Telehealth By Debi Dean

Telehealth By Debi Dean

Project Aim Develop a model of care for telehealth consultations with medical teams in the rural and remote communities (Cairns & Hinterland, Torres and NPA and the Cape) for people with type 2 diabetes. Easy.

Hyde Park

Tower Bridge

Childhood Memories..

The Diabetes Centre first used this technology in 2005, and was used ad hoc until the employment of telehealth project officer in July 2010. The next twelve months were involved in service and equipment mapping, identifying priorities, searching available processes, procedures, standards etc. Available research suggests that it takes up to two years to establish a telehealth service. Our telehealth model of care supports the Diabetes Centre s vision and philosophies it is not a stand alone service. Every single piece of data is captured and used to validate, improve and evaluate our service. Every telehealth consultation is unique because of the need to reflect the specialties aim and objectives, the primary care organisational and educational needs and the needs of the patient.

Barriers to Telehealth Funding lack of financial incentives, cost effectiveness Time can double the consultation and time needed to learn the technical aspects Infrastructure internet access, reliability Equipment Skills needed for IT support Preference for traditional approach Moffat JJ, Eley DS (2011) Barriers to the up-take of telemedicine in Australia- a view from providers. Rural and Remote Health, II:1581

Barriers Overcome - Medicare Telehealth Item Numbers - Work instruction, procedure, process - Internet access improved but - Cisco VCU, Movi, Jabber - Statewide Telehealth Training - Support, support, support

Service Areas Cairns & Hinterland Torres & NPA Cape York

Primary Care Providers Torres & NPA Queensland Health Cape QH, RFDS, Apunipima Health Council Hospital GPs and GPs Hinterland QH, RFDS, various Indigenous Health Councils, Hospital GPs and GPs

What is telehealth? telehealth essentially means health care at a distance and is the electronic transmission of clinical information via telecommunication technologies. Telephone Email Internet

Video Conference Dr Ashim Sinha and Debi Dean

Diabetes Services Medical reviews Existing diabetes in pregnancy reviews Gestational diabetes Paediatric reviews High risk foot reviews Diabetic Foot surgical reviews Diabetic Foot orthopaedic reviews

Telehealth Process Is telehealth appropriate? Does the referral meet your standard? Are patient s contact details available? Offer e-appointment Send the patient an appointment letter Facilitate the consultation Provide necessary documentation

Referrals Does the referral meet our referral criteria? Are the relevant investigation results available? To name or not to name? All patient s current contact details are required, including email address

Other Considerations.. Contacts Equipment, room and training Consent Medicare Jabber Security

Where to Locate

Patients are currently required to sign a QH Patient Consent for Telehealth Clinical Consultations Jabber - Users Guide.pptx Information Pamphlet Consent Form Information Pamphlet

Under the National Health Care Agreement, patients attending Queensland Health public hospitals have a choice to be treated as a public or bulk billed patient. If the patient consents to being bulk billed, they are asked to sign a DB2-OT Assignment Form (pdf) which then is returned to us via fax or email.

The Medicare Story On 1 st July 2011 Medicare introduced specific telehealth Item Numbers. The MBS stated For electronic bulk bill claiming, at the time of the consultation, you can see verbal consent from the patient to assign the benefit to you. You can then lodge the bulk bill claim directly to Medicare on behalf of the patient. This remained unchanged on 1 st July 2012 but then on the 5 th July 2012, the schedule stated that the patient s signature was required.

Item Numbers Consultant Physician - 112-110 - 116-132 - 133

JABBER A standards based product and is interoperable with our endpoints Negatives: Positives: 1. No address book 1.Free to download 2.It works! 2. Need to dial in 3. Very limited technical support 4. Quality dependent upon internet Download software at www.ciscojabbervideo.com

Occasions of Service and Case Conferences 200 Telehealth Growth at CDC Patients 180 160 140 120 100 80 60 40 20 0 2009-2010 2010-2011 2011-2012 Case Conference Patient Consultation

Education

Connecting with the Patient Inclusion of family and/or carers Inclusion of the patient s primary care team Active participation because of involvement of visual display and discussion. Aim: through education, we further empower, increase self efficacy and hopefully, achieve improved outcomes for the patient.

Communicating with the Patient Completely location dependent: Initial contact/communication is often via the Health Worker/Nurse/GP By phone By Email By text

Impact on Patient Care They do not have to travel to Cairns saves times, inconvenience and money Primary Care Teams are engaged and educated Reduction on patients with diabetic foot from the Islands Expansion of the multi-disciplinary team Increased patient satisfaction

Patient Feedback My GP gave me the option of travelling to Cairns ( 2 hour trip) to attend the Diabetes Clinic which I did many years ago when first diagnosed with type 1 diabetes and pregnant with twins. Or, option two was a tele link conference at my local hospital, a 30 minute drive from my home. I chose the tele link conference and was very happy with this experience. I am nearing menopause and was having difficulty controlling my blood sugar levels and weight. I have just completed my third tele link conference and from a consumer point of view I find it excellent. You know what time your appointment is and you can ask as many questions as you like. Since my first tele link conference my insulin has been changed and my HbA1c has gone from 9.5 to 6.5 and I have to say I feel so much better. If I have any questions I can just email and I have an answer within days.

Telehealth is not a new concept and is fast becoming more widespread and for very good reasons. Telehealth can be used to create the bridge between the patient and specialist and allow the GP or other health professional to be present, ultimately creating optimal patient care. Last year we linked into 33 of the 40 identified VCU sites. We provided 80 OOS and discussed the management of a further 183 patients. We provided education to 302 HCPs and extended the multidisciplinary team concept to many of our recipient primary care providers. Debi_Dean@health.qld.gov.au 07 4226 4672