Telehealth to go high tech for aged care

University of Queensland researchers have received a grant for almost $1 million from the National Health and Medical Research Council to conduct a four-year study into the use of telehealth in residential aged care facilities, involving a web-based clinical support system and clinical-grade video conferencing technology.

The Centre for Online Health (COH) and Centre for Research in Geriatric Medicine (CRGM) joint study, led by the centres' director Len Gray, is a randomised control trial that will see video conferencing technology deployed as a mobile wireless device at the resident’s bedside and operated by a geriatrician from a remote telehealth studio.

The main aims of the study are to investigate the potential to reduce transfers to emergency departments and reduce transport costs, as well as improve access to specialists, prescribing practice and the quality of care for residents.

Professor Gray said it is the most extensive trial of telehealth ever undertaken in residential aged care worldwide. Because of the complex nature of illnesses among residents, the study will focus on conventional or “clinical-grade” video conferencing equipment.

“While video conferencing with Skype or other PC-based systems works well for general conversations, it is still of insufficient reliability and quality for clinical diagnostic work,” Professor Gray said.

“Clinical-grade technology is essential when performing a consult with an unwell or frail older person. Conventional video conferencing allows the user to control the camera with better precision, compared with a smaller, hand-held camera.

"Our systems enable detection of subtle eye movements, observation of mobility patterns and reading of fine print, through the remotely controlled pan and zoom functions. The need for this quality of video is important for working in nursing homes, where there will often be no medical support at the patient’s end.”

The trial will also involve a web-based clinical decision support system, built by the centre over the last decade, which has been used in hospital care for older people. It uses a structured assessment overlaid with a number of processes to help interpret clinical observations.

“The web-based support system has been trailed successfully in about 10 hospitals, so we are confident that we can use the same concept and modify it for long-term care,” Professor Gray said. “We’ve found that not only does it work, but patients like it.

“The desire for telehealth is greater in residential aged care than in hospitals, where facilities are isolated and it's often a struggle to get health professionals to visit them. Although the technology is a bit more expensive, residential care providers have indicated that the cost is not a major barrier to them in terms of affordability.

"Telehealth needs to be performed often – and systematically – to ensure that it is affordable and effective. As usage increases, the cost will come down.”

Residential aged care facilities are entitled to an on-board incentive payment through the Department of Human Services along with Medicare item numbers for each consult, but Professor Gray said many facilities had already invested in video conferencing equipment to provide education for their staff.

“The unique benefit we have is that we go to the patient's room,” Professor Gray said. “Taking a patient to an office with a conventional video system means the resident is disrupted. We’ve found that it is more efficient and a better experience for the patient when we go directly to the patient’s bed.

“You give yourself maximum flexibility if you have mobile wireless and high-definition video. The price will dramatically reduce over the next five years, but we suspect it's already sustainable with a small investment from the facility. Many facilities are enthusiastic about this telehealth model and see huge potential for their residents and staff.”

The project will also involve the design of telehealth studios at participating geriatricians' hospitals. Again, most hospitals have some type of video conferencing technology, but this project will involve running long sessions for the geriatrician with several patients, as well as other specialists such as psychiatrists.

“The studio will be like a doctor's consulting room but with better acoustic treatment, different lighting and correctly configured video systems. It has to be comfortable and have access to computers to review x-rays and other medical reports.”

The trial model involves a geriatrician being affiliated with each facility, who provides weekly video consultations. This offers add-on benefits besides having regular access to a specialist.

“What we are trying to do is create relationships between the geriatrician and each facility. If the geriatrician is attending a facility regularly in a virtual capacity, he or she will hopefully form a strong, working relationship with facility staff.

"The benefit of these relationships is that processes and protocols will be better understood and implemented, as well as providing the in-house staff with support and extra skills. It is good for families too, in that their GP will have some specialist support.”

Visiting GPs will also be invited to participate in the model, he said. “We will put forward a proposal to GPs that a specific geriatrician will be present at a certain time to discuss patients, and he or she will welcome discussion.

“It has to be efficient for the GP. To interact directly with a specialist requires complicated scheduling, which is difficult. In an ideal world, over time, GPs might be happy to do their nursing home rounds at the same time the geriatrician is there.”

The trial will involve 10 residential aged care facilities, five allocated as a control group and five intervention sites. The control group will conduct business as usual in the first year, with telehealth-enabled geriatrician sessions offered to the intervention group. After the first year, the control group will be offered the opportunity to use the telehealth model.

“We will be able to compare things like how many people are transferred to the emergency department from the home in that year with telehealth and how many without,” Professor Gray said.

“We suspect that using telehealth will reduce transfers by about 20 per cent. There are many possible benefits to geriatric patients and to the facilities that care for them. This study will critically examine all of those ideas.”

Posted in Aged Care

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