $0 $0 $0 $0 Vendor Resources G&S $0 $0 $0 $0 $0 $0 Other Resources (External) G&S $0 $0 $0 $0 $0 $0 SOFTWARE TOTAL $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 HARDWARE TOTAL $0 $0 $0 $0 $0 $0 Maintenance RMR $0 $0 $0 $0 $0 $0 RECURRENT TOTAL $0 $0 $0 $0 $0 $0 Benefits N/A TANGIBLE BENEFITS 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $0 $0 $0 $0 $0 $0 LINKED BUSINESS BENEFITS 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $0 $0 $0 $0 $0 $0 TOTAL BENEFITS $0 $0 $0 $0 $0 $0 Net Benefit / (Cost) 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 TOTAL TOTAL $107,000 $0 $0 $0 $0 $107,000 Source of Funding Summary WITHIN EXISTING GENERAL FUNDS 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 TOTAL TOTAL $0 $0 $0 $0 $0 $0 REQUIRING ADDITIONALGENERAL FUNDS 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 TOTAL TOTAL $107,000 $0 $0 $0 $0 $107,000 SOURCE OF FUNDING TOTAL $107,000 $0 $0 $0 $0 $107,000 telegeschnsubmission20032004doc382.doc Page 20
    • SEH – TeleHealth Submission 2003/04 APPENDIX 2 - High Level Work Breakdown Structure Current Date 29-Jul-03 WBS Last Updated Enter Date Year 1 Financial Year FTE DAYS FTE DAYS FTE DAYS FTE DAYS Days ISD Resources Business Vendor Other Resources Total Phase Stage Task START DATE END DATE Resources Resources Initiation and Project Startup Initiation 7.00 7.00 Planning Planning TOR 0.00 Project Plans 0.00 Project Reporting 0.00 Set Up Managing the Analysis and Business Process 33.71 33.71 Project Design Review and Requirements Implementation 0.00 Planning and SDLC Acquisition and Procurement 0.00 Build Test Integration 0.00 Implementation Implementation 215.00 215.00 Closing the Evaluation Post 7.00 7.00 Project Implementation Review Implementation 0.00 closure Support Support and 0.00 Maintenance Planning Operational 0.00 Handover Post Project System Evaluation Review over 2.00 2.00 Review Lifecycle Recurrent Recurrent Maintenance 0.00 Support 0.00 0.00 264.71 0.00 0.00 264.71 telegeschnsubmission20032004doc382.doc Page 21
    • SEH – TeleHealth Submission 2003/04 APPENDIX 3 - Risk Analysis IDENTIFY ANALYSE EVALUATION STRATEGY ProjectInternal or External to Assumptions that qualify the Option to manage the Risk Preferred strategy for addressing the Risk Description of Risk Addressing the Risk Consequence of not Likelihood Reference Number Risk Area Impact Risk Sustainability Project may not be Project Officer E NSW Health may put L H Start raising the If the NSW Health TeleHealth re-funded in future position would a lower priority on profile of the project Initiative decides not to fund years either cease or this type of project within GESCHN to this project for longer than 12 other source of next year. gain Network months, the following funding would support and support strategies are proposed: need to be from participating found. partners. • Spread the benefits widely within South East Health Ensure that so the likelihood of a objectives of project funding source for are met, publish continuing support is results, to increase maximised likelihood of further • Consider future funding next year. contributions from recipient partners in the Continue to seek service ways to expand on • Seek recognition of the and improve the benefits within GESCHN so project in that the Network may preparation for prioritise this activity for another submission future funding next year. • Seek other sources of rural funding, e.g. RHSET HR Trouble recruiting Implementation I The skills required Ensure position is If problems occur, position suitable person of project for the position are L M advertised as soon must be well supported as would be at a mid-career level, as funds are soon as project commences, in delayed. so the risk of this available. order that it progresses quickly telegeschnsubmission20032004doc382.doc Page 22
    • SEH – TeleHealth Submission 2003/04 happening is not to make up for lost time. Objectives may high. Ensure that position not achieved in is advertised widely. time available. telegeschnsubmission20032004doc382.doc Page 23
    • SEH – TeleHealth Submission 2003/04 telegeschnsubmission20032004doc382.doc Page 24