ehealth conference 2011 - dr anthony smith, centre for online health
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Emerging Health Applications and Emerging Health Applications and Mobile Delivery
TELEPAEDIATRICSTELEPAEDIATRICS
Associate Professor Anthony Smith
Centre for Online Health
eHealth @ CeBITJune 1 2011 - Sydney, Australia
Centre for Online HealthUQ research centre closely linked with the RCHUQ research centre closely linked with the RCH
Ce t e o O e ea tUQ research centre closely linked with the RCHUQ research centre closely linked with the RCHresearch activities combined with service deliveryresearch activities combined with service deliveryt l di i t l h ltht l di i t l h lthtelemedicine, telehealth…telemedicine, telehealth…teaching teaching –– eHealthcare courses, SFT ConferenceeHealthcare courses, SFT Conferencefocus is on clinical workfocus is on clinical work
telepaediatricstelepaediatricspptelegeriatricstelegeriatrics
Why telehealth?y te e ea t
Inequality of access to health careInequality of access to health careSSpecialistpecialist services typically in metro areasservices typically in metro areasDistributed populationDistributed populationLarge distances and travel timeLarge distances and travel time
++llogisticsogisticsggcostscostsstressstressiinconveniencenconvenience
Where is the incentive? e e s t e ce t e
It It is is more convenient to transfer a patient more convenient to transfer a patient through the conventional system than to arrange through the conventional system than to arrange a telehealth consultationa telehealth consultationa telehealth consultation a telehealth consultation
O f h f i d f ff iO f h f i d f ff iOne of the factors required for an effective One of the factors required for an effective telehealth service is a single point of contact telehealth service is a single point of contact --telehealth coordinationtelehealth coordinationtelehealth coordinationtelehealth coordination
Smith AC, Isles A, McCrossin R, Van der Westhuyzen J, Williams M, Woollett H and Wootton R. The point of referral barrier - a factor in the success of telehealth, Journal of Telemedicine and Telecare 2001; 7 (Suppl.2): 75-78
Telepaediatric Servicee epaed at c Se ce
Commenced in November 2000Commenced in November 2000Central referral centre with 1800 direct phoneCentral referral centre with 1800 direct phoneCentral referral centre with 1800 direct phone Central referral centre with 1800 direct phone number:number:
RCHRCHRCHRCHMater ChildrenMater Children’’s Hospitals Hospital
Clinical support service Clinical support service –– not technology drivennot technology drivenLargest reported service of its kind in AustraliaLargest reported service of its kind in Australia
Smith AC, Isles A, McCrossin R, Van der Westhuyzen J, Williams M, Woollett H and Wootton R. The point of referral barrier - a factor in the success of telehealth, Journal of Telemedicine and Telecare 2001; 7 (Suppl.2): 75-78
Telepaediatric Servicee epaed at c Se ceG lGeneral
paediatrics
S bSub-Specialist referrals
Home telehealth
Telepaediatrics
Critical careIndigenous
health screening
Neonatal intensive
care
Telepaediatric Activity (10y)Neurology
10%(n = 11,250 consultations)
e epaed at c ct ty ( 0y)
ENT7%
Burns14%
General Paediatrics5%
7%
Endocrinology5%
Orthopaedics
Nephrology3%
Oncology3%
Child Psychiatry27%
O hth l l
Cardiology2%
Orthopaedics2%
Other18% Dermatology
2%
Ophthalmology2%
Telepaediatric Activitye epaed at c ct ty11 250 consultations over 10 years11 250 consultations over 10 years11,250 consultations over 10 years11,250 consultations over 10 years2400 consultations per y2400 consultations per y
2400
2800
2000
2400
1200
1600
400
800
02000 2002 2004 2006 2008 2010
Post-acute burnsost acute bu s
17% of all burns outpatients17% of all burns outpatients
FTF appointments Telepaediatrics
17% of all burns outpatients17% of all burns outpatients
1800
2100pp p
1200
1500
atio
ns
900
1200
Con
sulta
300
600
02001 2002 2003 2004 2005 2006 2007 2008 2009 2010
ENT pre-screening clinics
2 years2 years –– 152 consultations (97 pts)152 consultations (97 pts)2 years 2 years 152 consultations (97 pts)152 consultations (97 pts)Retrospective audit of medical notesRetrospective audit of medical notesDiagnosis Diagnosis –– 99%99%Management Management –– 93%93%
Smith AC, Dowthwaite S, Agnew J and Wootton R. Concordance between real-time telemedicine assessments and face-to-face consultations in paediatric otolaryngology. The Medical Journal of Australia. 2008, 188 (8): 457-460
Indigenous healthd ge ous ea t
Middle Middle ear infections are very ear infections are very commoncommon
LongLong--term impact:term impact:
11--3y; severe disease burden (discomfort)3y; severe disease burden (discomfort)44--5y; slow language5y; slow languagey; g gy; g g55--7y; slow learning7y; slow learning1010--11y; behaviour problems, truancy11y; behaviour problems, truancy15y; 15y; illiteracy, substance illiteracy, substance abuseabuse
Indigenous health screeningd ge ous ea t sc ee g
Community health servicesCommunity health servicesVisiting specialistsVisiting specialistsg pg p
ENTENTDentalDentalDermatologyDermatologyOphthalmologyOphthalmology
Outreach –physical travel OphthalmologyOphthalmology
PsychiatryPsychiatryRespiratoryRespiratory
to remote sites
Indigenous health screeningd ge ous ea t sc ee g
Indigenous health workersIndigenous health workersSpecialist Specialist outreach services and telehealth supportoutreach services and telehealth supportpp pppp
ENTENTDentalDentalDermatologyDermatologyOphthalmologyOphthalmologyOphthalmologyOphthalmologyPsychiatryPsychiatryRespiratoryRespiratory
Indigenous health screeningd ge ous ea t sc ee g
To provide routine health screening for all Indigenous children in Cherbourg and surrounding communitiessurrounding communities
To develop a service which can be managedTo develop a service which can be managed locally by dedicated Indigenous health workers.
To improve screening rates – above 90%
To ensure early detection (assessment) and treatment of chronic diseases.
Indigenous health screeningd ge ous ea t sc ee g
= Telepaediatric health screening unit
C = Telepaediatric health screening clinic
= Specialist siteS
D = Database
BiloelaMoura
Woorabinda
C
DS
Mundubbera
Kingaroy
Theodore
Gayndah MurgonCherbourg
Indigenous health screeningd ge ous ea t sc ee gPre: 380 / 980 = 39% (average rate per annum)Pre: 380 / 980 = 39% (average rate per annum)Pre: 380 / 980 = 39% (average rate per annum)Pre: 380 / 980 = 39% (average rate per annum)Post: 83% (first 12 months)Post: 83% (first 12 months)
100
Overall screening rate % (n=980)
70
80
90
100
40
50
60
10
20
30
02006 2007 2008 2009 2010
Indigenous health screeningd ge ous ea t sc ee gResults (February 2009Results (February 2009 –– June 2010)June 2010)Results (February 2009 Results (February 2009 –– June 2010)June 2010)
Cherbourg region only All Casesg g yTests Pass Fail Tests Pass Fail
Ear 301 113 188 1046 699 347physical (62%) (33%)Hearing 215 172 43
(20%)884 807 77
(9%)( ) ( )
Vision 151 127 24 (16%)
721 638 83(12%)(16%) (12%)
Anaemia 109 75 34 (31%)
628 521 107(17%)
Elliott G, Smith AC, Bensink ME, Brown CA, Perry C, Stewart C and Scuffham P. The Feasibility of a Community-Based Mobile Telehealth Screening Service for Aboriginal and Torres Strait Islander Children in Australia. Telemedicine and eHealth Journal, 2010, 16 (9): 950-956
Telepaediatric robotsp
Smith AC, Coulthard M, Clark R, Armfield N, Taylor S, Goffe R, Mottarelly I, Youngberry K, Isles A and Wootton R. Wireless telemedicine for the delivery of specialist paediatric services to the bedside. Journal of Telemedicine and Telecare 2005, 11 (Suppl. 2): 81-5
Telepaediatric robotsLogistics:Logistics:
pLogistics:Logistics:
All referrals centrally managed through the COHAll referrals centrally managed through the COHSystems operated over VPN ISDN or DSLSystems operated over VPN ISDN or DSLSystems operated over VPN, ISDN or DSLSystems operated over VPN, ISDN or DSLRemote management of systemsRemote management of systems
ffRoutine testing of systems and email alertsRoutine testing of systems and email alerts
Telepaediatric robots20052005 –– Gladstone Hospital, no paediatricianGladstone Hospital, no paediatrician
p2005 2005 Gladstone Hospital, no paediatricianGladstone Hospital, no paediatrician
daily ward roundsdaily ward roundssubsub specialist consultationsspecialist consultationssubsub--specialist consultationsspecialist consultations
Smith AC, Coulthard M, Clark R, Armfield N, Taylor S, Goffe R, Mottarelly I, Youngberry K, Isles A and Wootton R. Wireless telemedicine for the delivery of specialist paediatric services to the bedside. Journal of Telemedicine and Telecare 2005, 11 (Suppl. 2): 81-5
Telepaediatric robots20062006 -- 2008 funding to expand robot network2008 funding to expand robot network
p2006 2006 2008 funding to expand robot network2008 funding to expand robot network
four new systemsfour new systemspaediatric support and educationpaediatric support and educationpaediatric support and educationpaediatric support and education
Smith AC, Coulthard M, Clark R, Armfield N, Taylor S, Goffe R, Mottarelly I, Youngberry K, Isles A and Wootton R. Wireless telemedicine for the delivery of specialist paediatric services to the bedside. Journal of Telemedicine and Telecare 2005, 11 (Suppl. 2): 81-5
Eliza – Mt Isa
ROY – Gladstone
Tiny Tom -Townsville
Emma - EmeraldGypsie – Gympie
Telepaediatric robotspNeonatal cases referred from Neonatal cases referred from Mackay to Townsville Mackay to Townsville –– about about 350 350 km apart km apart
Limited communication Limited communication during admission, discharge during admission, discharge planning difficultplanning difficult
Mackay
Weekly ward rounds with Weekly ward rounds with both sites the patient andboth sites the patient and
Tiny Tom – Townsville
both sites, the patient and both sites, the patient and familyfamily
Family costs Travel time FTF (n=200)
a y costs• Average per family
(min)
Di t
( )
VC (n=200)
Distancetravelled (km)
Direct costs(A$)
Time off work(min)
0 50 100 150 200 250
Smith AC, Youngberry K, Isles A, Mc Crossin R, Christie F and Wootton R. The family costs of attending hospital outpatient appointments via videoconference and in person, Journal of Telemedicine and Telecare 2003; 9 (Suppl. 2): 58-61
Health department
QueenslandQueensland HealthHealth
ea t depa t e t
Queensland Queensland HealthHealthPatient travel subsidy $Patient travel subsidy $4545M+ M+ per yper ypotential potential for significant savingsfor significant savings
Smith AC, Scuffham P and Wootton R. The costs and potential savings of a novel telepaediatric service in Queensland. BMC Health Services Research 2007, 7:35, available online at http://www.biomedcentral.com/1472-6963/7/35
Key lessons
T l di i h l i t h lthT l di i h l i t h lth
ey esso s
Telemedicine can help improve access to health care Telemedicine can help improve access to health care for people in rural and remote communities, but its for people in rural and remote communities, but its uptake has been slow and fragmented.uptake has been slow and fragmented.uptake has been slow and fragmented.uptake has been slow and fragmented.
For telemedicine to become a mainstream For telemedicine to become a mainstream service, its focus must move beyond service, its focus must move beyond simply the provision of equipment and simply the provision of equipment and network connectivitynetwork connectivitynetwork connectivity.network connectivity.
The success of telemedicine depends onThe success of telemedicine depends onThe success of telemedicine depends on The success of telemedicine depends on administrative and clinical systems that administrative and clinical systems that support its operation.support its operation.
Smith AC and Gray LC. Telemedicine across the ages. The Medical Journal of Australia. 2009, 190 (1): 15-19
Critical factorsC t ca acto s
Clinical servicesClinical servicesInfrastructure equip and telecommunicationsInfrastructure equip and telecommunicationsInfrastructure, equip and telecommunicationsInfrastructure, equip and telecommunicationsAdministrative and clinical systemsAdministrative and clinical systems
Developments...e e op e ts
National Broadband Network (NBN)National Broadband Network (NBN)
Potential for telemedicine...Potential for telemedicine...
Improved access and affordabilityImproved access and affordabilityGreater reliabilityGreater reliabilityGreater reliabilityGreater reliabilityPrimary care applicationsPrimary care applications
Developments...e e op e ts
Medicare (MBS) reimbursements for videoMedicare (MBS) reimbursements for video--consultations commence in July 2011consultations commence in July 2011
IIterativeterative implementation recommended:implementation recommended:security, privacy and authenticationsecurity, privacy and authenticationhhardwareardware and softwareand softwareInteroperability and integrationInteroperability and integrationcchangehange managementmanagement
Gray LC, Smith AC, Armfield NR, Travers C, Croll P, Caffery LJ. Assessment of Telehealth Implementations and Associated Requirements. Dept. of Health and Ageing, May 2011
Change managementC a ge a age e t
Telehealth implies a change in practiceTelehealth implies a change in practiceRRee--thinking how services are delivered (FTF, VC)thinking how services are delivered (FTF, VC)This may take considerable time and the results This may take considerable time and the results are unpredictableare unpredictableNNeeds organisational support for success eeds organisational support for success ––across a wide range of settingsacross a wide range of settings
Gray LC, Smith AC, Armfield NR, Travers C, Croll P, Caffery LJ. Assessment of Telehealth Implementations and Associated Requirements. Dept. of Health and Ageing, May 2011
ConclusionsCo c us o s
Centralised telehealth coordination model is Centralised telehealth coordination model is effectiveeffective aand sustainablend sustainableeffective effective aand sustainable.nd sustainable.
Service delivery models should include aService delivery models should include aService delivery models should include a Service delivery models should include a combination of telehealth, outreach, local and combination of telehealth, outreach, local and tertiary servicestertiary servicestertiary services tertiary services
Practical tips…act ca t ps
Develop new telehealth services systematicallyDevelop new telehealth services systematicallyStart small and gradually expandStart small and gradually expandg y pg y p
New applications:New applications:New applications:New applications:Feasibility, technical, user satisfactionFeasibility, technical, user satisfactionClinical efficacy Clinical efficacy –– comparable to FTFcomparable to FTFyy ppEconomic evaluation Economic evaluation –– patient, health service, societypatient, health service, society
Learn from experience Learn from experience –– successes and failuressuccesses and failures
SFT 11SFT-11• December 1st 2nd 2011; Brisbane• December 1st -2nd, 2011; Brisbane• 2nd Annual General Meeting – ATHS• Abstracts close 25th July 2011
www.sftconference.com.au• Australasian TeleHealth Society
www aths org auwww.aths.org.au
Dr Anthony Smith
Deputy Director, Associate ProfessorCentre for Online Health
Email: [email protected]: www.uq.edu.au/cohq