TELEHEALTH - Innovation in Healthcare Delivery Midland Region joint - - PowerPoint PPT Presentation

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TELEHEALTH -

Innovation in Healthcare Delivery

Midland Region joint Boards, 7 November 2014

Simon Everitt, BOP GM Planning and Funding, Owen Wallace, BOP GM Information Management Ernie Newman, Project Coordinator

Agenda

• Introduction to Telehealth
• What is Telehealth?
• What is the existing base?
• Creating a Telehealth Community
• Demonstration Project
• Observations / Lessons Learned
• Opportunities for Future
• Making it sustainable
• Regional Perspective

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What Is Telehealth?

• Means many things! Examples:

1 Use of telecommunications as an enabler of clinical or managerial communication involving health services 2 Video consultations in which there is a patient present, and remote monitoring of patients’ conditions

• “Telehealth” is understood in the sector, but for public

understanding we are learning to talk about “Video Doctor services” or “Video Outreach Clinics.”

• Today in the context of the BoP and the Project we are

focused on the use of video communication for clinical consultations between health professionals and patients.

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NZ Telehealth Examples

• NZ Telepaediatrics – national network delivering Starship

grand rounds & clinician support (10+yrs)

• Canterbury / West Coast – remote support for primary and

secondary service delivery in West Coast (10+yrs)

• Waikato – Teledermatology service (10+yrs)
• Northland – base hospital support for rural facilities eg Renal

service between Whangarei & Kaitaia (5yrs)

• BOP – Mental Health clinical support service (5+yrs)
• Te Whiringa Ora – community based remote monitoring (3yrs)
• Regional Cancer Networks – Multi Disciplinary Meetings

support (<2yrs)

Telehealth Demonstration Project

• Ministry of Business, Innovation and Employment
• Wanted to explore how Ultra Fast Broadband and Rural

Broadband would be used in health

• National Health IT Board
• Telehealth is part of the Health IT Plan, wanted to learn more of

what works and otherwise in NZ setting

• Bay of Plenty District Health Board
• Selected for the Project because of existing commitment
• Tairawhiti District Health
• Joined early 2014 – significant potential benefits

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The 2 Phases Of The Project:

March 2013 - August 2014 – “Evangelise and Scatter” – supply cameras and connectivity to suitable health sites with receptive professionals, encourage use, and learn from the results. September 2014 - February 2015 – “Consolidate and Sustain” – build usage and scale into established video infrastructure, aiming for regular usage within solid, sustainable frameworks.

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Telehealth Project “Community”

Map dated Nov 2013. Since added Te Araroa, Tikitiki, Ruatoria,Te Puia, Tokomaru Bay, Tolaga Bay, Gisborne x5, Kawerau, Katikati, Te Puna

VIDEO CAPABILITY SEPT 2014

3 Examples of Telehealth Service:

• Video Outreach Clinics
• Video Doctor Services
• Emergency Support

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VIDEO OUTREACH CLINIC Church Street Surgery, Opotiki

Video Outreach Clinics:

• Hospital-based services being delivered to patients in
• utlying communities – Examples:
• Diabetes, Tauranga hospital to Opotiki practice –
• perating
• Diabetes, Gisborne Hospital to Te Puia and Tokomaru

Bay Hauora – starting early November

• Mental Health Christchurch specialist with Tauranga

patients, and Gisborne hospital with Ngati Porou clinics -

• perating
• Renal, Hamilton Hospital to Whakatane Hospital –

starting 18 November

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Video Doctor Service:

GPs consulting patients in hard-to-reach communities by

• video. Examples:
• Te Awanui Hauora on Matakana Island, with Te Akau

Hauora at Papamoa Beach – operating; to be joined by Katikati and Te Puna

• Ngati Porou sites – patient at one clinic with GP at another

– coming soon

• Video:

EMERGENCY SUPPORT Treatment room, Opotiki Community Health Centre

Emergency Support

• Video support for front line staff handling emergency

situations

• Examples:
• Opotiki Community Health Centre - Video support from duty

GP at home after hours

• Whakatane-Tauranga ED/ICU support (pre-dated Project) –

limited usage

• Gisborne Hospital support for Ngati Porou clinics in

emergency – yet to convince Gisborne ED doctors

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Other Opportunities Awaiting:

The opportunity:

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Opportunities:

• Smoking cessation – already trialed Gisborne-Ruatoria
• Palliative care (3 hospices video-enabled)
• Mental health – child and adolescent, addiction services
• Chronic Conditions - Cardiology, Respiratory (COPD)?
• Maternity – eg Rural birthing units to O&G support?
• Allied Health - eg Dietitian?
• Other?

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The Payback: Major Beneficiaries

• Short Term –
• Patients in isolated communities,
• Health professionals - reduced need to travel / more consult time,

support for rural practitioners

• Medium term –
• Chronic condition patients - comprehensive, timely and less intrusive

management via combination of video and remote monitoring;

• Health professionals working to full extent of their practice capabilities
• Long term –
• Patients who currently miss out on treatment will be captured and

treated earlier due to easier interaction with services, with a wide range of savings from earlier intervention

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The Potential Is Enormous:

• Earlier interventions & better deployment of clinical resources
• Lower travel time & $ for patients - timely treatment, reduced DNAs
• Earlier intervention - longer term cost savings
• Reduced locum & travel costs for DHB
• A key enabler of 21st century health service delivery systems,

designed to cope with aging population, aging health workforce, and advanced health technologies

• Telehealth does not exist in isolation. It enables change but

does not itself create change. Requires re-engineering of services if telehealth isn’t to become expensive overhead.

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Observations & Lessons Learned

“Telehealth Is Easy” Because:

• Technology & connectivity aren’t the issue:
• Entry level technology is inexpensive to install
• Connectivity has improved markedly in recent years
• The running cost is low – a video call within NZ is often

cheaper than an equivalent voice toll call

• Client adoption - many users understand and are

comfortable with video due to early, “free” examples such as Skype

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“Telehealth Is Hard” Because:

• Telehealth is disruptive to conventional ways of working:
• impact on clinical work flows
• remuneration structures / practices
• medico-legal accountabilities and risk
• how disparate groups work together – primary/secondary/tertiary;

doctor/nurse; hospital clinics

• Video challenges the basic tenet that the only way for a

patient to consult a clinician is one-on-one, face-to-face

• Network carrier commercial arrangements and

behaviours inhibit widespread expansion

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Lessons

• It only takes a handful of visionaries to start a movement

for change; the trick is to identify and work with them

• Speed of adoption - Primary / Community vs Secondary
• Sustaining the gains requires stakeholder commitment

and leadership

• Challenge of appropriate investment:
• End Points:

$300 to >$30,000

• Rooms:

<$5000 to >$60,000

Where To From Here?

• Regional Telehealth Strategy - developed 2013/14
• Regional Telehealth Advisory Group – transition from

interest group to advisory group

• Chaired by Dr Ruth Large, Waikato ED specialist
• Regional Co-ordination – development of consistent

approaches - policy, protocol, standards, templates

• Local operational delivery – engagement and adoption

likely to be greatest at local &/or sub-regional levels

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Questions / Discussion