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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
outlying communities – Examples: • Diabetes, Tauranga hospital to Opotiki practice –
operating • 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 - operating
• 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