Dedicated telehealth services double in the Darling Downs

Close to 18 months since initial planning and a year since its official launch, Queensland's Health-e-Regions telehealth project is putting some early runs on the board, including providing comprehensive geriatric assessments for nursing home residents, conducting weekly ward rounds at a small regional hospital and developing a sustainable business model so the project can continue in the longer term.

Health-e-Regions is centred around the Darling Downs towns of Dalby, Chinchilla and Miles, and involves providing a range of telehealth services for paediatric, adult and geriatric patients in a number of settings. Led by the University of Queensland's Centre for Online Health (CoH) with the support of Queensland Health and UQ's research commercialisation arm UniQuest, it has been funded by a $1.3 million investment from natural gas company QGC.

At the heart of the project is the extension of existing telehealth services established and run by COH such as the long-standing Queensland Telepaediatric Service and the adult and geriatric services run from the Princess Alexandra Hospital (PAH), as well as scoping out the potential for new telehealth services to create a “whole-of-community” system that best suit the needs of the towns and their surrounding regions.

This includes working with aged care facilities, regional hospitals and general practices to assist in setting up telehealth services or creating better connections for existing services with remote clinicians in Brisbane and Toowoomba.

While part of the project does involve helping facilities to implement telehealth systems, such as through the COH's recently commercialised RES-e-CARE business that provides high-tech assistance to residential aged care facilities, the majority of the work involves scoping out needs and building relationships with local healthcare services and providers.

Last week, a community event was held in Chinchilla – pop. 5500 and 300km from Brisbane – to mark a year since the official launch and raise more awareness of what is available through Health-e-Regions. According to the COH's deputy director and project lead Anthony Smith. the next event will be in Dalby – pop. 12,000 and 210km from Brisbane – where the local hospital now runs weekly ward sessions for its predominantly elderly patients with geriatric specialists in Brisbane.

“As we expected at the beginning of the project, none of this was going to happen overnight,” Associate Professor Smith said. “That is one thing we declared upfront to QGC, who have been very supportive. There needs to be relationship building done behind the scenes.

“The project itself was never designed to be just a technical installation. It has been a complete process where we've been looking at developing relationships where they don't currently exist, or looking at existing relationships where we can assist them with telehealth. It is a process of invigorating or generating telehealth activity.”

In Chinchilla, the Health-e-Regions team has been working closely with Illoura Village, a 66-bed aged care facility operated by Southern Cross Care that is serviced by GPs from the Chinchilla Medical Practice.

The project is delivering the Res-e-Care service to Illoura, with a specialist geriatrician from Brisbane actively seeing patients for the last six months. “They are generally doing weekly rounds with patients and they do comprehensive assessments, which do require a bit of time,” A/Prof Smith said.

“They've done 26 consultations since March for 19 residents who have had a complete review. All of that information is shared with the GP so they can review the care plan. In some cases the GPs can be involved in the telehealth consultation and talk to the geriatrician. That is working really well.”

The COH does recommend setting up dedicated telehealth rooms, but for small facilities without the space and for those residents who are too frail to be moved, mobile telehealth systems are available. COH recommends using high-definition cameras in order to properly carry out a visual assessment.

Illoura Village is using a mobile telehealth trolley, which can be transported to the bedside. A/Prof Smith said one of the main concerns when setting up in each town was that they have not yet been connected to the NBN, and both ADSL and 4G can be a bit hit and miss.

“Fortunately in Chinchilla the 4G connectivity is excellent, so we have installed one of our mobile telemedicine trolleys which connects to the 4G network, and it can be transported around the entire facility,” he said. “The video quality is excellent during a call.”

He very much attributes the success of the program at Illoura to the people working in the facility and the nearby medical practice, who he says have put a great deal of work into making it possible. Some of the Chinchilla GPs themselves have previously done some telehealth consults using their iPads and Skype, but like many rural clinics space is at a premium so a dedicated telehealth room is not possible.

This will hopefully change in Dalby in the next year following some capital works, but for the Chinchilla GPs, the project is providing a mobile trolley to support a range of new specialist services including endocrinology.

A/Prof Smith said probably the major barrier to expanding GP telehealth services in regional towns is not the technology but who the GP can refer to and how to do that referral. “That's a really important process, so now we're working with the GPs to assist them in relation to information. For example, if they have a patient with one of these conditions, here are the doctors they can refer to at these facilities.

“Quite a few organisations have put effort into building directories so we are not the first to do that but because we're trying to assist with bridging services and connecting services from facilities in Brisbane, where we have a responsibility in providing services, we are just trying to make that process easier for them.”

At Dalby Hospital, the COH has been providing remote general ward rounds in one of its medical wards. Most of the ward rounds have been in relation to elderly patients, so that service is being provided through the PAH geriatric telehealth service as a weekly clinic.

“That is running extremely well,” he said. “There are nurses that lead those consultations and patients are seen at their bedside. There is also an aged care facility connected to the hospital called Karingal, and telehealth has been working like lightning there. They have been flying through geriatric consultations and seeing patients every week.”

While the project has predominantly been concentrating on geriatrics because of the high proportion of elderly patients in these kinds of small rural hospitals, A/Prof Smith said his team has been promoting a range of services.

“Paediatrics, adults and geriatrics is our general message and we are working on all of those different services,” he said. “We have provided support in Miles for example, for mental health, and assisted with its child and youth mental health service to see a patient out there who would normally drive in to Brisbane. They can stay at home now, which is excellent.”

The Darling Downs is seeing major fluctuations in population groups due to the extensive gas and mining activities in the region, so while in the past there was a higher proportion of older people, there is also a reasonably high proportion of young ones too, which is why paediatric telehealth is a priority area.

Another priority is getting the word out to the locals, part of the reason why the current events are being staged. The team has recently had a paper accepted for publication that examined both the pre- and post-implementation of telehealth, which found that for the whole Darling Downs region, activity has doubled in the last two years.

“While it can't all be attributed to Health-e-Regions, activity has almost doubled in the public health system,” A/Prof Smith said. “If you look at all of the hospital-based telehealth activity, the Darling Downs stands out in Queensland as a leading region for telehealth. It has been quite impressive. I know the health department is happy about that too as we expect activity to steadily increase.”

Queensland Health and the Queensland's Minister for Health are strong advocates for the potential of telehealth in a vast state like Queensland. The government has put in $36 million over four years to expand telehealth services, predominantly using existing infrastructure that sometimes is lying dormant due to a lack of coordination.

A parliamentary inquiry has been going for most of the year to investigate what the current state of telehealth is and what the opportunities are for the future. The inquiry's report, to be released in the next month or so, will further inform that four-year investment.

For A/Prof Smith and his team, the work continues on talking to both clinicians and patients to raise awareness of current telehealth services and the potential for new ones. The sustainability of the services is one of the key factors in the project, with A/Prof Smith saying that the Health-e-Regions project funding was dependent on the generation of new services being financially sustainable in the long term.

He said Health-e-regions funding had helped accelerate the use of telehealth in the Darling Downs, with new telehealth systems installed or improvements made to existing infrastructure. The majority of services provided now are eligible for Medicare rebates or funding through the state public hospital system.

“All of the services we are developing definitely have a life beyond the life of the project, so it's not going to stop at the end of the year,” he said. “That was one of our commitments at the onset of the project, to align new services with conventional funding sources, and we've been able to do that successfully.”

Posted in Aged Care

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