Rural and Remote Telehealth Conference 2011

Welcome to HISA’s blog from our Rural and Remote Telehealth Conference.  This blog will be your link to the going’s on here in Cairns over the next 2.5 days.

The development of this conference is the result of passion and clinical interest from a geographically dispersed group of serving committee members.  The team ranges from Northern WA, Darwin, Perth and to the depths of the Grampians, metro Sydney and Northern Qld.  The diversity of opinion, experience and view point means that this conference will be rich in content.

We have an impressive program and line-up of speakers from Canada, India, America, Scotland and from all across Australia.  Senator Conroy will be presenting on Tuesday morning via a live cross from Sydney.  There is going to be a demonstration of the practical aspects of telehealth, a keynote detailing the new MBS item number releases, and a hypothetical session involving DOHA, DBCDE, NEHTA and others.

Posted in Rural and Remote Telehealth Conference 2011, Uncategorized | Tagged ,

Games for health workshop notes

I have a particular passion for this space, I see the innovation coming out of the gaming industry as one of the fastest growing of any sector, fuelled by significant R&D budgets, healthy consumer demand and commercial models as well as a desire and freedom to be innovative and try new things from both an industry and consumer perspective.

Gaming is not only fun, but with connectivity and the surgence in multi-player gaming it’s also a way to be part of a community and communicate with friends old and new.

Dr Stuart Smith of the Neuroscience research centre chaired today’s workshop.  Stuarts interest in games for health started when he was working in a spinal unit, predominantly filled with the results of young male bravado, alcohol and a speeding car, and seeing how these young men were bored with the repetitive tasks of traditional rehab, frustrated by the lack of feedback and not seeing the results of their efforts – hard to see through the skin and see the muscles reforming,  Stuart saw a massive opportunity the games could play in meeting some of these barriers to uptake and adherence to rehab, and so the spark was ignited.

There is a lot of bad press about games, it’s addictive, drives aggression in young men, makes you fat and lazy and lack of social interaction etc – BUT there are also a lot of positives in particular with movement gaming and social gaming.

Todays’ workshop asked the participants How do we build a games for health industry in Australia? – how do we bring together game developers and health researchers and enable a strong line of communication so we can work together for mutual success.

We were very lucky to have Bob Hone, Red Hill Studies in LA come and share there experiences of creating movement games for parkinsons, with some fantastic results.

They were initially approached by clinicians providing therapy for stroke patients and asked can you help us use these new tools to improve patient outcomes?

Exercise has been shown to slow and even halt the progression of disease, so can movement through a gaming interface do the same?

The games were inspired by clinical needs – the physical therapists says – I want the patient to do X and then the gaming guys build a game around the movement required.

 

clinical needs guiding movement design for games

 

 

 

 

 

 

 

It was important to have a modifiable gaming regime – so developers can focus on the hard code – and clinicians can use “builder app” to do minor amendments – e.g move that button 5pixels to the left.

  • Clinically defined motions
  • Adaptive games designed to elicit defined motions
  • Level design to create progressive difficulty
  • Iterative prototype testing with patients
  • Clinical trial to validate efficacy
  • Online tracking for clinician oversight and ongoing tuning.

The psychology of gaming is important – finding the right balance of not too hard not too easy – so your confidence improves, but failure is Ok too Its good to fail as it drives you to try harder. People feel success and a sense of achievement when they get to a new level.

Posted in HIC2011

Summary of Indigenous Informatics workshop

Fantastic first session of the indigenous Informatics group, this initiative was put forward and indeed chaired on the day by Tam Shepherd, HISA board member, Queensland Health senior executive and general ehealth guru, who felt that there was a piece missing in the eHealth conversations  – to understand the unique needs of delivering health informatics to the indigenous communities.

Today was an opportunity to meet others working in this space, to learn and share our experiences and find common themes we can pull together and create advocacy to drive change.

I was really impressed by the depth and breadth of knowledge of the participants of the workshop and most importantly the passion to create change and the commitment to work together to achieve this.

The day kicked off with a brilliant welcome to country to start things off on the right note, acknowledging the past and celebrating key events such as the apology from Kevin Rudd and the promise to close the gap – health is vital to making this happen.

The eHealth agenda is a national agenda, yet the indigenous agenda is different and isnt’ being addressed – identity, infrastructure and privacy are key issues that are unique to many of these communities

NBN – some of these communities don’t even have a road, or a reliable power source – so how will information flow here?

ICT support and ability to understand computers is vital – what happens when IT support isn’t just a floor away?

The stage was then handed over to Selwyn Button, CEO QAIHC  – Queensland Aboriginal and Islander Health Council presenting on their experiences in delivering Community controlled health services.

QAIHC’s primary role is to provide strategic policy and advocacy, member support services, as well as undertake negotiations with government.

Population demographics are different – younger, transient, higher burden of illness, need for social services, geographical spread, historical perception of where communities are most in need.

Service providers like employment, housing, education – all impact on health and need to work together to create meaningful change.

Comprehensive primary health care model – trialled and delivered by Apunipima Cape York health council through family centre approach to CPHC.

Set of primary care indicators based upon research to determine service needs, developed extraction tool to support service in data analysis and interpretation.

MIMASO – drug and alcohol client information system – developed by community controlled sector organisation, used in both community controlled and mainstream service sector.

Time spent on administrative tasks does not allow for being innovative and thinking to the future, too much time spent fighting fires, rather than clearing the path for future.

Some questions and comments from the audience:

Is the information being collected by the community groups to use as indicators available for people to use? – yes, you can look at the closing the gap website to get this information

In the wet season in the Kimberly, we have a shared system so when things get flooded we can rely on shared systems. This also was a big driver in uptake when people realised that having it electronically meant in floods or disasters they still had the data.

The group then broke into 4 to brainstorm what they felt the biggest barriers to uptake of eHealth or health informatics in indigenous affairs is, our group came up with some really strong comments that I felt could be applicable in all major ICT projects, change management, knowing what your use cases’s are and who your end users will be and developing not only the systems but understanding the drivers for adoption for them to not just use a system because they have to , but embrace and adopt it and want to be part of making it better.

We were then treated to some learning’s from the international community with Teresa Wall Deputy Director General, Maori Health Directorate from New Zealand, and talked about Ethnicity Data and the various cultural implications and the experience in New Zealand collecting information on ethnicity and reminding us that the context of how you ask for the data is just as important as what data you ask for.

Examples of how NZ moved from a blood quota to a multi choice – e.g you used to say I am half Maori, or quarter islander which led to a lot of identity issues, now people can tick as many or as few ethnicity groups as they choose to identify with.

Don Newsham, CEO of COACH Canada’s equivalent to HISA, “COACH is all about ensuring we have the professional people with the necessary skills and capabilities across Canada to actually make the EHR happen. So that, along with supporting the practice of health informatics, protecting privacy and guidelines and particular areas like that, COACH is really integral to the profession and the professional in HI in Canada.”
CEO Don Newsham

Don presented on the Canadian experience in Health informatics in particular with engaging with First Nation communities. I had to leave to attend a meeting so I was unable to hear the rest of his presentation, but you can see a brilliant talk from Don here http://www.coachorg.com/default.asp?id=933&article=215

Finally we heard from the experience in our own country, the northern territory has had a lot of success with the rollout of their SEHR (shared ehealth record) and it was wonderful to hear from the team about their stories of success and challenges they faced.

We then came together to review the initial output fromt eh brainstorming where we looked at the barriers, and then analysed these in the view of what we had just learnt from the experiences of others in this space.

A few clear themes came out:

  • Collaboration – working together on a shared common vision and end goal
  • Connectivity the actual nuts and bolts of getting internet connections to communities
  • eHealth literacy – of both patients and providers
  • Information exchange – interoperability of systems to share the relevant information
  • Culture and change management – understanding the unique cultural needs of these communities and how that impacts not only in how we engage but also what we request – may lead to unique data sets.
  • Sustainability – need to make sure we are building a scalable solution for the future.

The group then workshopped some ideas for how to address these barriers and this will lead to a vision statement and initial overview for the group to work together to achieve.

All in all a brilliant first day and one I was very proud to be part of, excellent facilitation by Tam Shepherd and open warm positive environment for sharing and learning created by all attendees.

Here’s to a focus on indigenous Informatics and how it can improve the health outcomes for these communities.

 

Posted in HIC2011, Uncategorized

Medicare rebates for Telehealth consutlations

Jennifer Campain – Department of Health and Aging. Improving Access to specialist services through Medicare rebates.

I have to admit I’m still a bit confused about who and how you get a medicare rebate but these are the notes I took from this, and I’m told more information will be coming from the department soon and that the website is a great source of information.

Connecting Health Services with the future: Modernising Medicare by providing rebates for online consultations.

  • New medicare items for Telehealth services.
  • Removing barriers for Australians in rural, regional and outer metropolitan areas.
  • $620M over 5years to support Medicare rebates for video consultations.

Financial incentive to adopt telehealth software and for training and education.

  • Males in regional and remote 1.2times more likely for mental health
  • Life expectancy 1-2yrs lower
  • 7years lower in remote areas, figures increase the more remote you are.

Key benefits are:

  • Post operative assessments,
  • discussion of diagnosis tests,
  • medication monitoring,
  • psychiatric consultations.

Big areas for people in aged care and want to care for them as well.

2002 telepsych available – low usage because of people not having the technology or training on how to use it.

So at patient end can be a nurse, aboriginal health worker or aged care worker – personal note here that I”m not sure this is strictly true, when I asked about this there was something about if they were registered as an exception instead of a GP – which I don’t really understand and any help on enlightening this subject would be great.

PN – If I live out in a rural area and I need to see a dermatologist I can arrange a consultation through my local practice and then have the video call with the specialist – who needs to sit with me in the room in order for the patient end to be OK ? If i had skype at home could I link directly with the specialist and it still get claimed for Medicare?

The patient venues and types of software have not been prescriptive intentionally to allow for trials of different solutions.

I wanted to ask – “Can you talk a little bit about the use of services like Skype and others where there may be a record kept overseas, how does that work in terms of the data privacy regulations for patient data being held overseas” But didn’t get a chance – anyone who can shed light on this again much appreciated.

Medicare fee structures – issues additional time, costs, complexity for practices who are not currently connected.

The service being provided at the patient end is new so new items for rebates are there.

Incentives will address barrier, we realise many practises are already at capacity and do not have the time to implement new systems and train staff on how to use it.

Will Doctors be able to do this from home? This could be a great incentive for working mum specialist to be able to move some of their cases to be able to do this from home.

Posted in HISA, Rural and Remote Telehealth Conference 2011 | 1 Comment

President Telemedicine Society of India – Proff K Ganapathy

Professor K Ganapathy – President Apollo telemedicine networking Foundation, President Telemedicine Society of India.

Every 6th person in the world lives in India.

Want to provide Equitable, Sustainable Healthcare for all – thats over 1Billion people…(Personal note – I’ve just returned from India and well I think this is incredibly ambitious, particularly with a multi language, multi religion community that still has a very strong Caste based view on the world. In one of the newspapers while I was there the government said that those living on 20rupees or more a day (thats less than 50c SUD) are not under the poverty line.)

Every 10th patient admitted to hospital is for a preventable issue often with medication mismanagement – WHO report.

Geography has become history. Now where you are is more and more irrelevant.

Angonda – first wii satellite hospital opened by Bill Clinton in 2000.

Apollo centre – oldest, largest telemedicine in south east asia – 115centres, 9 overseas. Over 69,000 consultations.

Child in north India had a serious brain issue – skull deformed, video call was had with the family at their local centre and three specialists who got together in Madras, (thousands of k’s away) and enabled a diagnosis and treatment advice – saved family thousands of rupees and days of travel.

80% of follow up from surgeries are now done via telemedicine.

Resource is relatively inexpensive in India so they have people who go to a patients home to enable evisits, so they set up a laptop and wireless connection on behalf of the patients and this links up to the doctor.

Now providing funding for an African help initiative, so that free telehealth consultations available for 52 countries in Africa to be able to access a cardiac or neurosurgeon and other health professionals – only able to give advice and diagnosis support at present.

Big success has been in being able to link up different students and doctors in areas where access to further education is sometimes not possible.

Big success with hospital on wheels, initial issue with the Wiisat being too big to fit on the roof and getting hit by tree’s as it travelled remotely – not smaller and not too much of an issue.

After a random call from a friend on a train who’s little baby was sick, they realised a tele-consultation can even happen on a train, given 23million indians go by train every day is there a way to put a clinic on the train? Currently in discussions with government to try and make this happen.

This could not have happened without the support of the Indian government and full task force support to create terms of reference and governance.

Professor Ganapathy finished his impressive presentation with these words “In Telemedicine we don’t’ talk about achieving world class, the world talks about achieving Indian class.”

Personal note – Health needs to address more than fixing a problem after it’s happened, e.g I broke my leg, it needs to look to preventative measures and ensuring people have clean drinking water and reasonable sanitation should be part of this too, what I saw in India is that this still has a long way to go, particularly with an ever increasing population that is causing infrastructure to struggle to cope –  it would be great if this could be addressed as part of improving healthcare.

Posted in HISA, Rural and Remote Telehealth Conference 2011

Healthcare in an NBN World a Hypothetical

Distinguished panelists were brought on stage and facilitated by Michael Gill to look at some hypothetical situations and how the new NBne neabled delivery of medicine might help them.

The first scenario was an older couple:

  • Living in their own home
  • South illawara NSW
  • Jack has slight dementia and Sue has sever arthritis
  • Unable to drive any longer.

Firstly Access to internet should be a right not a want, particularly when we see research showing that the use of computers and particularly engaging through social media can slow onset of dementia – we should all be doing it now !!

It’s important that people start to use and familiarise themselves with technology now before they need it – familiarise themselves with the tools e.g video conference.

eHealth readiness is important – and we need to look at technology that people actively embrace – social networking, online photo albums, games, reading the newspaper – and how we can use this to teach people how to interact and use digital so that when they need to use these same or similar tools for health this isnt’ a barrier.

It needs to be more than just doing what we do today via video – we need to take this as an opportunity to revolutionise and improve service delivery of health

Multidisciplinary care – many people are involved in the care and not just within the health system – wife looking after husband, daughter in London providing support to mum when she struggles with Dad’s increasing dementia, and of course the GP, specialists, nurses and allied health who work together to provide a care plan.

Aboriginal communities – the internet is so important it is the major communication tool for the whole community, and often shared.

In broadband rollout we should be doing the worst areas first it will make the biggest impact so don’t focus on improving urban areas already with good service.

Second scenario: Mr and Ms Jones, Family have opted to have a PCEHR, daughter with a chronic autoimmune conditions, live in Dubbo NSW.

Having their info in a shared online capacity such as the PCEHR means the patient has more choice to access other services, they don’t’ have to worry about who they choose to care for them having the info they need and through telehealth and remote consultations they don’t need to be limited by location either..

If the net goes down, where does the liability lie? People go back to basics, pick up the phone and dial triple zero get in the car and go to the docs, we need to ensure we dont’ fall into same old trap of letting hard cases create bad laws.

Health network needs to be strengthened, so that if disaster or other event, that the system is prioritised to stay online.

Dr Trevor Lord commented that there is enormous risk in doing a telephone consultation without having the record infront of you – and they have seen major improvements since making the records available in the kimberly. ( I really want to go to the Kimberly and see the amazing work they have done in action)

Need to think beyond just linking up doctors and doctors – it’s more than that and we need to ensure we think about this for the future of telehealth.

eHealth has revolutionised medication management for the kimberleys. We can create a dialogue with pharmacists again and involve them in the care.

It’s not about the people that provide the equipment –it has to be about the people understand about whats required, and use the money wisely and plan for the future –

Medication management is a definite area for improvement, simple reduction in mismedication, ED admissions etc through the use of PCEHR and eHealth to access accurate timely trusted information.

Dr Jenny May closed off with a brilliant vision – I’d like to get to a world where we drop the e it’s not ehealth, e education it’s just the way we do things. Here here!!

Posted in HISA, Rural and Remote Telehealth Conference 2011

Dr Ed Brown, CEO, The Ontario Telemedicine Network in Canada.

Give you a sneak peak of what’s going on in Canada, what the key success factors and an idea of what they believe the future of telemedicine is.

13M people in Ontario most people live (12M) in the south e.g Toronto – but in the north no actual roads, so use of planes to get around.

Use of trailers in the middle of nowhere to deliver healthcare and use telemedicine connected service machines in these areas.

So rural and remote issues are in common in delivering healthcare needs – big difference will be weather – Canada issues are snow –Australia wet season, heat.

One of the largest telemedicine network – 1,200 sites and using 2,200 systems. Not for profit group – funded by government mainly.

Vision – Telemedicine will be a mainstream channel for healthcare delivery.

It shouldn’t be about the technology, it should just be another way to deliver healthcare.

Goals

  • Enable fair and Equitable access to health
  • Improve the quality of health care services delivery
  • Support the sustainability of Ontario healthcare Systems
    • Reduce costs, and improve operational effectiveness

Service delivery channel

  • Live interactive videconferencing
  • Emergency telemedicine
  • Provider Education and admin
  • Store forward

It’s not about inventing technology, it’s about figuring out how to make it useful  how to integrate it with existing practices.

  • 97% of people satisfied with telemedicine.
  • 83% said there team worked better as a team via telemedicine.

Last year having telemedicine in place saved over 25M in travel grants of people in the north not having to travel, this along made the whole service (22.5M) a cost saving to gov.

A major benefit has been educational opportunities through these video links providing opportunity for further learning to those rural community workers who may not otherwise get access to further education sources.

Store Forward Telemedicine – being used particularly in Dermatology.

#1 cause of blindness is diabetes so remote teleopthamology is really important in preventing blindness in this community

Telehomecare for chronic disease management – very excited about this area,

813 cases

  • 64-66% decrease in hospital,
  • 72-74% reduction on emergency admissions.

1% of ontarios population account for 49% of Ontatios total hospital and home care budget – these are the target for telemedicine

Key success factors:

  • Harmonised governance
  • Technical standards
  • Supporting services
    • Directories, scheduling, tech support, privacy/security/ end-user training
    • Service monitoring, reporting
    • Inclusive membership model
    • Service effectiveness and evolution
      • Policies, procedures and cost reduction.

Driving adoption – need to understand and create a sales pitch around the value proposition for the individual stakeholders.

How and where will the tools be accessed and how will they be rebated/funded for the delivery of this care.

Look for local champions, Peer champions, Refinement of the ROI strategies.

Took a sales and marketing approach to this – very refreshing to hear this!!

Look at integration of these services rather than just a new service rollout.

So what to the future?

Some of the major priorities

  1. Increase awareness and adoption and ensuring it aligns with key health priorities
  2. Population based telehomecare for chronic disease
    1. Plan to have 40,000 patients using it in next 2-3years

Matchmaking facilities to link up the people who need care with those who have the availability to deliver it using same philosophy as social media. – this will be a virtual healthcare channel.

Telemedicine directory will be available soon so people can find the right people and understand how they can make appointments.

Rolling out telemedicine services so all docs have capabilities with PC and camera.

 

Posted in Uncategorized

Senator Stephen Conroy – NBN address from CEBIT

Many articles from respected journalists will be available to cover Senator Conroy’s announcement and my notes below are a quick summary of the key points I tried to capture as he was speaking (very quickly I might add!)

Here are some links I have found of coverage:

http://www.smh.com.au/technology/technology-news/conroy-launches-aggressive-nbn-sales-pitch-20110531-1fdoz.html

http://delimiter.com.au/2011/05/31/cebit-conroy-releases-digital-economy-strategy/

My notes are as follows:

The honorary Senator Stephen Conroy spoke via videolink from CebIT in Sydney to discuss the NBN.

The Gillard has a vision that is unreservedly bold, by 2020 this nation will be amongst the leading digital economy – that we will harness the potential of the NBN we propose to deliver savings, to enable us to compete on an international landscape and improve the way we deliver healthcare and education.

The NBN will facilitate a more connected, inclusive community – to drive innovation, that the distance that previously defined our working and social lives will be increasingly irrelevant.

If we are to achieve this vision we have work to do – Australia is falling behind other countries in our region – June 2010 ranked 18 for broadband penetration.

In June 2009 21.5% of business took orders online. Just under 50% didn’t have a web presence.

Only 29.7% bus located outside capital cities have a website.

World economic forum Global information tech report – network readiness report – how economies are utilising broadband for future usage, we ranked poorly.

Once people see the possibilities of high speed broadband they will be excited about the future.

The Gillard will government will take coordinated approach to delivery vision to all Australians.

The National digital economy strategy has 8 key goals that will allow us to measure how we will become a leading digital economy by 2020.

You can go to the redeveloped nbn website to find out more and download the newly released strategy which is available for all.

Initiative 23.8M provided over 3 years to reduce the number of Australians who are not engaged in the digital economy – establish a digital hub to provide digital training and to experience what they can do with high speed broadband – to develop skills to participate in the digital future of Australian.

Non metropolitan regions the focus, a 10% increase in broadband connectivity resulted increase in productivity.

Targeted action to minimise digital exclusion so everyone regardless of location can benefit from the NBN.

Australian business fall well behind other OECD countries in terms of businesses with websites and those engaged in ecommerce.

NBN enabled education programme to enable regional areas to access multi level educational services.27.2M to source, implement and deliver services to improve online educational services

The nbn and the digital economy, the most immediate benefit is likely to be healthcare

Posted in HISA, Rural and Remote Telehealth Conference 2011

Telehealth and the power of proximity

Jenny May, Chair NRHA (National Rural Health Alliance)

How can we get telehealth to ALL Australians? What are the issues with affordability, accessibility and adoptability.

It is commonly understood that your postcode determines your health outcomes, we have a focus now from government and funding to support bridging this gap and improving outcomes for aboriginal and torres strait islanders, as well as rural and remote Australians. So that those who need it most get access to care.

We need to focus care on those who currently have the worst access to care, those in remote communities and provide teh infrastructure and technology to get them online- you will see teh best results by doing this – not by making an urban community who already has access get it a bit quicker.

Elephant in the room – consumer expectations, who will pay for this, how do we ensure people get access to service that need it.

Other uses of using telemornitoring to see if the older person has gotten out of bed today, has forgotten to turn the gas off etc – will they be able to afford it? Do we need to create cost benefit analysis for this to show savings in future care needs through use of these servces.

The key though is usability, and a lot of bad sentiment was had by users initially because they had no support. Since having a dedicated person to support video conferencing there has been a radical shift in acceptance. But how do we support rural community centres to do this? Can’t afford to have an ICT tech person in each centre but need to look at future workforce needs this. A shared or managed service in a community to service not only the health centre but others, schools tourism centres etc ? Like an ICT Locum!

Posted in HISA, Rural and Remote Telehealth Conference 2011

Chris Ryan, Attend Anywhere

Chris Ryan – Attend Anywhere, presented instead of Mukesh Haikerwal – The changing role of Telehealth,

Attend Anywhere has been managing telehealth outcomes since 98, evolved open management since 2001. Not one of the bits, more a coordination of the bits

Coordinated 25,000 site hours via VC in 2010.

Also provide RACP physician lecture series, now in its 9th year

Key findings to date from Video consutlations

  • People agreed the value is beyond debate, rapid growth due to convergence of drivers
  • It’s a driver for eHealth adoption
  • High community and provider expectations.

Veterans affairs in US has invested 1.4B in telehealth to enable veterans to get care at their own home.

Video consultation is just another mode of transport so to speak, another way to deliver a healthcare conversation. So need to teach people how to drive.

Posted in HISA, Rural and Remote Telehealth Conference 2011

Virtual Maternity – a big idea

CEO of HISA and e-health champion Dr Louise Schaper kicked off the Big Ideas session for the afternoon, an opportunity to look at some big ideas for the future of telehealth, how can we use these new services to change the game and revolutionise how we deliver care.

Michael Gill, the Chair of the conference and also Director, Internet Business Solutions at Cisco joined Helen Timms, Nursing and Midwifery directo from Caboolture Hospital to discuss the idea of virtual maternity.

I wasn’t aware that Australia currently is 3 times higher than world average for caesarians. This means we have a much greater need for post op/post birth care for mum and bub.

Currently a book is provided to new mums, a paper book. Yet many mums don’t read it – who reads the instructions manual when you get a new phone? We need to make the information accessible in easy to digest, searchable snippets that can be accessed when their is a need – e.g 2am baby won’t breastfeed, don’t know what to do help!

Childbirth education classes are run at certain venues and times – so not everyone can attend because of transport issues – if it was online, it would open up access.

Timeliness is essential in educating – breastfeeding in infancy is inversely associated with adult BMI. Starting breast feeding is not always easy  they need help and information at the point of need – the internet provides this instant access when and how you need it.

It also provides access to a community of likeminded people and we have seen this with massive uptake in facebook groups and online forums for new mums.

A research proposal was put together to ask the question – Can web2.0 (social media) and other ICT solutions be used to improve the reach and quality of antenatal care and if so how?

Approach – 12 month program of desk research, consultation with Australian maternal health professionals and parents, including focus groups and workshops with a sample of 24 expectant mothers and a team of midwives and clinicians in Australia.

So far not one negative comment, everyone very excited by the opportunity – for 9 months to be able to get support when you need it online versus having to wait and go to a clinic.

So can we virtualise maternity care ?

Most activity has been done on the actual birth putting cameras in a birthing suite – rather than the pre and post care. As this is a journey – usually 9 months, it lends itself very well to the use of an interactive engaging portal to find information and share experiences.

The virtual maternity service they are creating is an interactive web portal with information and services to enable engagement and interaction for users.

So far indication from the usage show an ROI of 1-2 Million over 18 months by creating a virtual maternity service.

Brilliant presentation and I look forward to finding out more about the service, and hopefully seeing this type of service available across Australia.

Posted in HISA, Rural and Remote Telehealth Conference 2011

Real life – Practical Aspects of Telehealth

A fantastic session where real life scenarios were played out with actors to showcase how telehealth can work.  Thanks to Cisco for making this happen.

Here are some key findings from the work the team have done to date.

If you have a bad bedside manner your not going to magically get better over teleconference – people skills are very important.

Key skills needed are:

  • Dealing with the technology itself – you need to commit to learning how it works and be patient, be prepared to learn from mistakes.
  • Ensure there are greetings, consent and everyone knows who is in the room – on both sides. Ensuring privacy and consent is an open process.
  • Explaining to patients whats happening and ensure levels of voice and movement are all ok.
  • It’s not just about talking – you can draw on a whiteboard or paper and ask them to interact, engagement leads to better outcomes and understanding.
  • Explain why a physical examination is not needed – people sometimes get a bit confused and think something is missing – a doctor there can do this and the specialist can get the information needed.
  • Keep checking positions – many people are on wheelchairs and they move around so make sure you’re still in frame for the patient.
  • Keep in mind eye contact, when you look at the screen your not looking down the camera.
    • This was tackled in TV land by having teleprompt built into the actual camera. We need to look at how to do this for laptops and desktop screens.

What doesn’t work with real time video conferencing ?  what should the priorities be? Lets not limit ourselves, we should be in a phase of discovery if people are keen to trial it then great come on board and lets learn what works.

One of the most important aspects is to have a coordinator to set up the calls and get everything together so no doctor/specialist time is wasted.  No more time should be spent than is currently spent in face to face.

Question – does someone need to be with the patient? At present medicare only rebates the doctor to specialist. Where best it is desirable to have the patient go to a clinic to then video conference with a specialist. But if someone is on a remote farm and has video conferencing capabilities shouldn’t they have the opportunity to have a consultation with a doctor?

Posted in HISA, Rural and Remote Telehealth Conference 2011

Prof John Wilson, Making sense of telemedicine and EHR in the workplace

Professor John Wilson, Head Cystic Fibrosis Service, Alfred Hospital Melbourne. Making sense of Telemedicine and EHR in the workplace.

The bigger problems are attitudinal not so much technical – we need integrated solutions to fit in with existing solutions.

Intergenerational report highlights that the number of people paying tax is going down and the number needing care is going up – not a good scenario.

It’s not easy to explain to people how to link up technology to people who are not literate in IT. And interoperability is a big issue.

It’s important to make decision making part of record keeping. Information needs to be actionable.

Barriers to implementation – be aware that one size does not feel all – staff and patients had different view – number one for patients –  patient privacy, vs lack of funding and slow internet access main issues for doctors.

Posted in HISA, Rural and Remote Telehealth Conference 2011

Use of Technology for health learning – Sally Clark, Notre Dame

Sally Clark, University of Notre Dame – Combining web based classrooms and e-learn tools. Increasing access to nursing education in the Kimberly.

It’s important to link patients and doctors, but we can also use this technology to improve educational pathways for resources in rural areas.

Developing pathways into Diploma and bachelor of nursing – e.g those in aged care or caring services wishing to upskill to become qualified nurses.

Asking students to have to come to a major town even if it is only every 6 weeks is still impractical as students couldn’t travel that far – you might have only 1 or two students in a community doing that course so not enough to form a corum for a face to face group.

Illuminate was used to provide online classroom so people can access this from home and feel part of a group – worked really well and out of 16 students who took up the course 14 finished versus 1 when students required to travel to Broome.

Biggest barrier was bandwidth and this often marred students view of the service.

Great to see the use of gaming and design to create an online nursing toolbox which helped students be motivated to do their journal work between sessions. A book with texts isn’t very exciting.

Maryann Martin Hospital – a virtual hospital where students go online and can learn and participate in care and answer questions throughout – like a virtual gaming version of their journal or workbook and gets far more engagement and usage by students.

Currently no integration with traditional consumer facing social media services like facebook, all interaction done through there own service.

Posted in HISA, Rural and Remote Telehealth Conference 2011

John Grant, Cisco – Innovations in post disaster care, Sichuan experience

John Grant from Cisco shared his experience of the Sichuan Earthquake and how they provided connectivity to enable delivery of care. Example many Trauma patients needed rehabilitation and doctors and nurses were flying up and down the province, a fantastic website driven by a gentleman in Hong Kong – sorry I missed his name, recommend you go and check out standtallchina.com.

Telepresence system by Cisco brought people into office in Hong Kong and linked them up with people in Sichuan. This was televised and led to a real understanding and motivation to support this moving forward.

Physiotherapists, counsellors and others in Hong Kong linked via video conference to Cheng Du (Sichuan) talking to patient and his doctor on how to do best exercises and activities to improve the use of his new prosthetic hand after surgery.

They also developed a mobile clinic so they can go into schools and other places and provide the service to the children who had to have amputations from injuries from the earthquake.

It is remarkable what can be achieved in a crisis, the political barriers are often dropped away as real need comes to the forefront – the key is to turn that into sustainable long term changes.

Another service that was created was a Mobile health Clinic to provide care to people who could not come into a hospital – big challenges came from very rough terrain and weather difficulties.

Amazing what a command and control government can do – the first call was a jittery bad static, one call from the minister of health to minister of ICT who then called CEO of China Telecom… in 20minutes broadband freed up and quality fantastic.

TV on the outside of the mobile health truck generated fantastic responses for public health announcements in areas often hard to get messages to.

Trucks have been so successful that the ministry of health is now looking to see how these can now be used to provide care ongoing in remote areas.

Jury is still out on whether the investment needed for these trucks is recouped by day to day care – the earthquake provided the catalyst to release investment which now means the trucks can be available.

4.4T spent on health care 15% on diagnosis 10% on monitoring, 70% treating. 5% predict.  The earlier and more accurately you can diagnosis the better the outcome and the less the cost will be both financially and emotionally.

Samsung created a disc that enables easy diagnosis. It’s a laboratory on the dish.

Can you bring the diagnosis out to the patient? In a controlled and safe trusted environment – why not?

Only $4 a test. And results in 11minutes,  device itself is not pressure sensitive. The discs and the reagents need to be stored between 4 and 12degree’s. Is it acceptable to pathologists – compared to the central laboratories it is 100% accurate.

Here is a link to a paper I found on Google on this – http://www.rsc.org/binaries/LOC/2008/PDFs/Papers/155_0694.pdf

Posted in HISA, Rural and Remote Telehealth Conference 2011

James Ferguson – NHS Telehealth Grampians Scotland

Mr James Ferguson from the NHS . Aberdeen Scotland. Will technology revolutionise healthcare in the 21st century?

Need to transform not just reinvent, or do the same things we normally do with technology.

Everyone knows the stats – 21% rise in 65+ from 2006 to 2016 62% rise by 2030.

The definition of insanity is to keep doing the same thing and expecting different results. Are we just Technologifying the existing process of face to face consultation or are we looking at technology as an opportunity to do things better, a need to take a giant leap forward rather than continue running on the hamster wheel.

Doctors tend to be very risk averse with litigation worries, so doctors rather send the patient to hospital “just in case”

Need to rethink the way we deliver care – separate data collection from Interpretation – we have been drilled into thinking that the Doctor MUST gather the data, it must be face to face – why? Isn’t the important part the interpretation of the data – is there a way to utilise different resources to gather the information remotely – particularly with predicted issues of limited resource availability and increased demand for care.

Telehealth will be the penicillin of this century – it was discovered in 1928 but not used till the war in 1939– we need a driver to push forward and transform the delivery of care through Telehealth.

In Scotland in 05 Kerr report stated you have to use more telehealth. So Scottish centre for Telehealth and telecare was created to understand pilots and harness the learning’s.

Main work done on Telecare – providing remote monitoring tools in the home for older people.

Interesting…. Says anyone can put a scope down or use an ultrasound.

Did a randomised blind test and showed people a 5minute video on how to use an ultrasound machine and asked them to do a scan and then showed results to 5 different radiographers and asked them if they saw a difference, noone could tell the difference between the ones done by new users (14yr old daughter of James!) and professional consultants.

Repeated the project in Canada on a mountainside with an iphone and skype – it worked and it was cheap .

Got the tools, got good evidence that this works – BUT people are not good at change, patients are open to this it’s the doctors who are holding it back.

Prioritisation for usage – Chronic obstructive pulmonary disease, stroke, paeds, mental health, rehab.

Key focus has to be on improving patient outcomes – yah!

James then went on to show a piece in the James Bond movie he wrote where James is poisoned and runs to his car and uses Telehealth to connect and enable him to save himself… well nearly clearly a beautiful Bond babe was needed as well!

Fantastic presentation by James and I recommend you to learn more about the work he has done and view the HISA website for the presentation when it becomes available.

Posted in Uncategorized

Notes from Welcome and first Plenary session

Jeanette Singleton, provides a welcome to country, she is a respected Tribal elder of the Yirrganydji people.

Michael Gill chair of the steering committee, then provides a further welcome and brief introduction to the topics to be discussed over the two day conference.

Telehealth – monitoring health at a distance, enabling connections, video capture and storage as well as real time 3D video environments.

Julie Harley Jones CBE – District CEO, Cairns and hinterland health service – kicks off the first plenary session to discuss her thoughts on telehealth.  Issues faced in rural and remote areas such as far north Queensland are unique– health services are not “just down the road” particularly in the wet season, whole areas are cut off and the only way to access services is by plane – very expensive.

How is technology helping QH to delivery healthcare to remote patients?

In CHHHC they service 250,000 people with 4,000 staff.

Mission is to provide care in or as near to a patients home as possible, only possible with the advent of telehealth.

QH spent 9.552B on healthcare, installed 85 new Telehealth systems, bringing the total to more than 800.

Over 900 video conf end points, linking to over 260 facilities, with 121thousand hours of video, increasing strongly each year.

Increased demand + pressures on Supply + new technology enabled models of care = high quality healthcare.

Telehealth being used for – mental health, cdm, cancer, maternity and populationss at risk Aboriginal and Torres strait islanders..

Benefits – more access, reducing travel costs and inconvenience for individuals, greater support for new grads and further education.

Diabetes, foot and wound services, diabetes management – big need in Cape York community.

Ehab-multidisciplinary rehab services showing great improvements to provide post op care to people back in their own community.

Cyclone Yasi – the biggest evacuation of patients in Australia – 200 patients in 18hours. Key learning’s came from the transfer of the records and ensuring robust connectivity for the future.
Future will be looking to– NBN, Private/public access – supporting indigenous, team based remote care.

Posted in HISA, Rural and Remote Telehealth Conference 2011

Rural and Remote Telehealth Conference begins

Hello everyone,

My name is Rachel de Sain and I have the privelege of writing a blog and sharing the exciting announcements, news and information being presented at the Rural and Remote Telehealth Conference brought to you by HISA.

Things kicked off this evening with a warm welcome from CEO Louise Schaper, who then handed over to Bernadette Gibbons from Telstra to introduce Kylie El-Sheikh CEO of Tristar Medical Group who provide a number of clinics in rural areas of Victoria and New South Wales and believe in providing the same quality of care to those outside major urban centres, and this goal is being achieved through the use of innovative telecommunication tools.  Jon Hughes, Director Smart Health Solutions at Telstra closed the presentation with an honest look at the e-health journey to date and his optimism that the increase of commitment and activity over the last 12months shows us we are moving in the right direction, but need to remember to look to systems, infrastructure and solutions already in place rather than just create new systems that may lead to further silos.

Things kick off tomorrow morning with a traditional welcome which I’m looking forward to and I am pleased that more conferences seem to be paying respect to the aboriginal communities.

Lots of great presentations planned for tomorrow, wish I could split myself in two and be at both sessions, but will try and capture the pertinent points and summarise for those that can’t attend the conference here on this blog.

If you have any questions or want to follow further I’ll also update key points on twitter using hashtag #thealth.

Posted in Rural and Remote Telehealth Conference 2011 | Tagged ,

DOHA E-Health Conference 2010 – Summary Resources

The HISAnews blog – this site has been ‘hit’ and referenced a LOT.  Thank you all for your positive feedback.  I’m so pleased this site has been useful for you.  For those of you who aren’t HISA members, I encourage you to join and become part of Australia’s peak body for health informatics and e-health.  We’ve been supporting and representing the community for almost 20 years and it’s a great time to be in e-health. 🙂

Videos capturing the webstreams and other materials is also available on the conference website – www.ehealthconference.gov.au/agenda.asp

Pieces from the press covering the event:

NBN sites Armidale, Kiama Downs to test e-health in NSW.  Karen Dearne, Australian IT, 1/12/10

Private sector key to e-health rollout, says Roxon. Karen Dearne, Australian IT, 1/12/10

AMA attacks e-health record plan.  Sue Dunlevy, Australian IT, 1/12/10

NBN first release sites to trial telehealth. James Hutchinson, Computerworld, 1/12/10

http://ehealthspace.org/

http://www.ehealthcentral.com.au/

 

Government announcements made at the conference:

Opening Address to the E-Health Conference, Revolutionising Australia’s Health Care, Melbourne.  Minister Roxon’s speech. 30/11/10.

Next Step for Telehealth Services for Patients.  30/11/10.  Released a telehealth discussion paper which can be found at www.mbsonline.gov.au Submissions close on 27 January 2010.

Mobile Phone Applications Could Help Revolutionise Health Care in Australia. 30/11/10

Telehealth Trials for NBN Sites: Armidale and Kiama. 1/12/10.  Announcement: $4m for NSW health to trial development of telehealth in people’s homes. Trial will allow installation of telehealth monitoring units and high-quality video conferencing in homes of veterans and people over 65 and at their clinics in Armidale and Kiama Downs.

Posted in AU News, DOHA E-Health Conference 2010 | Tagged , , ,

Rosemary Huxtable, Deputy Secretary, Department of Health and Ageing

Topic: Next steps and the way forward – working together

 

  • We are here in partnership with all stakeholders in e-health.
  • Thanked participants and organisers for pulling a successful event together in such a short timeframe.
  • Thanked NEHTA for their assistance with organising the pre-conference roundtables.
  • Last 2 days have been ‘fantastic’.  Great to hear from so many national and international experts in e-health.
  • We will be learning from the lessons espoused by others in this forum.

Key messages:

  • E-health is a reform enabler.  Sits at the centre of health reform.  Includes telemonitoring, PCEHR and telehealth and others.
  • Significant investment on the table from government – $466m for PCEHR; $350M telehealth; NBN investment
  • Acknowledged cautions on what to expect and need to manage expectations.
  • Need to deliver PCEHR and others and have that as a platform for further investment
  • Importance of getting legal framework right.
  • Privacy and consent arrangements right – current quality clinical information available, balanced with consumer control.
  • Engagement – formal mechanisms to engage State and Commonwealth governments and other stakeholders where information flows and we need to find the mechanisms to guide and influence and to enable the level of collaboration and engagement that everyone is seeking.
  • Critical success factors – produce a high value record that transforms the consumer and clinician experience.
  • Need to produce a high value product that can be built on as we continue to go forward.
  • Need to show tangible benefit in a relatively short timeframe – “the living business case challenge”. Drive the capacity to persuade others that further investment is needed.
  • Sustainability – a model that can be integrated with practice and that provides a viable basis going forward.
Posted in DOHA E-Health Conference 2010 | Tagged ,