Telehealth. A Tale of Two Pilots. Rural Health Continuing Education Videoconference Royal Australasian College of Physicians.

Transcription

1 Telehealth A Tale of Two Pilots Rural Health Continuing Education Videoconference Royal Australasian College of Physicians June 2, 2014

2 TelerehabilitationPilot, Caulfield Hospital Sarah Smyth, Manager Clinical Innovation & Interdisciplinary Projects CDAMS TelehealthProject, Caulfield Hospital Liz Rand, Manager Cognitive Dementia & Memory Service Dr Olivia Gobbo Geriatrician, CDAMS Troy Bailey ehealth Manager Lower Murray Medicare Local

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4 Background Caulfield Hospital (Alfred Health) has provided a variety of telehealth services since 2010 Since 2012 we have collaborated on two new projects 1. TeleRehabilitation 2. Cognitive & Dementia Memory Service Outreach Assessments Both projects designed to provide support and service to rural and regional areas Both projects used similar tools and methods, but had a different focus and outcome Both funded via Victorian Department of Health Project Grants

5 Pilot 1 TeleRehabilitation

6 Telehealth in Rehabilitation Pilot Two, 6 month projects established between Caulfield Hospital and Bass Coast Regional Health Northeast health Wangaratta Funded by Victorian Stroke Clinical Network Grant (Victorian Department of Health) Focus was on Subacute Inpatient Stroke Rehabilitation

7 Project Aims Staff Capability Building Improve the knowledge and skill of regional inpatient staff in managing stroke/complex rehabilitation Patient Satisfaction Ensure that the provision of telehealthclinical advice is acceptable to regional patients Facility Capability Building Increase the likelihood that more complex patients would be accepted for ongoing rehabilitation in their local facility

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9 Technology Utilised existing Polycomfacilities with direct dial access to both facilities simple, quick Involved IT Resource assistance at both ends with two trials, and training of project coordinators at both ends Reliable, good vision Audio quality dependant on size and acoustics of room used. Limited to where Polycomsystem could be set up

10 TeleRehabilitation Model Allied Health and Nursing focus primarily Project Officers at both facilities

11 Education 1. Structured program at commencement of service Telehealth familiarity Survey of Education Needs Established Toolkits (eg Stroke Guidelines) 2. A Flexible program responsive to needs Neuropsychology Rehabilitation Nursing OT/PT/SP/Medical inservices Ad hoc eg sling and hoist use Familiarity with equipment Rapport Joint understanding of terms..

12 Patient Advice Sessions

13 Key Documentation Telerehab Pilot

14 Patient Advice Sessions - Learnings Referral consider using existing patient documents Clarify goals of session verbally with clinicians prior to session During session Patient participation very important Patient advocate role essential Facilitator/time keeper essential Room acoustics

15 Project outcomes Improve the knowledge and skill of regional staff in inpatient rehabilitation for complex patients. Telehealthclinical advice is acceptable to patients receiving rehabilitation in a regional hospital setting Increase the likelihood that more complex patients would be accepted by Regional facility for ongoing rehabilitation rather than remain in metropolitan facilities

16 Pilot 2 Telehealth Outreach Cognitive Dementia and Memory Service

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18 Problem A shortage of medical specialists and neuropsychologists for CDAMS in regional Victoria Long wait for diagnosis Reduced access to treatment

19 Telehealth Outreach Cognitive Dementia and Memory Service Mildura Caulfield Bendigo

20 Project Overview 3 Clinicians in 3 Locations Geriatrician from Caulfield CDAMS Psychiatrist from Bendigo CDAMS Nurse from Sunraysia CHS Mildura CDAMS 28 Mildura CDAMS Clients 15 fortnightly ½day clinics for 6 months Evaluated by a satisfaction questionnaire 4 Face to Face visits

21 Technology PC with VIDYO desktop VC software Polycom with Blue Jeans or VIDYO software Medicare Local support Technical Support Hosting Software

22 Client Appointment Process

23 Key Documentation CDAMS Pilot

24 Background to Telehealth in Dementia Literature review Early studies significant technical problems Recent studies showed diagnostic correlation between telehealth and Face to Face (F2F) assessment Tests validated included MMSE and RUDAS Concerns re inability to examine patient

25 Preparation is Key to Success Administrative support essential Careful patient selection Patient information available including referrals, access to results Road testing of technology Need a back up plan

26 Practical Telehealth Dementia Assessment Clinician in room with patient at remote end Tailor assessment to patient Utilise familiar assessment tools MMSE, RUDAS, ADAS-COG, MOCA Acknowledge limited Physical Examination Intermittent Face to Face sessions

27 Telehealth Scorecard Positives High degree of client satisfaction Provides a service where it is not otherwise available Creates strong links between services Educational opportunities for rural practitioners Negatives Complex to establish Requires clinician at remote end with patient Ongoing need for F2F visits Unsuitable for some patients eg NESB, Deaf Unable to examine patients TECHNOLOGICAL PROBLEMS

28 Project Outcomes Can medical specialists use videoconferencing to diagnose dementia? Can a neuropsychological assessment be done by videoconference? Will everyone like it?

29 Sustainability Model has ongoing support An alternate way to use existing funds Cost equivalent to remote travel model More costly than salaried clinicians onsite however provides more robust workforce and can be more flexible and responsive to demand Future development Could use MBS items 2 nd opinions, case conferencing & advice to local clinicians.

30 So, what have we learnt from these pilots?

31 Telehealth Training Demystify the machine! > log on, zoom, mute, pan, cheat sheet Understand how to manage the environment > lighting, sound, vision/background Know your Role Etiquette. > Chair/timekeeper, Patient Advocate > Introductions, timing, preparation, interruptions, privacy Back up Plan > Technical support, Remote contact phone numbers Ongoing orientation tools and plan

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33 Barriers Technology fears and concerns Perception of it being a second class option Remote areas concern re loss of business case for a real person Technology Cost if not block funded

34 Workforce Co-ordinators at both ends required for start up Face to face element essential to building rapport IT support

35 Consider. Medical Specialists need to check indemnity > Honorary Appointments an option Memorandum of Understanding/Contract Good for facility to facility agreements?need to confirm regular demand of work for staffing?need to build in block elements with ability to be flexible Agreed roles and responsibilities Fee for service model would require good planning and realistic funding

36 Process & Evaluation Mimic existing processes where possible > Eg existing referral information > Ensure collation of comprehensive client information Clear understanding of tools, roles & responsibilities Be prepared to modify and be flexible For some clients or circumstances, face to face will be the only way Evaluation an important part of any new initiative > Requires Client, Carer and Clinician feedback

37 Basic Technology Use existing IT systems where possible Regional facilities often well resourced in IT Requires Organisational support to succeed Skype is not suitable Use peak body resources available Link with Medicare Local

38 Technology Options Requirement Software Facilitated Hardware Easy-to-use Reliable Low cost High quality Interoperable Secure

39 Resources Alfred Health are also happy to provide copies of documentation templates used in our pilots upon request

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41 A very positive experience In conclusion Telehealth is simply a different tool for the same process The tool and process can be simple or complex Doesn t completely replace face to face

42 Sarah Smyth Manager, Clinical Innovation & Interdisciplinary Projects Caulfield Hospital, Alfred Health Ph Liz Rand Manager, Cognitive Memory & Dementia Service Caulfield Hospital, Alfred Health Ph Dr Olivia Gobbo Geriatrician Cognitive Memory & Dementia Service Caulfield Hospital, Alfred Health Troy Bailey ehealth manager and CPD Officer Lower Murray Medicare local