Telehealth research goes commercial for aged care

The Queensland-based research team that has developed protocols to support geriatric care using telehealth has established a new commercial business called RES-e-CARE, a teleheath service being offered to residential aged care facilities.

Researchers from the University of Queensland's Centre for Online Health (COH) and the Centre for Research in Geriatric Medicine (CRGM), led by Len Gray and Anthony Smith, have been testing the use of high-definition mobile wireless video consultations between specialists and RACFs, and are now building RES-e-CARE as an academic telehealth service operating on a commercial basis through the university's commercialisation arm, Uniquest.

RES-e-CARE will be offered to aged care facilities to provide regular geriatric consultations supported by purpose-built video conferencing studios, high-quality electronic data systems and clinical support staff trained in telehealth.

The team also plans to add to its roster of consultant geriatricians and to expand the panel to other disciplines, for example psychiatry and dermatology, and to also investigate offering allied health and specialist nursing services on a cost basis through telehealth.

Professor Gray said the idea was to take what his team has developed in its residential aged care research and offer it on a commercial, financially viable basis.

“This is taking what we have learned about telehealth in residential aged care and testing what we conceive of as a business model in the real world,” Professor Gray said. “It is halfway, in our minds, to a full commercial process.”

He said the basic clinical services that will be offered include an agreement with individual RACFs for access to specialist services via telehealth. Each facility will be allocated a geriatrician who will make regular virtual visits – generally once a week – and develop strong relationships with residents, nurses and visiting GPs.

“Our business is a virtual private practice,” he said. “We are setting up a practice with geriatricians as the key medical personnel, but during 2014 we expect to begin to add other disciplines that we think will be required by RACFs. That will depend on what we perceive to be the need and also of course the availability of the relevant specialists.

“Central to our process though is that each facility will have its own geriatrician. The affiliated geriatrician will establish a relationship with the RACF so that geriatrician will get to know the staff and the residents and the GPs and become, if you like, a part of the staff.

“This arrangement has similarities with private hospitals, where specialists base part or all of their practice around the hospital. Since all work is dependent on referral from GPs, it is critical that the specialist offer services that are perceived by the GP, RACF staff and residents to be of high value.”

The COH has established dedicated telehealth suites at its Princess Alexandra Hospital (PAH) facility in Brisbane. Studios are equipped with high-definition video conferencing technology, wall-mounted screens, high-tech lighting and sound equipment and computer systems that allow access to resident/patient medical files.

Professor Gray is a strong advocate of using high-definition equipment for telehealth, particularly for older, less mobile patients and aged care residents.

“Our standard is high-definition video conferencing with remote camera control,” he said. “We are consulting at a distance with patients who have often have complex diagnostic problems. A medical practitioner is not usually present at the patient end to assist in clinical examination. Residents often also have cognitive, hearing and visual impairments, that make interaction with low-quality vision and sound systems problematic.

“Current PC-based, low-cost solutions don't currently provide the level of clinical capabilities that we require in a relatively unsupported environment.”

Part of RES-e-CARE's offering will be to work through the technological challenges that face each RACF, and also to provide intensive training for nurses on how to prepare a case for the specialist. Professor Gray estimates that about two-thirds of video consults to an RACF with a remote specialist take place without a GP in attendance.

The RES-e-CARE team current has two facilities fully equipped and working with an affiliated geriatrician – the Cairns Aged Care Plus Centre and Masonic Care Queensland at Sandgate in Brisbane – and is scheduled to add 10 or 15 more over the next few months. It will then look at adding other medical disciplines, and other non-Medicare compensated services such as allied health and specialist nursing that would normally be met at cost by the facility.

“Allied health and nurse specialist services are probably most relevant to rural facilities that can't easily access therapists and nutritionists,” he said.

“For example, an aged care facility in outback Queensland may want access to a speech pathologist. The RACF would secure the service through RES-e-CARE on a fee-for-service basis. If they already have the telehealth infrastructure in place, that will mean the service will be relatively less expensive.

“A key consideration in developing a service is to ensure that there is sufficient telehealth work demand for specialists. Once there are sufficient RACFs using RES-e-CARE, a wider range of specialties will have sufficient demand that involvement in teleconsultation will become financially viable.

"We believe that once 10 RACFs are participating, quite a range of specialties will be in sufficient demand to begin engagement.”

Posted in Aged Care

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