Specialist paediatric health services for patients in remote locations: the role of telemedicine in Australia

Size: px

Start display at page:

Download "Specialist paediatric health services for patients in remote locations: the role of telemedicine in Australia"

Justina Perry
5 years ago
Views:

Specialist paediatric health services for patients in remote locations: the role of telemedicine in Australia Dr Anthony Smith, Associate Professor

1 Specialist paediatric health services for patients in remote locations: the role of telemedicine in Australia Dr Anthony Smith, Associate Professor Deputy Director Centre for Online Health Acknowledgements Prof Shuji Shimizu Yoko Noda Kyushu Hospital University Sponsors Centre for Online Health, UQ

Broad interest and experience in telehealth New models Service delivery Evaluation Teaching

2 Mud map (Overview) Centre for Online Health (COH) Australia in context Paediatric telemedicine services logistics Recent developments Government funding Future trends Centre for Online Health Broad interest and experience in telehealth New models Service delivery Evaluation Teaching Queensland Telepaediatric Service >12y Adult/geriatric telehealth services SFT Conference

3 Ireland Great Britain Germany Japan New Zealand Texas Background Queensland - second largest state, pop ~ 4.2 m 60% population SE corner 20% major coastal towns 15% remote (650,000) Indigenous 520,000 Qld 150,000

Telemedicine Any medical activity involving distance can be done in two ways real time (e.g. videoconferencing) pre recorded (e.g. email) Telemedicine Why do telemedicine?

4 Telemedicine Any medical activity involving distance can be done in two ways real time (e.g. videoconferencing) pre recorded (e.g. ) Telemedicine Why do telemedicine? There may be no alternative Telemedicine may be better than existing conventional services

Key issues Extensive distances and location of specialist health services Equity of access to health services for regional and remote population Large videoconference networks but relatively slow

5 Key issues Extensive distances and location of specialist health services Equity of access to health services for regional and remote population Large videoconference networks but relatively slow uptake Telehealth coordination INCENTIVE Single point of contact Manages referral Liaises with specialists Scheduled appointment Facilitates medical records Manages videoconference session Collects activity data Organises follow up if required Smith AC, Isles A, McCrossin R, Van der Westhuyzen J, Williams M, Woollett H and Wootton R. The point of referral barrier - a factor in the success of telehealth. Journal of Telemedicine and Telecare 2001; 7 (Suppl.2): 75-78

6 Telepaediatrics in Queensland Telepaediatrics in Queensland Neurology 10% (n = 11,250 consultations) Burns 14% ENT 7% General Paediatrics 5% Endocrinology 5% Child Psychiatry 27% Cardiology 2% Ophthalmology Other 2% 18% Dermatology 2% Oncology 3% Nephrology 3% Orthopaedics 2%

7 Telepaediatrics in Queensland 13,650 consultations over 12 years 2400 consultations per y Consultations

telemedicine assessments and face-to-face

2008, 188 (8): 457-460 Indigenous health

disease/deafness rate Long term impact: 1

8 Telepaediatrics ENT 2 years 152 consultations (97 pts) Retrospective audit of medical notes Diagnosis 99% Management 93% Smith AC, Dowthwaite S, Agnew J and Wootton R. Concordance between real-time telemedicine assessments and face-to-face consultations in paediatric otolaryngology. The Medical Journal of Australia. 2008, 188 (8): Indigenous health screening ~90% significant disease/deafness rate Long term impact: 1 3y; severe disease burden (discomfort) 4 5y; slow language 5 7y; slow learning 10 11y; behaviour problems, truancy 15y; illiteracy, substance abuse

9 Indigenous health screening Community health services Visiting specialists ENT Dental Dermatology Ophthalmology Psychiatry Respiratory Outreach physical travel to remote sites Indigenous health screening Indigenous health workers Specialist outreach services and telehealth support ENT Dental Dermatology Ophthalmology Psychiatry Respiratory

10 Indigenous health screening To provide routine health screening for all Indigenous children in Cherbourg and surrounding communities To develop a service which can be managed locally by dedicated Indigenous health workers. To improve screening rates above 90% To ensure early detection (assessment) and treatment of chronic diseases.

Telepaediatrics Indigenous Health Pre: 380 /

(first 12 months) Elliott G, Smith AC, Bensink

The Feasibility of a Community-Based Mobile

Torres Strait Islander Children in Australia.

11 Telepaediatrics Indigenous Health Pre: 380 / 980 = 39% (average rate per annum) Post: 83% (first 12 months) Elliott G, Smith AC, Bensink ME, Brown CA, Perry C, Stewart C and Scuffham P. The Feasibility of a Community-Based Mobile Telehealth Screening Service for Aboriginal and Torres Strait Islander Children in Australia. Telemedicine and ehealth Journal, 2010, 16 (9):

Journal of Telemedicine and Telecare 2004, 10(4):193-198 Telepaediatrics Burns FTF FTF / VC Consultant A Consultant B Concordance % n=25 Concordance % n=25 Appearance 68 60 Scar thickening 60 64

12 Telepaediatrics Burns Compare FTF to VC assessments 12 months 25 patients 1.One observer, alternating process FTF/VC VC/FTF 2. Two observers, FTF consults Smith AC, Kimble R, Bailey D, Mill J, and Wootton R. Diagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients. Journal of Telemedicine and Telecare 2004, 10(4): Telepaediatrics Burns FTF FTF / VC Consultant A Consultant B Concordance % n=25 Concordance % n=25 Appearance Scar thickening Contractures Range of motion Activity level Breakdowns Decision making Smith AC, Kimble R, Bailey D, Mill J, and Wootton R. Diagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients. Journal of Telemedicine and Telecare 2004, 10(4): CRICOS Provider No 00025B

13 Telepaediatrics Burns 17% of all burns outpatients FTF appointments Telepaediatrics Consultations Telepaediatrics Surgery Rapidly expanding Routine clinics with all paediatric surgeons 6 clinics per month, up to 2 hours each multi site appointments Pre admission, reviews and education Referrals: Direct to QTS via 1800 number Patients triaged at the RCH OPD according to postcode Appointments held at nearest regional hospital

Telepaediatrics Home support Video links to families at

nursing and allied health staff Logitech video via

Telepaediatrics Robots Telepaediatric robots Commenced

14 Telepaediatrics Home support Video links to families at home Palliative care, oncology Support from medical, nursing and allied health staff Logitech video via broadband connection Laptops and PCs flexible Telepaediatrics Robots Telepaediatric robots Commenced 2004 mobile, wireless videoconference systems child friendly direct to bedside

15 Telepaediatrics Robots 2005 Gladstone Hospital, no paediatrician daily ward rounds sub specialist consultations Smith AC, Coulthard M, Clark R, Armfield N, Taylor S, Goffe R, Mottarelly I, Youngberry K, Isles A and Wootton R. Wireless telemedicine for the delivery of specialist paediatric services to the bedside. Journal of Telemedicine and Telecare 2005, 11 (Suppl. 2): 81-5 Eliza Mt Isa Tiny Tom - Townsville ROY Gladstone Emma - Emerald Gypsie Gympie

16 Neonatal ward rounds Often full care team attend Medical Nursing Allied Health Social work Mackay Base Hospital ICN, Townsville Hospital Round led by neonatologist Family members may participate Usually informal educational opportunities CRICOS Provider No 00025B

17 Cost minimisation analysis Child and adolescent psychiatry services e-cymhs 30 month period Costs of providing telepaediatrics - video Costs of providing outreach visiting psychiatrist Potential costs if patients travel to the RCH Smith AC, Stathis S, Randell A, Best D, Ryan V, Bergwever E, Keegan F, Fraser E, Scuffham P and Wootton R. A cost-minimisation analysis of a telepaediatric mental health service for patients in rural and remote Queensland. Journal of Telemedicine and Telecare, 2007, 13 (Suppl. 3): Telepsychiatry 30 months 606 consultations Method FTF Patient travel ($) FTF Outreach Visiting Psychiatrist ($) Telemedicine Patient seen via videoconference ($) Total cost 514, , ,753 Average Marginal Smith AC, Stathis S, Randell A, Best D, Ryan V, Bergwever E, Keegan F, Fraser E, Scuffham P and Wootton R. A cost-minimisation analysis of a telepaediatric mental health service for patients in rural and remote Queensland. Journal of Telemedicine and Telecare, 2007, 13 (Suppl. 3): 79-83

18 Telepsychiatry (30 months) Actual 800,000 Patient travel Cost ($) 400,000 Visiting Psychiatrist Telemedicine Number of consultations

19 Developments in Australia Medicare items for online consultations recently introduced in July 2011 General practice Broad range of health specialties Focus on video consultations $620m+ invested by Commonwealth Government Financial incentives 1 st consultation, loadings Funding for training, support Promising sign for telehealth in Australia... Telehealth uptake New MBS telehealth items what is the prognosis? Likely uptake, long term trends? Learn from experience (successes and failures) Telepsychiatry in Australia Commonly reported, telehealth friendly MBS items for telepsychiatry introduced early 2003

Background Mental health in Australia 1/3 population (7 million) live outside major cities Rural and remote population: Higher prevalence of chronic health conditions 16% more likely to report mental

20 Background Mental health in Australia 1/3 population (7 million) live outside major cities Rural and remote population: Higher prevalence of chronic health conditions 16% more likely to report mental problems Prevalence of mental health conditions is about 12% Approx. 800k people Telemedicine potential! Methods Review of MBS activity for psychiatry services Reports via Medicare Australia* July 2002 June 2011 FTF and VC items compared Exclusions Services by hospital doctors to public patients in public hospitals Department of Veteran Affairs (DVA) funded services *

Methods Review of MBS activity* for psychiatry services

consultations Benefits paid Medicare costs * http://www.

shtml Telepsychiatry MBS items MBS items (for VC) introduced

min 302 355 >30 min and < 45 min 304 356 >45 min and < 75

21 Methods Review of MBS activity* for psychiatry services Activity reports included: Services delivered number of consultations Benefits paid Medicare costs * Telepsychiatry MBS items MBS items (for VC) introduced in 2003 Consult time FTF VC <15 min >15 min and < 30 min >30 min and < 45 min >45 min and < 75 min >75 min Ref:

22 Telepsychiatry MBS items Registered services (July 2002 June 2011) Consult time FTF VC <15 min , >15 min and < 30 min 302 2,372, >30 min and < 45 min 304 4,319, >45 min and < 75 min 306 6,389, >75 min , Total 13,811, Ref: Telepsychiatry MBS items Benefits paid (July 2002 June 2011) Consult time FTF VC <15 min 300 $12,501, $73,611 >15 min and < 30 min 302 $158,144, $246,630 >30 min and < 45 min 304 $440,522, $221,258 >45 min and < 75 min 306 $941,480, $380,118 >75 min 308 $59,479, $12,873 Total $1,612,128,061 $934,489 Ref:

23 Results Benefits paid (July 2002 June 2011) Results Benefits paid (July 2002 June 2011)

24 Results Benefits paid (July 2002 June 2011) Summary MBS Activity (July 2002 June 2011) 14 million services (psychiatry consultations) $1.6 billion MBS funded psychiatry services FTF VC % Services 13,811, Benefits $1,612,128,061 $934,

Findings Despite item numbers being available for telepsychiatry since 2003, uptake has been very slow Considering reported telehealth success in psychiatry results may be surprising?

25 Findings Despite item numbers being available for telepsychiatry since 2003, uptake has been very slow Considering reported telehealth success in psychiatry results may be surprising? Telehealth success factors Critical factors Funding Clinical services (clinicians) Infrastructure, equip and telecommunications Administrative and clinical systems Smith AC and Gray LC. Telemedicine across the ages. The Medical Journal of Australia. 2009, 190 (1): 15-19

FTF) Clinician support (near and far) Perseverance Smith AC and Gray LC. Telemedicine across the ages.

26 Telehealth ingredients Careful design clinical requirements Organisational support willingness to change Re engineering conventional referral processes Complementary (with outreach, patient travel) Incentives must be comparable (or better than FTF) Clinician support (near and far) Perseverance Smith AC and Gray LC. Telemedicine across the ages. The Medical Journal of Australia. 2009, 190 (1): Potential MBS psychiatric services (July 2002 June 2011) <3000 consultations per y Number of services (VC)

27 Practical tips Develop new services systematically Start small and gradually develop New applications: Feasibility, technical, user satisfaction Clinical efficacy comparable to FTF Economic evaluation patient, health service, society Learn from experience successes and failures Conclusions MBS funding for telehealth is welcomed in Australia Based on telepsychiatry experience, realistically the uptake of MBS telehealth items is likely to take time A whole of system approach is essential for the successful integration of telehealth

Conclusions Model used for telepaediatrics in Queensland is likely to be useful for other states and countries Service delivery models should include a combination of telehealth, outreach, local and

28 Conclusions Model used for telepaediatrics in Queensland is likely to be useful for other states and countries Service delivery models should include a combination of telehealth, outreach, local and tertiary services Opportunities to strengthen clinical networks and deliver high quality specialist services in the most efficient manner Dōmo arigatō Dr Anthony Smith Associate Professor Deputy Director Centre for Online Health asmith@uq.edu.au Web:

Improving health service delivery through telehealth expansion in Queensland

Improving health service delivery through telehealth expansion in Queensland Andrew Bryett, Acting Director, Statewide Telehealth Services, Queensland Health, Australia Queensland 22% of the land mass