TEMSU – Our Expectations are Infinite

Matthew Barneveld1, Sharon Young2, Deanne Crosbie3

 

1 TEMSU, Queensland Health, Townsville Hospital, Townsville Qld, 4810, temsu@health.qld.gov.au for Author 1

2 TEMSU, Queensland Health, 125 Kedron Park Road, Kedron Qld, 4031, temsu@health.qld.gov.au for Author 2

3 TEMSU, Queensland Health, Townsville Hospital,, Townsville Qld, 4810, temsu@health.qld.gov.au for Author 3

 

Background:
The Telehealth Emergency Management Support Service (TEMSU) centrally coordinates telehealth emergency support for referring rural and remote clinicians to clinically appropriate service providers via videoconference.
The TEMSU service improves access to rural generalist, emergency specialist and subspecialist advice and support, generally for lower acuity presentations, across rural and remote communities, based on locally agreed processes.
TEMSU facilitated advice will help ensure early and appropriate clinical intervention and improves capability to manage patients locally, helping to:

  • avoid unnecessary retrieval
  • identify and manage patient deterioration
  • increase local clinical capacity
  • improve patient outcomes.

Results:
Since commencing in 2013, TEMSU has matured from a service offering a general, non-critical, emergency support model to one which also now facilitates multiple specialist emergency support models across Queensland.  Specialist support models now established in some Hospital and Health Services (HHS) include Paediatrics, Maternity and Stroke management, with the aim to further expand the range of specialty services available via TEMSU.  For example, TEMSU has assisted with the implementation of specialised support services for rural and remote clinicians such as Wound Care Management through the innovative use of technologies such iPods for enhanced video imagery.

Discussion:
TEMSU has collaborated with the LCCH Burns unit staff to support their acute telehealth access  for non-critical consultations where required state-wide.  Discussions have commenced to implement a similar model for adult burn patients for the use of the RBWH Burns Unit.
Working with various Hospital and Health Services, models of care are being investigated that include Acute Mental Health, Correctional Services and support for Aged Care Facilities.
There are many opportunities to evolve allied health practitioner models that support the care of rural patients.  Currently, TEMSU is working with Deaf Services Queensland to trial the use of telehealth for Emergency Auslan Interpreter Services, with the aim that, if successful, it will lead to state-wide unscheduled telehealth interpreter support being available to the deaf community.  It is envisaged that TEMSU will expand so far as to build sustainable partnerships with a range of Non Queensland Health Service Providers.
With the right technology and the ever evolving improved internet capabilities in Queensland’s rural and remote locations, the expectation for where we will be in the future is endless.  Our skilled and motivated team want to use this workshop to explore these and other opportunities with the users of TEMSU and providers of care.

Telehealth parent counselling trial and research project

Nicole Owen BSW MSW1, Stephanie Golden Roser BSW2,

 

1 Child & Youth Community Health, Children’s Health Qld, Qld Health, C/O PO Box 1060 Noosa Heads 4567. nicole.owen@health.qld.gov.au

2 Child & Youth Community Health, Children’s Health Qld, Qld Health, Locked Bag 1 Caboolture 4510. Stephanie.goldenroser@health.qld.gov.au

 

This trial supported 12 Early Intervention Parenting Clinicians (EIPC/EIC) (social workers and psychologists) located at 9 child health services to set up video conference capability and deliver video conferencing (VC) counselling sessions to caregivers in rural and remote communities or those who cannot access a centre. It evaluated the set up and deployment, functionality and sustainability of VC counselling in the trial sites, including the clinician and client experience and satisfaction of VC delivery of parent counselling. The research component of the project is ongoing and will formally evaluate the parent’s and clinician’s experience of using VC and clinical outcomes.

The trial encouraged partnerships in the trial sites between the clinicians, the Telehealth Support Unit (who sponsored the trial) and local telehealth coordinators.   We run monthly VC training sessions with clinicians and telehealth colleagues and this was successful in enhancing VC skill level, confidence and clinician engagement. In the trial phase, 42 clients were told about the trial and 4 families utilised the VC sessions through local health centres or hospitals and all were satisfied with this mode of service delivery. There were minimal technical difficulties and additional clients are now engaged in ongoing VC service delivery in these sites.  The trial highlighted technical barriers such as lack of  internet access to rural/remote communities which affected the delivery of VC parent counselling services.  Data was collected on reasons why parents did and did not want counselling delivered through telehealth.  Main reasons for wanting VC parent counselling is that no service available in their area or large travel distance to access face-to-face service.  The research component has commenced VC into clients’ homes using the new Qld Health Telehealth Portal link generator.  One client’s feedback:

“Love being able to do this in my own home.  More flexible” (Working mum of young children).

This presentation will outline the findings of the trial and the initial data from the research project.  There will be a discussion of the implications for the future of telehealth in child health and similar services, and strategies for ongoing promotion and development of telehealth, and clinician and client engagement.

Maintaining mature mouths utilising teledentistry

Debra McKenzie1, Eilleen Shepherd2, Jacinta Pitt3, Carolyn Bourke4

 

1 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

debra.mckenzie@health.qld.gov.au

2 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

eilleen.shepherd@health.qld.gov.au

3 Rural Health and Aged Care, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 jacinta.pitt@health.qld.gov.au

4 Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 carolyn.bourke@health.qld.gov.au

 

Background:

Maintaining mature mouths utilising teledentistry is an innovative model of care enabling Darling Downs Hospital and Health Service’s (DDHHS) Residential Aged Care Facility (RACF) residents to have oral checks and dental reviews via a live streaming videoconference appointment with a Dentist. This integrated approach is between DDHHS’ Oral Health Clinic (OHC), Telehealth Team, seven RACFs, as well as RACF residents and their families.

Methods:

DDHHS’ TeleDentistry program was initially trialled in January 2014 using a dental probe connected to video conference equipment. The trial highlighted some technical issues which had to be overcome and also provided the opportunity to fine tune operational, administrative and nursing processes. Once the issues were addressed, the trial was recommenced at DDHHS’ Mt Lofty Nursing Home in Toowoomba in November 2014.

The Oral Health Therapist (OHT) visits the RACF and performs a chart audit, reviewing dental care plans. Each consenting resident receives an oral review in the privacy of their own room. The oral health therapist records the dental review and management plan in the resident’s record in collaboration with the Registered Nurse (RN).  If the OHT finds an issue that requires further investigation, a referral is made by the RN for the resident to be reviewed by a Dentist via Tele Dentistry. A time is scheduled where the Oral Health Therapist uses live streaming of the RACF resident via an inline camera. The Dentist views the live feed from their office and advises on appropriate treatment to commence locally, or advises that the resident is required to be seen in person at the OHC.

Results:

The following outcomes have been achieved:

  • 204 residents have had a dental assessment, 57 have had a tele-dental referral/consultation and 16 have required further appointments at the dental clinic.
  • Increased awareness of residents’ oral health needs and oral health requirements
  • Reduction in QAS and nurse escort time and costs for transporting residents to Oral Health Clinics
  • Addresses a major barrier for residents accessing appropriate oral health care
  • Reduction in the number of inappropriate referrals to a dentist by first screening residents
  • More efficient use of Dentist time
  • Minimum disruption to resident’s daily routine
  • Patient comfort maintained
  • All residents are up to date with yearly visits
  • Proactive approach finding areas of concern before they become a problem to the residents i.e. pain
  • Staff are becoming more in-tune with technological advances

Discussion:

TeleDentistry has allowed residents to receive optimal dental care while remaining in their own surroundings and eliminated the need for frail residents to be transported to the OHC via ambulance with a nurse escort. To improve the knowledge, skills and attitude of RACF staff in oral health, each nurse working in a RACF is required to undertake mandatory online training regarding oral health via the DDHHS online learning portal “Darling Downs Learning Online” (DDLOL). Future objectives include introducing the program into private aged care facilities and investigating different technology.

Only a click away: A workshop on best practice in telesupervision

Ms Priya Martin1

1 Cunningham Centre, Darling Downs Hospital and Health Service, QLD-4350 & International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, SA – 5001. Priya.Martin@health.qld.gov.au

 

Background

The need for clinical supervision in non-metropolitan settings where health professionals face a number of challenges in accessing professional support is well-documented. While supervision has historically been provided face-to-face, the use of distance supervision using technology is on the rise. Distance supervision or telesupervision refers to clinical supervision conducted by using technology such as telephone, email or video conferencing. This usually occurs when the supervisor and supervisee are not co-located. With the rise of social media, tools such as blog, micro-blog, wiki, video chat, virtual world, podcast and social networks can also play a role in telesupervision. Moving from traditional face-to-face supervision to telesupervision calls for clear guidelines and recommendations for using technology to undertake clinical supervision. Compounding this issue, there is a paucity of documented evidence on the best practice for health professional supervision, especially distance or telesupervision. It is acknowledged that those who use technology for supervision are unaware of ways to use it effectively.

Objectives

Although technology is increasingly being used in supervision, best practice in this area is not widely discussed or understood. Therefore, the objectives of this workshop are to:

  • Highlight evidence-based factors that lead to effective telesupervision practices in the health professions.
  • Facilitate contextualisation of information on evidence based telesupervision to the participants’ work settings. This is expected to inturn lead to a better-supported workforce, and improved outcomes for patients and organisations as effective supervision is said to lead to better patient, organisation and staff outcomes.

Methods

A literature review on telesupervision has been undertaken to synthesise information on best practice in this area. The best evidence from the literature will be layered with the author’s insights and experiences gained from undertaking primary and secondary research on telesupervision. Using best practice principles in teaching and learning, this workshop will be interactive and facilitate contextualisation of the discussions to participants’ work settings.

Discussion

Providing or receiving supervision using one or more technology mediums will be discussed. Information will be provided on establishing a contract, addressing ethical concerns, maintaining confidentiality as well as other considerations while undertaking telesupervision. Discussion will be facilitated on how best to translate the new knowledge gained to participants’ work settings and contexts.

Conclusion

It is expected that this workshop will provide a forum for rural and remote health practitioners to acquire evidence-based information on telesupervision. It is further expected that effective telesupervision practices arising from attendance at this workshop will influence telehealth in general, as well as lead to improved outcomes for clients and organisations.

Every referral is a patient with a problem and a doctor who needs assistance

Jane Connolly1, Lex Lucas2, Vicki Sheedy3

 

1 ACRRM, GPO Box 2507, Brisbane, QLD, 4001, j.connolly@acrrm.org.au

2 ACRRM, GPO Box 2507, Brisbane, QLD, 4001, l.lucas@acrrm.org.au

3 ACRRM, GPO Box 2507, Brisbane, QLD, 4001,v.sheedy@acrrm.org.au

 

ACRRM Tele-Derm service is designed to provide rural doctors with rapid access to specialist dermatology advice and receives approximately 500 cases annually from rural doctors seeking assistance using a telehealth store and forward model.

This presentation will show the impact an online advice service can have on rural health services through supporting the rural generalist to treat their patients locally, improve their knowledge and skills in an environment of support and encouragement to operate at the top of their licence.

Skin conditions account for 14.8 out of every 100 patient encounters in general practice and 10.4% of the total reasons for encounter, making skin conditions one of the most common presentations in Australian general practice.[1]

Skin disorders can be chronic, painful, visually distressing, life altering and at worse cause death, however long waiting lists and large distances to travel are disincentives for patients to seek medical assistance.

Results from a recent survey to ascertain the impact the service was having in reducing the need for patients to be referred to a dermatologist showed that only 10% of the complex dermatology cases were not resolved locally with the support of Tele-Derm and required a referral to a specialist dermatologist.

The Australian College of Rural and Remote Medicine Tele-Derm service is a store and forward teledermatology service, free for all Australian rural doctors.  Funded by the Australian Government, Department of Health Rural Health Outreach Fund the service has been operational for twelve years.

In addition to responding to cases submitted for advice, the Tele-Derm dermatologists provide education material in the form of ‘case of the week’ (grand rounds style) and education cases to the 2700 online users on a weekly basis.  Tele-Derm hosts an encyclopaedia of dermatological conditions based on previous submissions to the service. Regular quizzes, discussion forums, journal article appraisals, and didactic articles and video presentations on important dermatological topics are also available.

Tele-Derm provides a safe environment of participation and collaboration where experiences amongst training and trained, isolated rural doctors are shared in a ‘community of practice’ to improve the care provided in rural and remote communities.

[1] Britt H, Charles J, Henderson J, et al. General practice activity in Australia 2000–01 to 2009–10 10 year data tables. Canberra: Australian Institute of Health and Welfare; 2010.

Every referral is a patient with a problem and a doctor who needs assistance

Jane Connolly1, Lex Lucas2, Vicki Sheedy3

1 ACRRM, GPO Box 2507, Brisbane, QLD, 4001, j.connolly@acrrm.org.au

2 ACRRM, GPO Box 2507, Brisbane, QLD, 4001, l.lucas@acrrm.org.au

3 ACRRM, GPO Box 2507, Brisbane, QLD, 4001,v.sheedy@acrrm.org.au

 

ACRRM Tele-Derm service is designed to provide rural doctors with rapid access to specialist dermatology advice and receives approximately 500 cases annually from rural doctors seeking assistance using a telehealth store and forward model.

This presentation will show the impact an online advice service can have on rural health services through supporting the rural generalist to treat their patients locally, improve their knowledge and skills in an environment of support and encouragement to operate at the top of their licence.

Skin conditions account for 14.8 out of every 100 patient encounters in general practice and 10.4% of the total reasons for encounter, making skin conditions one of the most common presentations in Australian general practice.[1]

Skin disorders can be chronic, painful, visually distressing, life altering and at worse cause death, however long waiting lists and large distances to travel are disincentives for patients to seek medical assistance.

Results from a recent survey to ascertain the impact the service was having in reducing the need for patients to be referred to a dermatologist showed that only 10% of the complex dermatology cases were not resolved locally with the support of Tele-Derm and required a referral to a specialist dermatologist.

The Australian College of Rural and Remote Medicine Tele-Derm service is a store and forward teledermatology service, free for all Australian rural doctors.  Funded by the Australian Government, Department of Health Rural Health Outreach Fund the service has been operational for twelve years.

In addition to responding to cases submitted for advice, the Tele-Derm dermatologists provide education material in the form of ‘case of the week’ (grand rounds style) and education cases to the 2700 online users on a weekly basis.  Tele-Derm hosts an encyclopaedia of dermatological conditions based on previous submissions to the service. Regular quizzes, discussion forums, journal article appraisals, and didactic articles and video presentations on important dermatological topics are also available.

Tele-Derm provides a safe environment of participation and collaboration where experiences amongst training and trained, isolated rural doctors are shared in a ‘community of practice’ to improve the care provided in rural and remote communities.

[1] Britt H, Charles J, Henderson J, et al. General practice activity in Australia 2000–01 to 2009–10 10 year data tables. Canberra: Australian Institute of Health and Welfare; 2010.

Current and Future Telehealth Technologies in Queensland Health

Daniel Best1

1 Telehealth Support Unit, Queensland Health, Level 2 / 15 Butterfield St, QLD, 4006, daniel.best@health.qld.gov.au

 

Telehealth technology is an ever changing environment within Queensland Health. Since the first introduction of two videoconference units with ISDN lines over 20 years ago, Queensland Health has now grown to one of the largest managed telehealth networks in the world with over 1,600 hardware based and 3,000 software based videoconference units in over 200 facilities. A major role of the Queensland Health Telehealth Support Unit is to research, test and implement emerging technologies. These technologies currently include:

  • A wide range of standard videoconference setups available to suit a variety of telehealth needs in Queensland Health. These include a range of trolley based solutions for consultations rooms or ward scenarios and wall mount solutions for dedicated telehealth rooms
  • Customised and fit for purpose telehealth setups including integrated operating theatre installations with connections to laparoscopes and endoscopes for live surgery scenarios
  • Portable clinical peripheral videoconference attachments such as otoscopes, dermatoscopes, and intraoral cameras
  • Connecting larger clinical equipment such as ultrasound machines and exercise stress test machines into videoconference equipment for live advice and diagnosis
  • Specialised microphones used in Speech Pathology to remotely assess patients’ coughs and swallows
  • Digital Stethoscopes for live remote heart and lung assessments
  • High end dual camera installations with extensive pan, tilt and zoom capabilities in resuscitation bays for emergency advice and coordination
  • Using an iPod touch as a hand held examination camera when connected to a videoconference system
  • Videoconferencing on iPads to allow telehealth at the patient’s bedside and even in their own homes
  • The Queensland Health Telehealth Portal that uses WebRTC technology to easily and securely allow external clients to videoconference into Queensland Health through any web browser without the need to download, install or register to anything

Future Technologies that are on the roadmap include:

  • Wearable videoconferencing solutions that can provide a “point of view” experience to assist in emergency consultations or live surgery
  • Virtual waiting rooms to assist large outpatient telehealth clinics by providing a dashboard overview of who is connected to the virtual waiting room and the ability to transfer patients in and out
  • Augmented reality scenarios including overlay and annotation capabilities during a videoconference to provide better directions for procedure based telehealth

By constantly researching and testing new technologies, Queensland Health benefits from a highly efficient, advanced and flexible telehealth network. Timely implementation of these new technologies is key to keeping clinicians enthusiastic and embedding telehealth as part of everyday clinical practice in the treatment of patients.

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