ITP Techblog

Telehealth is redefining the way people interact with health services and can contribute enormously to how individuals manage their own health. That's according to Ernie Newman, project facilitator of the Telehealth Demonstration Project in the Bay of Plenty, who spoke at the IITP National Conference in Tauranga last month.

He says it's a logical step for health services to utilise modern communications technologies, and that telehealth is a vital part of an evolving ecosystem that targets appropriate services and situations.

Global trend

Earlier this year the OCED released a report 'ICTs in the Health Sector - toward smarter health and wellness models' which neatly sums up the new approach to healthcare:

"Today's health care is reactive, episodic, and focused on disease. The new health care will need to be pro-active, preventive, and focused on quality of life and well-being. Current health care is hospital- and doctor- centred. The new smart models will need to be patient- centred and much care will be provided at home and include the broader social network (with family and community contributing significantly to individual health and well-being.)"

NZ experience

Telehealth is a component of the National Health IT Plan, and while there have been several successful implementations around the country, few applications have had sufficient scale to show telehealth's full potential.

This is partly why the Telehealth Demonstration Project was launched. It is a tripartite initiative of the Ministry of Business, Innovation and Employment, the National Health IT Board and the Bay of Plenty District Health Board.

Bay of Plenty was chosen because the clinicians and management are telehealth-literate and have a track record of innovation. Some telehealth initiatives that were already underway were in the areas of speech language therapy and mental health.

In addition, the region itself has the "appropriate demographics" - an aging population, remote communities, and Maori health challenges. It also helped that Ultra Fast Broadband (the government-backed national fibre broadband rollout) is more advanced in the Bay of Plenty than in most other regions.

Flagship implementation

The heart of the project is the creation of a Telehealth Community centred in Opotiki, a town with a population of 8950, and which is the northern gateway to the East Cape.

The project has set up Cisco Jabber cameras in 10 GPs' rooms, nurses' areas, and in the Assessment Room at Opotiki Health Centre. These link with outlying centres, GPs' homes after hours, palliative and district nursing services, and the Whakatane Hospital emergency department.

Since going live earlier this year the telehealth project has enabled clinical support for Opotiki nurses after hours, support for aged care facilities, and specialist consultations with Opotiki patients.

In addition, it has provided GP consultations for outlying areas when no doctor is available. For example there are many isolated settlements near East Cape towns such as Te Kaha (pop. 373), and getting GPs to visit on a regular basis is a constant challenge.

During Newman's presentation he featured an online demonstration to the Maori health centre (Hauora) on Matakana Island - a community only reachable by boat. With the benefit of a connection enabled by the Rural Broadband Initiative (the companion rollout to the UFB) and the Cisco high definition camera (about $400) the picture quality was superb, making it clear how conditions such as skin rashes can be confidently and accurately diagnosed by video.

Newman says the approach adopted by the project team is "Build it and they will come".

If the technology exists to enable remote consultations via a high definition video link then what specialist healthcare can be delivered? Here are a three examples:

District/Palliative Care Nurses

A trial is underway with district nurses in Tauranga and Whakatane, as well as Eastern Bay and Waipuna hospices, where physical visits to patients are interspersed with virtual ones if the patient has a computer or tablet, a camera and a broadband connection.

Aside from cutting down on travel time and potentially increasing the number of 'visits' available to patients, when the nurse is engaged in a virtual consultation from a healthcare centre or hospital, he or she is has access to a GP or specialist for advice if required.

Aged Care Facilities

The project team is trialling cameras in aged care facilities. Depending on the circumstances this can take the form of a telehealth "kiosk", a consultation room, or a mobile trolley. The telehealth facilities are used for after-hours advice from GPs, specialist follow-up, speech language therapy, dietary and mental health services, and geriatrician support for nursing staff.

Remote Monitoring

Patients in the community with long term conditions, what is known as "frequent fliers", can have their condition monitored remotely. Sensory devices are installed at home and monitored from a central point. With more equipment available on the market the prices are falling to very attractive levels. This has been trailed by the Bay of Plenty District Health Board through Te Whiringa Ora, Whakatane for several years.

Roadblocks

As you might expect, when you introduce a new way of delivering an essential service, there are plenty of issues to address. These include:

• On-going funding model.
• Clinical and administration support (bookings, documentation, room hygiene).
• Politics (medical, management, iwi, communities)
• Workflow/team care.
• Medico-legal issues.

Success

Telehealth fits well alongside other key drivers of health sector change, such as greater use of nurses and pharmacists, more self-management of health, and care in the community rather than institutions. But to be successful it's vital to get the clinical leadership on board, so they can ensure that telehealth is an integral part of the way their teams deliver healthcare.

Also, if telehealth is to become a 'business as usual' tool, then the technology itself must be reliable and user-friendly. It doesn't have to be 'gold-plated' either - simple equipment such as Cisco's Jabber cameras can be very adequate, Newman says.

If you get it right, then telehealth can be a win for everyone. Medical practices can enjoy efficiency gains and be financially better off, aged care services can improve and become cost-neutral, patients can benefit from the convenience of not having to travel to the main centres for basic care and the District Health Board will see fewer emergency presentations and unplanned admissions.

Newman says that in the Bay of Plenty they have made a good start, but there is a long way still to go.