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Digital Regions InitiativeChronic Disease Management for Regional and Rural Communities

Dr David DoolanDirector, Clinical IT Support and Development

Information Technology and TelecommunicationsMarch 2010

Digital Regions Initiative

The four year $60 million Australian Government initiative will co-fund innovative digital enablement projects with state, territory and local governments to improve the delivery of education, health and/or emergency services in regional, rural and remote communities.

State, territory and local governments seeking funding will be required to provide matching funding.

The Digital Regions Initiative commenced in 2009 and concludes in 2013.

HNEH application announced in December 2009 by Prime Minister as one of seven successful Round One projects

http://www.dbcde.gov.au/all_funding_programs_and_support/digital_regions_initiative

ABS Definition of ‘Regional’ does not include

Newcastle, Lake Macquarie, Maitland and Raymond

Terrace.

DRI Funding and Governance

$11.8M Capital Funding July 2010 – June 2013

– Commonwealth $4.9M

– NSW Health $3M

– HNEH $3.9M

HNEH $1.8M recurrent

Strict financial and milestone reporting

Must be complete by December 2012

What is included in DRI

Chronic Disease Management System ($5M)

Telehealth equipment to 10 sites and 200 homes with central Telehealth management system ($3.3M)

Digital Imaging Reporting and Delivery improvements ($1.9M)

Network upgrade to 9 sites ($1M)

Program Management ($0.6M)

NO SERVICE DELIVERY!

Chronic Disease Management System

CDM to run within CAP similar to that used in New Zealand, Canada and US (HNEH LICENCE)

Workflow

– Establish program and parameters

– Enrol Patients

– Manage patients

– Notify clinicians

– Report outcomes and variances

GP secure clinical messaging

How to ‘operationalise’ this model

CDM Task List

Data entry form: CDM Home Care

Activity Summary

Summary view of Diabetes Data

Notifications

Example of a trend view

Population Reporting

CDM Issues

Program development and maintenance

Patient enrolment (how many?)

Overlap with existing systems especially CHIME

Interaction with GPs and other external providers

Level of integration with other systems and telehealth

Facility Based Telehealth The following sites will get videoconference equipment

– Ashford

– Boggabilla

– Bundarra

– Gwabegar

– Moree AMS

– Mungindi

– Pilliga

– Tambar Springs

– Toomelah

– Warialda

The following Hospitals will get desktop telehealth equipment (20)

– John Hunter

– Calvary Mater

– Tamworth

– Armidale

Bluetooth

RS232 port

InfraRed port

The Telehealth Monitor supports a number of external biomedical devices for collecting clinical data such as • Weight • Blood pressure monitor • Blood glucose meter• Peak flow meter• Oxygen saturation monitor

Home Based Telehealth

Patient Data Flow in the home

Host

Server

Questionnaire is started

Data and patient answers are sent to the Orion Server

Your weight is: 83 kg

(person s teps on scale)

Are your legs swollen?

Do you feel short of breath?

Below target weight

Have you been exercising?

Your data and responses will be sent

Above target weight

Do you use an extra pillow at night?

Yes No

Your weight is: 83 kgYour weight is: 83 kg

(person s teps on scale)

Are your legs swollen?

Do you feel short of breath?

Below target weight

Have you been exercising?

Your data and responses will be sent

Above target weight

Do you use an extra pillow at night?

Yes No

teps

Are your legs swollen?

Do you feel short of breath?

Question Tree activated

Below target weight

Have you been exercising?

Your data and responses will be sent

Above target weight

Do you use an extra pillow at night?

Yes No

Question Trees are configured for each distinct program

Separate database for central

data store and administration?

In home device or PC?

Telehealth Issues

Clinical staffing and responsibilities

Patient identification, enrolment and management

Patient, clinician and equipment scheduling

Potentially separate data store and system

Not intended for real time monitoring but as a partial substitute for physical visit

Risk of increasing patient reliance and driving up service demand

Digital Imaging

Direct network extension to 4 private imaging providers in Sydney and Melbourne to improve turnaround times of reporting

Delivery of imaging reports via Medical Objects secure messaging

External web based PACS for outside providers with secure link embedded in report

Network Upgrades (4 MBS)

Ashford

Bundarra

Gwabegar

Moree AMS

Nundle

Premer

Pilliga

Tambar Springs

Toomelah

Next Steps

Finalise funding agreements with Commonwealth and State and begin recruitment and vendor contracts

Commence implementation in July 2010 with all infrastructure projects completed by Jun 2011

CDMS

– Program 1 live Mar - Jun 2011 (Diabetes?)

– Program 2 live May – Jul 2011 (Aboriginal Health?)

Home based telehealth – 200 homes by December 2012

Questions and Discussion