A presentation given by Susan Jury & Andrew Kornberg at The Journey, CHA Conference 2012, in the 'Enhancing Outcomes Through Innovations in Technologies' stream.

1. Enhancing outcomes through innovations in technologies:
Sustainably integrating video consulting
into a busy outpatients department
A/Prof Andrew Kornberg
Director Neurology
Susan Jury
Telehealth Program Manager
The Royal Children’s Hospital, Melbourne
October 2012
Children’s Hospital’s Australasia, Sydney

2. Overview
1. Medicare incentives and eligibility for
providing video-consultation
2. Telehealth models of care
3. Major potential benefits of telehealth
4. Systems in place, planned and in
development for integrating video
consultation in specialist clinics
(outpatients).

3. Medicare eligibility
Provider: Patients:
• Must have an MBS • Outer metro &
provider number rural/regional
• Specialist
Patient end • RACF patients
• GP
• Midwife • Aboriginal Medical
• Practice Nurse Services
• Nurse Practitioner

6. The sums – GP at patient end
Plus $4,800
once off per
$200 doctor*
$150
Bulkbill incentive
$100
$50
Telehealth incentive
$0
Level A 5mins Telehealth item #
Level B
(Like Item 3) Level C (difference)
<20mins Level D
>20mins Usual Item no. rebate
(Item 2126, >40mins
(Item 2143,
like item 23) (Item 2195,
like Item 36)
like Item 44)

7. The sums - specialist end
Plus $4,800
$400 once off per
$350
$300 doctor*
$250
$200
$150
$100 Bulkbill incentive
$50
$0 Telehealth incentive
Simple new Telehealth item # 112
Simple review
(Item 110) Complex new
(Item 116) Complex Usual rebate
(Item 132)
review (Item
133)

8. Possible telehealth models
• Specialist to pt directly at home
(routine follow-up, unplanned, emergency etc)
• Specialist to pt with local healthcare provider
(GP, Practice Nurse, paediatrician etc)
• ‘Outreach clinic’
(RCH led or locally led - booking, triaging etc)
• Multidisciplinary
• Nurse-led
• Psycho-social?
• Peer support?
• Networking?
• Family meetings?
• Education?

9. So far…
Telehealth Within a F2F Clinical offices
clinic OPD clinic
• Neurology x x
• Respiratory x x
• Allergy x x
• Dermatology x
• General paediatrics x
(sleep, encopresis, behaviour, etc
)
• Gynaecology x x
• Refugee (with translator) x
• Gastro

10. Soon…
Telehealth clinic Within a F2F Clinical offices
OPD clinic
• Dermatology x x
• Dental – cleft & x
emergency
• Immunotherapy? x
• Etc, etc…. x

11. Systems
• Citrix GoToMeeting
• Website to join consultation
www.rch.org.au/telehealth
• Support – website, 1:1, 1800 Citrix help
• Online sign-off Medicare

12. Sustainable integration
IT
• INTEGRATION WITH USUAL SYSTEMS
PROCESSES
• As similar to F2F as possible - ‘business as usual’
(triaging, booking, letters etc)
• Introduce as ready; small steps; willing
• Support, up-skilling confidence at all levels
• Minimise inconvenience & time impact, esp. on
consultation
• ‘Plan B’

13. Receipt of referral & triaging
External or internal referral, or ID of suitable patient
• Parent information – factsheets, website
Receipt of
• ‘Info packs’ for OPD referral & triaging
Billing &
• Liaison & support – Medicare
Booking
• Referrer, triage staff,
clinician, OPD staff, patient
The consultation

14. Booking
• Book with clinician agreement only
• IBA ‘appointment types’
• Telehealth new
• Telehealth review
• Telehealth clinic
• email templates (IBA letters)

15. Minimising impact on the
consultation time
• Pre-test set up
• Ease of software
• Website, step-by-step & support
• Plan B

16. Impact on consultation time
(23 respondents)
100%
90% >10 minutes extra
80%
70%
60% 5-10 minutes extra
50%
40%
30% > 10 min more
20% 5-10 min more
10%
1-5 minutes more
0%
Same amount of time
Set-up etc The clinical Extra admin EXTRA Less time
consultation for YOU admin for
others

17. Causes of delays
1. Waiting for pt to join consult
2. Connection sound, video etc
3. Setting up own sound, video etc
4. Patient, GP or RCH doctor late

18. Feedback for improvement
Scheduling • Needed to cancel patients before & after consult to ensure
we were ready and because we had no idea how long the
consult would last. As we are booked weeks in advance, we
needed to cancel pts.
• Patient late so disrupted rest of day for both doctors.
Preparation • Will ensure I have my usual props (sample pill
packets etc) with me next time.
1:1 support • Worked well with susan jury liaising with GP practice. We
could not have done this without this hands on support.
Video- • Patient (child) wouldn't stay in the room & kept playing up
consultation • Eye contact difficult with mother
skills training

19. Feedback for improvement
Specific technical • Consider having a portable examination light to
requirements or enable better illumination of the patient's eczema.
recommended
Room set-up • Next time I will run it in a room with 2 screens, one for
the video and one for my clinic software to access the
notes.
Processes streamlined • Checklist for both clinicians to use re administrative
with training & tasks
support • What is the Medicare billing process
• How to book a review
• Whether there was a referral current
• What item number we were up to

20. Minimising impact on the
consultation time
• Pre-test set up – automating
• Ease of software – increased familiarisation
• Website, step-by-step & 1:1 support
• ‘Early sign in’ – patient 5-10 minutes early
• ‘know when to bail’ (plan B)
• 1st consult in a F2F clinic
• Scheduling – allow 30 minutes (currently)
• Local up-skilling (OPD, dept’s etc)

21. The video-consultation loop
Receipt of referral
& triaging
Billing &
Booking
Medicare
The consultation

22. Billing &
Medicare
• Email
template
• eSign
online form

23. RCH telehealth
www.rch.org.au/telehealth
A/Prof Andrew Kornberg
Director Neurology
andrew.kornberg@rch.org.au
Susan Jury
Telehealth Program Manager
susan.jury@rch.org.au , tel (03) 9345 4645