Susan Jury & Andrew Kornberg - TeleHealth at RCH

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

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  • Specifically within context of an OPD dept - excludes patient experience, satisfaction, etc.
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  • SCJhttp://www9.health.gov.au/mbs/fullDisplay.cfm?type=note&qt=NoteID&q=A58
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  • AjkNeurologyRespiratoryAllergyDermatologyGeneral paediatrics (sleep, encopresis)Refugee (with translator)GynaecologyDental – cleft & emergencyGastroWithin OPD clinicClinical officesresp
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  • akPre-test & step-by-step guide‘Plan B’ – acting quicklyLocal & specific support ‘Desk D’ – contained, now A1 (bigger)SupportLocal ‘experts’Introduce slowly / when ready / willingMe
  • SCJID pt within an OPD clinicBook a TH aptf/up with me to liase testing etcFTA? None yet…Starting to work w OPD staff more – info pack, eligibility areas, etc.Currently I facilitate triage – aim to be run by depts own triage staff (eg allergy CNC)
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  • Susan Jury & Andrew Kornberg - TeleHealth at RCH

    1. 1. Enhancing outcomes through innovations in technologies:Sustainably integrating video consultinginto a busy outpatients departmentA/Prof Andrew KornbergDirector NeurologySusan JuryTelehealth Program ManagerThe Royal Children’s Hospital, MelbourneOctober 2012Children’s Hospital’s Australasia, Sydney
    2. 2. Overview1. Medicare incentives and eligibility for providing video-consultation2. Telehealth models of care3. Major potential benefits of telehealth4. Systems in place, planned and in development for integrating video consultation in specialist clinics (outpatients).
    3. 3. Medicare eligibilityProvider: Patients:• Must have an MBS • Outer metro & provider number rural/regional• SpecialistPatient end • RACF patients• GP• Midwife • Aboriginal Medical• Practice Nurse Services• Nurse Practitioner
    4. 4. 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)
    5. 5. The sums - specialist end Plus $4,800$400 once off per$350$300 doctor*$250$200$150$100 Bulkbill incentive $50 $0 Telehealth incentiveSimple new Telehealth item # 112 Simple review (Item 110) Complex new (Item 116) Complex Usual rebate (Item 132) review (Item 133)
    6. 6. 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?
    7. 7. 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
    8. 8. Soon… Telehealth clinic Within a F2F Clinical offices OPD clinic• Dermatology x x• Dental – cleft & x emergency• Immunotherapy? x• Etc, etc…. x
    9. 9. Systems• Citrix GoToMeeting• Website to join consultation www.rch.org.au/telehealth• Support – website, 1:1, 1800 Citrix help• Online sign-off Medicare
    10. 10. Sustainable integrationIT• INTEGRATION WITH USUAL SYSTEMSPROCESSES• 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’
    11. 11. Receipt of referral & triagingExternal 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
    12. 12. Booking• Book with clinician agreement only• IBA ‘appointment types’ • Telehealth new • Telehealth review • Telehealth clinic• email templates (IBA letters)
    13. 13. Minimising impact on theconsultation time• Pre-test set up• Ease of software• Website, step-by-step & support• Plan B
    14. 14. Impact on consultation time(23 respondents)100%90% >10 minutes extra80%70%60% 5-10 minutes extra50%40%30% > 10 min more20% 5-10 min more10% 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
    15. 15. Causes of delays1. Waiting for pt to join consult2. Connection sound, video etc3. Setting up own sound, video etc4. Patient, GP or RCH doctor late
    16. 16. Feedback for improvementScheduling • 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) wouldnt stay in the room & kept playing upconsultation • Eye contact difficult with motherskills training
    17. 17. Feedback for improvementSpecific technical • Consider having a portable examination light torequirements or enable better illumination of the patients eczema.recommendedRoom 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 administrativewith training & taskssupport • What is the Medicare billing process • How to book a review • Whether there was a referral current • What item number we were up to
    18. 18. Minimising impact on theconsultation 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)
    19. 19. The video-consultation loop Receipt of referral & triaging Billing & Booking Medicare The consultation
    20. 20. Billing &Medicare• Email template• eSign online form
    21. 21. RCH telehealth www.rch.org.au/telehealthA/Prof Andrew KornbergDirector Neurologyandrew.kornberg@rch.org.auSusan JuryTelehealth Program Managersusan.jury@rch.org.au , tel (03) 9345 4645

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