Experiences Implementing Telehealth

Services at St Vincent’s Private

Hospital Brisbane: implications for

correctional healthcare

Professor Harry McConnell

Mr David Jukes

Mr Phillip Greenup

The Question

How can I deliver the best available

healthcare to my patients to improve

their wellbeing and quality of life with

the greatest efficiency of resources?

Answer • Imagination

Answer

• Imagination + • Innovation

Answer

• Imagination + • Innovation + • Interactivity

• Imagination +

• Innovation +

• Interactivity =

TeleHealth, the transfer of health information from wherever it is, to where it needs to be

My own background

• Former Experience in USA as Prison Doctor at Maximum Security Facility and Forensic Psychiatrist at Secure Unit and current work as medicolegal expert for complex care patients

• 20 years of TeleHealth experience (30 years including email and phone)

• Experience with World Health Organisation, World Bank Institute, Global Development Learning Network, Worldspace, International NGOs, consulting to national and state governments, director of LIGHT- Leadership in Global Health Technology

• TeleHealth projects in Kenya, Mozambique, Sri Lanka, PNG

• Director, Neurosciences, St Vincent’s Hospital Brisbane

• Professor of Neuropsychiatry and Neurodisability/ Clinical SubDean, Griffith

Examples

• George, a 27 yo man in Brisbane with developmental disorder, intellectual disability, refractory epilepsy, and severe post-ictal aggression

• Sam, a 42 yo man in rural NSW with severe traumatic brain injury, PTSD, seizures, cognitive impairment, wheel chair bound requiring multiple carers

• Sally, a 20 yo woman in regional QLD with severe non-epileptic seizures resulting from PTSD who was requiring daily ambulance trips to hospital

• Alice, a 73 yo woman with a rare encephalopathy in rural QLD, with no access to hospital locally; treatment implemented in shared care with GP, now in SVHB

Introduction to SVPHB

Established in 1954 as Mt Olivet Hospital –

Brisbane’s “Hospital for the incurably ill and

dying” by the Sisters of Charity.

Specialist services have expanded, but remains

a significant provider of Palliative Care and

Geriatric Medicine in Brisbane.

SVHB TeleHealth Project Details

• Funded by the Telehealth Support Program under

DoHA’s “Connecting Health Services with the Future:

Modernising Medicare by Providing Rebates for Online

Consultations” initiative.

• The Telehealth Education and Support Project (TESP)

was established to;

– Develop and disseminate training materials

– Assist practices is becoming telehealth-enabled

– Ensure greater uptake of the use of Medicare eligible

telehealth consultations

Page 10

Specialist Uptake

Day/Month/Year Footnote to go here Page 11

• Specialists provided with information and incentive

sheets specific to their area of practice

• Most if not all specialists demonstrated a willingness

to take part in telehealth consultation as long as

appropriate administrative and technical support was

provided

• Specialist frustrated by eligibility restrictions

Initial Survey

Page 12

Conducted in September 2012 by Queensland Rural

Medical Education (QRME).

• Are you using telehealth consultations and item numbers

in your practice?

• If so, how often do you use them?

• For what specialties have you or are you using

Telehealth?

• Are there any problems with using Telehealth?

• If so, what are they?

Initial Information Campaign

Page 13

Survey identified concerns;

•Availability of specialists

•Assistance with MBS

billing

•Legal requirements

regarding consent

•Technical Issues including

bandwidth and security

Awareness Activities for GPs

Page 14

• Information sent to all GP clinics in the Greater

Darling Downs region

• Doctor Magazine

• Continual Professional Development (CPD) sessions

on Telehealth usage in the GP Clinic were provided.

• Information evenings hosted at St Vincent’s Private

Hospital Brisbane ….

• Limited success, increasing Telehealth usage among

GP sample from 60 – 69%

Information for potential patients

Page 15

Generating awareness

among consumers that;

•Telehealth is safe, proven

and available

•May be a clinically

appropriate alternative to

travel

•Should be discussed with

their GP

•Advertising and editorial in

rural magazines

Page 16

Information for current patients

Patients on waiting lists considered based on;

• Clinical Appropriateness

• Geographic eligibility

• Willingness to trial a telehealth alternative to travelling

• Comfort with and availability of technology

Session delivered using low-cost, software based video

conferencing technology.

Workflow

Day/Month/Year Footnote to go here Page 17

Referral Received

(Fax)

Geographic Eligibility Check

(Support Staff)

Clinical Suitability Assessed

(Specialist)

GoToMeeting Invitation & Consent to BulkBill as Email

Agreement

(Support Staff)

Implications for Correctional Healthcare

• An inmate’s trip to the doctor amounts to a very expensive security risk. Transporting the prisoner often requires two security guards, a vehicle, and a driver. There are risks of escape, of holdups and other crimes

• Not every medical concern requires a trip; most prisons have their own doctors who can treat inmates in house. However, specialty care requires outside consultations.

• The U.S. Department of Justice and the U.S. Department of Defense have reported that telemedicine consultations represent more than 60% in savings over traditional direct, in-person consultations.

• The use of telemedicine and EMR (Electronic Medical Records) in the state of Texas has reduced their cost to provide medical care per day per inmate from about $19 to $9.67.

References:

Douglas C. McDonald, PhD, et al. Telemedicine Can Reduce Correctional Healthcare Costs,' prepared by Abt Assoc.,

Inc. for The Joint Program Steering Group Office of Science and Technology National Institute of Justice,

Bernie Monegain, Ed., 'EMR, Telemedicine Saves Texas $1 B,' HealthcareITNews, (August, 2011)

Implications for Correctional Healthcare,

cont’d

• A 2005 study which analyzed many studies on telemedicine in prisons, found that inmates were very satisfied with using telehealth as a model of care.

• The number of health complaints that result in trips outside of a secure facility has dropped significantly as a result of the introduction of telehealth in correctional facilities in North America. Each avoided trip saves hundreds or even thousands of dollars in transport and security expenses. It has been demonstrated to be a highly effective tool in health care delivery without compromise to patient safety and actually improving staff safety.

• Indeed most studies of telehealth in correctional facilities show it can increase quality of care due to interaction between specialist and caregiver, giving greater access to specialty care.

Doarn et al, 2005, Integration of Telemedicine Practice Into Correctional Medicine: An Evolving Standard

Types of Telehealth

• Phone consultations

• Texts

• Email

• Use of Medical Objects

• Social Networking

• Public Health/ Awareness campaigns

• Digital radio

Types of TeleHealth, continued

• Online therapeutic tools with no practitioner, e.g. online CBT, telepsychiatry, treatment of anxiety disorders, agoraphobia

• Codec videoconferencing

• Holographic displays

• Desktop videoconferencing

• Electronic Medical Record (EMR)

• Personalised Electronic Health Records

• Health information systems

Types of TeleHealth continued

• ePrescribing

• Second opinions software

• Store-and-Forward

• Robotic surgery

• Virtual Colonoscopies

• Teleopthalmoscopy, remote otoscopes, endoscopes

• Remote stethoscopes

• Haptic medical devices

Types of TeleHealth continued

• Teleradiology

• Telepathology services, results, tele-electronmicroscopes

• Home-based telehealth, chronic disease monitoring (eg glucouse, pO2, vitals)

• Ambulatory ECG, BP monitoring

• Fitness and preventative health eg monitoring BMI. Steps, Weight, calories, diet, aerobic measures, sleep, etc

• Remote EEG monitoring

• Remote seizure monitoring

Types of TeleHealth, continued

• Remote sleep studies

• Tele-education –patient, professional, family/carer

• Case conferences/ Grand Rounds

• Simulation based eLearning

• Health Gaming/ Virtual Reality

• Online Patient Support Groups

• Online health research – shared databases, datamining, online questionnaires

Types of TeleHealth, continued

• mHealth – mobile apps, device independent

• Clinical decision support (CDS), Cloud computing

• Google glasses/ wearable technologies

• Geographical positioning technologies

• Technologies other than Internet:

– Satellite, Outernet (LEOS), Digital Radio,

– Short-wave, Conventional Radio

– POTS,

– Bluetooth, Infrared,

– WANs, Radiofrequency Identification (RFID), mobile home healthcare

Principles of TeleHealth

• Security/Privacy

• KISS: Use of the simplest technology for the task

• Back-ups

• It’s NOT about the technology, it’s about the patient

• Education, education, education

• For videoconferencing:

– Wear plain coloured shirts

– Test in advance

– Check audio volume, quality, feedback – much more important than video

– Use of headphones, audio settings to avoid feedback

– Positioning of camera, lighting of room, back lighting

– Be always aware when system is on; watch ‘offline’ conversations

– Be aware of time zones

TeleHealth at St Vincent’s Hospital Brisbane

• Multidisciplinary

• Routine part of clinical practice: inpatient/outpatient/daypatient

• Used for rural, remote, international, and for consultations within Brisbane where there are access/ safety issues

• Multiple Specialities

– Neurology –adult/paediatric

– Psychiatry

– Disability

– Chronic Pain

– Geriatrics

– Palliative Care

– General Medical

– Neurorehabilitation

– Medico-legal

TeleHealth at SVHB, continued

• Specialist referrals

• Second Opinions

• Medico-legal reports

• Case conferences

• Staff education

• Assistance in setting up local TeleHealth capability

• Pastoral Counselling

Conclusion

Day/Month/Year Footnote to go here Page 29

• Addition of Telehealth services to SVPHB has allowed patients

some choice/options in how they prefer to receive their healthcare

• Increased geographical reach of the hospital

• Inclusion of GP in consultations increases the continuity of care

• Although only 2 sessions were cancelled due to technical difficulties,

technical support of administration/clinical staff would improve

service

• Funding for items should be extended to those aging in place,

consumers of community palliative care or where disability makes

travel difficult

Conclusions

• There are many TeleHealth Opportunities for the

Healthcare of people in correctional facilities

which can improve their health outcomes, save

money and keep patients and staff safer

• TeleHealth is becoming pervasive and

represents the most efficient way of ensuring the

best possible care for your patients

• Imagination, Innovation and Interactivity will

enable the essential health information to go

from wherever it is to where it needs to be!