1. Purpose This Procedure is performed as a means of providing increased access to clinical advice and consultation, education and liaison between services and facilities through the use of telemedicine. 2. Application This Procedure is to be followed by all staff throughout West Coast District Health Board (WCDHB). 3. Definitions For the purposes of this Procedure: Telemedicine is taken to mean the use of video-conferencing equipment (which enables simultaneous verbal and visual communication) with patients, clinicians, management and educators/supervisors located at some geographic distance from each other. 4. Responsibilities For the purposes of this Procedure: All staff members are required to only use Telemedicine equipment after they have been trained in its use Clinical staff are required to: - ensure that the standard of treatment provided to patients is maintained when using telemedicine; - document the session and its outcome in the patient s clinical record. a Designated Staff Member is required to be responsible for: - the booking of equipment; - monitoring equipment use; - equipment maintenance and use; - providing staff training; 5. Resources Required This Procedure requires: i) Telemedicine equipment ii) Telemedicine Booking Form iii) Sign To Indicate Room Is In Use/Engaged iv) West Coast Telemedicine Clinics Contact Details Form Telemedicine Procedure Page 1 of 6
v) Generic letter to patient containing: Dear Sir/Madam You have a follow up appointment in the clinic this is a telemedicine appointment Totry and ensure that patients are seen in a timely fashion, and as close to home as possible, we carry out some of our clinics by video conference. This is the appointment that you have been offered. During the clinic visit, you will be in the clinic shown on your appointment letter, and your Specialist will be in another location, and you will be talking over a video conference network. We expect that you will get a similar level of service as you would if you were having a face to face appointment, and that you may get your appointment sooner than would otherwise have been possible. However, if you would prefer not to have your appointment by video conference, then please feel free to phone the Central Booking Unit at Grey Base Hospital on 0800 924846. You will then be rebooked into a face to face clinic. Yours sincerely 6. Process 1.00 Introduction 1.01 Telemedicine services are available at WCDHB for liaison and communication amongst its Services in order to: i) enhance the care and treatment of patients and their family/whanau/caregivers; ii) increase the efficiency of inter-service care delivery; iii) increase the scope and availability of education and supervision for staff and patients. 1.02 Clinical staff are required to ensure that the standard of treatment provided to patients,, the right to informed consent, privacy, and dignity, and cultural safety are maintained at all times when using telemedicine. 1.03 The use of Telemedicine in Mental Health must be within the legal framework as set out in the Mental Health (Compulsory Assessment and Treatment) Act 1992.and Amendments 2.00 Uses Of Telemedicine 2.01 Telemedicine may be used for the following: i) Patient interviews for: - follow up after an initial consultation to review treatment; - providing a second opinion; - emergency assessments; - gaining additional information. Telemedicine Procedure Page 2 of 6
ii) Team/group meetings (including patient and their family/whanau/caregiver) for: - discharge planning; - family conferences; - patient review; - maintaining patient contact with their family/whanau/caregiver. iii) Consultation/liaison between clinicians, managers, community groups and patients. iv) Education and supervision for: - one to one supervision; - group/peer supervision; - distance learning for education programmes; - maintaining up to date practice through information sharing. v) Management for: - liaison with other providers; - professional body meetings; - interviewing prospective staff at a distance for recruitment. 2.02 Suitable telemedicine patients for use in outpatient clinics include those which are followup visits from first specialist assessments or admissions, where the clinician feels there is a low probability the visit will need to involve a physical examination AND the patient lives closer to a distant clinic with a videoconference unit than they do to Grey Base Hospital. 2.03 Where booking follow up appointments is concerned, the clinician will identify patients for a telemedicine clinic by choosing the telemedicine option or writing TELEMEDICINE and the timeframe in the follow up instructions, or by indicating the same information in their ward discharge plan. 2.04 Where possible the use of a telemedicine clinic for follow up should be discussed with the patient prior to a booking being requested. 2.05 It may be possible for some first specialist assessments to be conducted by telemedicine for the purposes of making more informed triage decisions, or determining the need for initial investigations. The patient should have seen the clinician in person at least once before a final treatment plan is made 2.06 Patient consultation by telemedicine should be consistent with the guidance provided in the Medical Council of New Zealand Statement on Telehealth. 3.00 System Administration 3.01 A designated staff member is to be responsible for the administration of the Telemedicine system, which is to include: i) booking of equipment (WCDHB Librarian (except for MHS who do this themselves)); Telemedicine Procedure Page 3 of 6
ii) equipment maintenance and use (WCDHB IT Department); iii) providing staff training (WCDHB IT Department). 3.02 CBU will be able to identify which patients on the follow up list are to be seen in a telemedicine clinic, and when they are due to be seen. They will also identify the closest telemedicine clinic to the patient. 3.03 CBU will contact the clinician when a number of patients are coming due for a telemedicine clinic, at least a month before they are due to be seen. 3.04 The clinician and CBU will nominate a suitable day and time for the clinic, which will include checking that the outpatient VC room in Greymouth is available. 3.05 For each of the patients to be booked into the clinic, CBU will notify the designated staff member at the distant clinic the patient will attend of the proposed date and time for the clinic appointment. 3.06 They will indicate on the booking list which physical location the patient will be attending, so this shows up on the clinic list. 3.07 The designated staff member at the clinic will confirm with CBU that the VC unit and room in the distant clinic are available, and that someone will be at the clinic to let the patient in and operate the VC unit. They will also notify the relevant Rural Nurse or GP so that they can also attend the appointment if available. 3.08 If the distant clinic is not available the patient will be booked into a later telemedicine clinic, or a face to face clinic. 3.09 When booking part day telemedicine clinics, mixed with face to face appointments, telemedicine clinics will be held first thing in morning for a morning clinic, or last thing in afternoon for an afternoon clinic. 3.10 The clinic appointment letter sent to the patient will indicate clearly that they have been booked into a telemedicine clinic and where they need to go to attend the appointment. It will include the generic letter explaining the telemedicine clinic. 3.11 If the patient rings and indicates they do not want to be seen in the telemedicine clinic they should be booked into the next appropriate face to face clinic. 3.12 Information entered into the patient administration system (PAS) should allow easy identification of which patients were seen in a telemedicine clinic and by whom, for reporting purposes. Telemedicine Procedure Page 4 of 6
4.00 Telemedicine Use 4.01 Staff members are only to use the Telemedicine equipment when they have been trained in its correct use and maintenance. 4.02 All Telemedicine equipment is to be booked via the designated staff member. 4.03 Users will ensure that a sign is placed outside the room to indicate that a Telemedicine session is in progress. (Sign to simply indicate that the room is in use/engaged). 4.04 Any Telemedicine equipment or system malfunction is to be reported to the administrator as soon after discovery as possible. 5.00 Patient Consent, Privacy And Safety 5.01 Patients, and their family/whanau/caregiver (if involved) are to be provided with clear information on how the Telemedicine equipment operates, who will be involved in the session and if any alternatives are available. 5.02 The patient or their representative are to be informed of their right not to participate. 5.03 The patient or their representative are to be informed of their right to withdraw from the session at any time. 5.04 Written consent is not required for the telemedicine consultation per se, but there may be other aspects of the patient s care that do make written consent necessary, in accordance with Rights 6 and 7 of the HDC Code of Rights 5.05 Where possible a clinical staff member is to be present with the patient during the session. 5.06 Patients are to be given the opportunity of having a support person present during the session. 5.07 The session is not to be recorded without the patient s prior written consent. 6.00 Telemedicine Session 6.01 All relevant documentation is to be obtained and reviewed prior to the session. 6.02 A full explanation is to be given to the patient and where applicable their family/whanau/ caregiver. 6.03 At the start of the session, all participants are to introduce themselves. Telemedicine Procedure Page 5 of 6
6.04 If necessary the camera(s) may need to be readjusted to reassure participants that there is no-one observing without permission. 6.05 If necessary the staff member in charge of the session is to give an explanation of the technical aspects of the Telemedicine equipment including sound quality and time delays, as well as camera placement. 6.06 The session is then to be conducted. 6.07 If the session has involved a patient then the session is to be documented in the patient s clinical record. 6.08 Within a Telemedicine clinic the clinic schedule will include information about what videoconference unit the patient will be at, and the landline number for the clinic, so the clinician knows where to dial in to. See the West Coast Telemedicine Clinics Contact Details Form 6.09 The clinician will dial in to the patient at the appropriate time. 6.10 The clinic appointment will be documented in the notes and by letter in the usual way, except that the clinic letter should be headed Telemedicine Clinic. 6.11 The clinical assistant will update the remote clinic locations if a clinic is running late, or chase down the far ends if they are not present when clinician tries to connect. 7. Precautions And Considerations The session is not to be recorded without the patient s prior written consent The use of Telemedicine in Mental Health must be within the legal framework as set out in Mental Health (Compulsory Assessment and Treatment) Act 1992 and Amendments. 8. References Draft Telecommunications Information Privacy Code (2002) Clinical Practice Guidelines For Using Videoconferencing Technology In Queensland MHS Healthlink South Ltd Telemedicine Procedure Medical Council of New Zealand Statement on Telehealth available at - http://www.mcnz.org.nz/assets/news-and-publications/statement-on-telehealthv3.pdf 9. Related Documents WCDHB Informed Consent Procedure Telemedicine Procedure Page 6 of 6