TeleStrong delivers allied health to aged care remotely

Allied health services provider HealthStrong has launched a new telehealth service to provide healthcare by video conference to the aged care industry.

HealthStrong has provided allied health services such as physiotherapy and podiatry to residential aged care facilities for over a decade under the company's former name Clinicall. It has now branched out into providing some of those services through its telehealth arm TeleStrong, as well as setting up CareStrong for the community care sector.

TeleStrong's operations manager, Tiffany Chaisson, said the company currently provided physiotherapy, dietetics and diversional therapy services by video conferencing, and has also developed a remote speech pathology program. A remote wound care service is in the works, as is a remote palliative care program.

Mrs Chaisson said the service was launched in response to the common problem of accessing allied healthcare professionals in rural and remote areas, but even in outer metropolitan areas and regional centres there was a problem, she said.

“The health system for aged care facilities isn't great at times,” she said. “Every area is very different – one can have one RN shared between three facilities because that is all they can get, and others have lots of RNs but limited access to GPs.

“TeleStrong came about from attending various conferences where there were always a lot of requests from rural and remote areas saying they need podiatrists or they can't get a dietitian. Our management decided to launch TeleStrong and with the sign-on incentive for video conferencing, we thought why can't we use video conferencing to provide the allied medical services they want remotely.”

The federal government's onboard incentive is currently $4800, which Mrs Chaisson said was enough to cover the equipment required. TeleStrong uses a web-based video conferencing system to facilitate the video conferencing.

“We have signed a contract with the service provider so the aged care facilities don't have to have their own software,” Mrs Chaisson said. “The video conferencing software is hosted on a private, secure, dedicated cloud, so all they do is log in to our licence so they don't have to pay licence fees or anything. They just have to get onto a computer with an internet connection.”

This dedicated conferencing software was chosen over free services such as Skype for a number of practical reasons, she said. “A lot of people are using Skype, which is very good for what it is, but because this is medical conferencing I thought this should be more secure and a little bit more high-end. We are looking at a wound management program and you need to have high-definition cameras for that.”

She said one of the benefits of the TeleStrong system was balancing bandwidth strength with visual resolution. “We set up some parameters for testing with a group who have some facilities in southern NSW,” Mrs Chaisson said.

“Their speed is not quite as bad as dial-up, but close. You can set parameters in our system and you may lose a little in resolution but you can still have a consultation. The IT manager there didn't think it would work at all and was surprised it did.”

Mrs Chaisson said if RACFs are already equipped with video conferencing equipment, TeleStrong can run a test to see if they interoperate, but if not the company can organise all of the equipment required at no out of pocket expense as the current $4800 on board incentive covers the cost.

Fees for consultations are quite reasonable, and Mrs Chaisson said each facility varies in how it charges residents, whether it be an all-inclusive fee or a base fee with additional services charged individually, so it would be up to the facility's managers to decide on passing on the associated costs.

Using diatetics as an example, the process might involve a dietitian physically visiting the facility and working with the care manager on assessments for all residents, which then could be followed up by video conference on an as needed basis.

“With a dietetics trial we did recently, we had the practitioner go up and see all of the at-risk residents and see what was needed, and that's what the facility wanted too as the residents hadn't been seen in a while as they had struggled with the dietetics service in their area,” she said.

“The care manager, when I was there, said she didn't think the video conferencing would be so good. It gives them a bit of confidence that they can access expertise. The dietitian can ask the nurse to weigh them weekly for example and look at the fluctuations, and then every couple of months review the at-risk residents.

“If there are any changes or they need to be revisited, they can book another teleconference. Or they may have some new residents that they can go through individually with the dietitian – they have bowel issues or they are being fed by PEG. There are lots of variables.”

Similarly with physiotherapists, practitioners can do an initial hands-on assessment and develop care plans for those who need it, and then follow patients up remotely. Ongoing education is another application of the technology, she said.

“With video conferencing, we can provide in-service education. If the facility wants diabetic education we can get our head podiatrist to talk about foot care and our other allied health practitioners about the other aspects of diabetes care. We can do training for people who are in remote areas so they don't have to fly anywhere. They have to get their CPD points so it has to be done anyway, and we can do it cost effectively.”

In the near future, TeleStrong may look at adding mobile devices to the offering, which would be very useful for the wound care service the company is hoping to introduce. It would also reduce some of the disruption to bed-bound residents experienced when they have to be moved to the video conferencing room required under the specialist rebate program.

The mobile devices would have to be high-end as the system codecs don't support the use of basic models, but Mrs Chaisson said it works well on tablets such Motion devices.

Next stop, however, is the development of a wound management service. “That came about because I spoke with a facility in the far west of NSW and they said this is what they have the main problem with. They only have one RN who is on staff and can't be on call for 24 hours, and so it is difficult to get her time when she comes in.

“Even if you have a good video camera and you put it up close to the wound, you can then describe it and talk about the discolouration or the smell to a remote wound care specialist.

“There are a list of questions that our head podiatrist has started from a diabetic point of view because of diabetic foot wounds, and we are working with a wound specialist nurse about the other sorts of wounds to add to that program.

“Obviously you can't do remote podiatry but our podiatrist can speak to the patient-end carers if they have a diabetic foot and address issues of diabetic management. As far as I'm concerned, if it will help the residents I'm all for it. If there are any services you require that TeleStrong doesn't have on the list, tell me what it is and I'll see what I can do.”

She said that while a lot of remote facilities struggle to get an allied health professional to visit, it can be even worse for nurses and GPs.

“There was a facility I went to in Sydney that had 200 beds – high care and independent living units as well – and they had 80 different GPs visiting them, because all of the residents had different doctors. But then you have facilities where they can't get a GP out there at all.

“Telehealth certainly can't do everything, but it is better than nothing.”

Posted in Aged Care

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