Telehealth for kids racks up major milestone
The Queensland Telepaediatric Service (QTS) has reached a milestone of 20,000 remote consultations since it began operating in November 2000 and is now one of the largest paediatric telehealth services in the world.
QTS connects medical specialists from its base at Brisbane's Royal Children's Hospital with over 100 regional and remote hospitals throughout Queensland.
Established and operated by the University of Queensland's Centre for Online Health, it has a dedicated telepaediatric co-ordinator and uses a mixture of phone, email and video conference, with about 90 per cent of all referrals resulting in a consultation by video.
RCH paediatric surgeon and burns specialist Craig McBride regularly uses QTS to link him with regional patients and with a network of scar management therapists throughout the state.
Dr McBride does a four-weekly telehealth clinic on a Thursday morning, and says the other consultants tend to do the same. His burns patients are generally seen first, followed by paediatric surgical patients.
“The burns consultations are with an [occupational therapist] from here and that timing works better for them. I do the paediatric surgery ones on my own. We book the patients into clinic review just as we normally would, only it’s telehealth rather than in the same room. We can also do ad hoc appointments if necessary.”
The types of paediatric surgery cases that are suitable for telehealth vary, but usually consists of the more common conditions such as hernia, hydrocele and undescended testes, he said. “We have also used it for follow-up of patients with more complex conditions that live a long way out of Brisbane.”
Pre-operative consultations as well as post are conducted, although post-operative is generally easier as the surgeon has met the patient in person. For surgery patients, pre-operative checks mean the team in Brisbane is more dependant on the clinician at the other end of the consultation to demonstrate problem areas, he said.
“If we can see a hernia bulging, then it’s easy to decide to book the patient for an operation. If the issue is undescended testis, then that’s potentially more difficult. Sometimes in that situation we can find a testis where others cannot, and determine that an operation is not required.
“It can be a little more difficult if the person at the other end can’t confidently act as our hands. In those situations we’ll generally book the patient for theatre in Brisbane, but see and examine them ourselves prior to surgery.
“Some of those patients end up not needing an operation after we see them. Their visit hasn’t been wasted though. Without telehealth we would have had to see them, get them back for a booked operation, then get them back a third time for review.”
For his burns patients, Dr McBride can both inspect the surgical site during the consult and view clinical photos that have been emailed previously.
“Photos are a good way of documenting progression of healing, and form a standard part of the record for us to refer back to,” he said. “Patients see their local therapist more often than they see us, so the local visit prior to telehealth is a good time to take and send photographs.
“The link is usually good enough for us to get an accurate idea of what’s happening on the day.”
A 2004 paper in Journal of Telemedicine and Telecare co-written by Dr McBride found that there was an 85 to 90 per cent concordance between telehealth opinions and direct opinions with the patient in the same room as the doctor.
Another paper in the journal Burns reviewing three years of using email and video conferencing for the delivery of post-acute burns care to children also found a high degree of satisfaction with the service from patients' families.
The children themselves tend to be pretty blasé about the experience of talking to their doctor through the telly, he said. “The little kids don’t know enough to know the TV shouldn’t talk back to them. The older kids are used to Skype. It’s a TV though, so they’re usually pretty engaged with it.”
The QTS predominantly holds its video consultations with the patients in the hospital or outpatient settings, as that is how the network has been built. For burns patients, a local therapist usually sits the patient and facilitates that end of the consult.
Dr McBride said there is a secondary benefit to having the patient come into the local hospital in that it increases their confidence. He has done a few consultations directly with GPs, but has not done a direct to home consultation, as there are potential privacy and security issues.
He believes that in addition to reducing travel time and cost to the patient and their families, a benefit of telehealth is that it provides a network of people throughout the state that work with his team in the way the team would work in Brisbane.
“It lets local therapists manage local patients and families, but gives them and the families the confidence that they’re backed up from the ‘big house’ in Brisbane,” he said.
“It also means I can teach local junior doctors on the run, as they’re often delegated to be the local person in the room with the patient when I see them, as someone has to record notes locally.”
Dr McBride said the telehealth facility was also used to teach medical students. Students on their paediatrics rotation are distributed throughout the state and to Brunei and the Ochsner Clinic in the US.
“Most of those places don’t have paediatric surgeons on-site. We telelink paediatric surgical tutorials to them once a week during their rotation from Brisbane, so they all get the same teaching as a part of their rotation.
“It’s resulted in improved marks for the paediatric surgical part of the exam at the end of the rotation. I think it’s better than a pre-recorded presentation – it gives them the chance to ask questions directly of us at the tutorial.”
Centre for Online Health deputy director Anthony Smith, who was also a co-author on the two 2004 papers, said the centre's mission was to give patients in regional and remote locations convenient access to high quality specialist health services as close to home as possible.
"QTS has been able to save thousands of families the physical and financial burden of a trip to Brisbane to see a medical specialist at a normally stressful and emotional time,” Dr Smith said.
COH also runs a geriatric telehealth service and recently launched a new commercial business called RES-e-CARE to provide high quality video conferencing to residential aged care facilities.
It also runs child and adolescent telepsychiatry services and a whole-of-community telehealth service in several towns in the Darling Downs region of southern Queensland.
Last year, it was part of a consortium that won a $2.5 million grant to set up a Centre of Research Excellence in Telehealth.
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