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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