Medtech Global has completed a successful trial of its new VitelMed telehealth solution in a Melbourne aged care facility and is now looking for clinical groups to partner it in a bid for funding under the federal government's new NBN-enabled telehealth pilot program.
It is also encouraging general practices, specialists and aged care providers who are considering taking advantage of the government's telehealth incentive to take the plunge now. The incentive program provides a one-off payment of $6000 for providing telehealth consultations, but will drop to $4800 after June 30.
Medtech Global acquired the rights to the VitelMed video conferencing and remote monitoring system, which allows the patient to see their doctor through their television, last year. The system also allows third parties such as specialists to join in the consultation and is predominantly aimed at chronic disease management.
Medtech Global's chief technology officer, Rama Kumble, said the technology was perfect for in-home care, which is the prime target of the NBN-enabled telehealth program. “This is exactly what the government is looking for – how can we do home care delivery – and this is great technology for that," he said. "Minister for Broadband Stephen Conroy said that 'the delivery of high quality healthcare direct to the home via NBN-enabled telehealth services will make a real difference to the lives of Australians with high healthcare needs, particularly those living in regional, rural, remote and outer metropolitan areas'. It is simple and the most convenient for remote home care.”
Mr Kumble said Medtech Global had approached several groups and all of them had shown interest. “In the end, we need a clinical group, a major health group that wants to do clinical research,” he said. “They are the ones who will capture the data and tell the government this is working or not. Our Manage My Health solution, which is a patient portal, combined with the VitelMed telehealth solution and our patient management system in Medtech32, gives the confidence for someone to run this pilot.”
The trial of the technology in the aged care facility has also given the company confidence that it can be used under the one-off incentive and the MBS rebate for video consults. “Patients who participated in the pilot reported an improved understanding and knowledge of their conditions, reduced anxiety and an increase in their quality of life,” Mr Kumble said. “Access to specialist services, which would otherwise not be possible, improved outcomes for patients and supported more efficient management of patient care delivery.”
He said the trial had shown that there were technological barriers that have to be overcome to ensure telehealth was successful. “The pilot has pointed out one key factor – the importance of upload/download bandwidth and its effect on audio/video conferencing,” he said. “From this experience, Medtech suggests practices upgrade their network to a minimum download and upload speed of 512kbps before considering consultations via telehealth.”
The one-off incentive and the MBS rebate scheme for specialists offering the service are both aimed at areas of need, one of which is aged care, where despite round the clock nursing care, it is often difficult to find doctors willing to attend a nursing home both during and after business hours.
To get a specialist to visit a nursing home is nigh on impossible, so video conferencing makes a lot of sense. However, the aged care sector has historically been reluctant to invest in the technology for a number of reasons. Cost is the main one, but the dearth of specialists willing to use the technology is another. And with no real incentives for GPs, they too have yet to really embrace the potential.
One GP who is happy to take the plunge is Igor Jakubowicz, who regularly provides medical care to the residents of the Martin Luther Homes aged care facility in The Basin in outer suburban Melbourne. He and a local dermatologist, Doug Czarnecki, partnered with Medtech to help run the trial, despite a lack of ongoing incentives for GPs themselves.
“I would use this whenever I can but I'm not paid for it,” Dr Jacubowicz said. “The MBS item number is for patients seeing a specialist – the aged care facility is considered an area of need but it only applies to specialists, so GPs don't actually see those benefits as they have to physically attend the nursing home anyway.”
He admitted it was hard to find specialists who want to give it a go, but as Dr Czarnecki is semi-retired, this works perfectly for him. While most specialists would like to see the patient in person initially, the potential is more in providing quick and easy follow-up care.
“If they are looking at a specific skin lesion, you can take a high res photo and can send it in advance through the system,” Dr Jakubowicz said. “If you have a good webcam, you can do a close up and it's high quality.”
At the aged care facility, the system was set up in a consulting room with a nurse attending the consultation with the patient. The GP or the specialist manages the consultation, with the specialist accessing it over the internet. The same situation could apply in the home, with a carer attending the consult, although Medtech has added software to allow family members not at home to sit in as well.
“We think the people who would like to use it are particularly long-term patients,” Mr Kumble said. “They are quite happy to have a consult in the evening. It will also be good for people who are non-English speakers if they have family members with them.”
While many GPs and specialists would prefer not to work out of hours, some like Dr Czarnecki are more than happy to do so. According to Dr Jakubowicz, Dr Czarnecki has offered his services to areas of need such as northern Tasmania, where there are few dermatologists to be found. The uptake hasn't been great, perhaps because GPs not in district of workforce shortage (DWS) areas are not remunerated, which is why both he and Medtech Global are keen for doctors to take advantage of the one-off incentive to at least get the infrastructure in place.
Dr Jakubowicz strongly suggests the government consider an MBS item number for GPs, which he said will vastly improve the uptake of the technology and at the same time make it far easier for carers, patients and their families.
Although the trial took place at a nursing home, the real potential of the system is in keeping patients in their own homes for longer. One component of the VitelMed system is a set-top box that people in the home simply attach to their television, through which they can see and interact with their doctor. The doctor and specialist use a PC-based program to consult while using their electronic medical record system to record the consulting notes and collect data from the remote medical device connected to the set-top box.
The VitelMed system also allows the doctor to remotely control the camera at the patient end with pan-tilt-zoom capability. A call log displays all call activities, with incoming calls, calls during absence and dialled calls clearly marked with distinctive colours. The call log menu is easily accessible by the patient and the doctor through a simple remote control with four navigation keys.
As soon as the patient receives a new message, the VitelMed unit will continuously flash until the patient opens the menu and the new message will pop up. This tool is often used as a reminder or alert function.
A unique feature of the system is the single RED button which, when pressed by the patient, results in a video call to the triaging centre. The call can be answered by the front-desk operator and transferred to a doctor anywhere in Australia. Other parties such as specialists and family members can just as easily be conferenced to establish a multi-party session. Patients can chose to connect to a healthcare provider of their choice using the directory on their television.
Family members can also join in the conversation remotely over the internet, as can specialists from their consulting rooms. Users of the family software can send text messages to each other and to the unit in the patient's home.
The system is also set up to connect via Bluetooth to off the shelf medical devices such as blood pressure monitors, blood glucose monitors, ECGs, pulse oximeters and spirometers. The system transmits this data to the care provider, which can help identify early escalation of developing problems and allows early intervention to avoid a potential hospitalisation.
The VitelMed service also allows a doctor to access a patient’s records and complete medical files in real time to gain a clear picture of the history and requirements of the patient. Mr Kumble said doctors can use any clinical software, not just Medtech32.
“We are truly excited about the possibility of providing equitable care to rural and remote patients using a technology that uses your home television,” he said. “We will be embarking on pilots in other countries such as India, where an integrated telehealth solution from Australia can deliver high quality medical services to rural populations.
“We are also talking to groups in New Zealand, where despite not having an incentive program, they are setting up a telehealth consortium due to a shortage of doctors.”This is an updated version of a story which first appeared in the April 2012 edition of Pulse+IT Magazine.