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.

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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.

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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.

 

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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