State by state: eHealth and telehealth in the NT

The Northern Territory's chief clinical information officer, Leonie Katekar, told the Rural Medicine Australia (RMA) conference that the NT was concentrating on four main areas in eHealth: telehealth, the implementation of its shared electronic health record, point-of-care testing and a refresh of its clinical information systems.

Telehealth has seen a lot of activity recently with the announcement that Telstra is working with the NT government on the National Telehealth Connection Service.

In the project's initial stages, Telstra and the NT Department of Health are working on upgrading infrastructure to improve bandwidth in remote communities that are using non-government health services and allowing them to dial in to the government service, Dr Katekar said.

“We have 85 remote sites and five hospitals that are all on the road to participating [in telehealth]” she said. “There are 56 government remote sites that are all connected and we are working in regards to getting the non-government sites connected.

“That has been a little more complicated than we thought but that is definitely progressing.”

The NT is already providing specialist outreach services between hospitals and to some remote sites, using high-resolution video conferencing and IP patient monitors between emergency departments. Royal Darwin Hospital is also providing specialist services to the hospitals at Tennant Creek, Katherine Hospital and Gove.

The NT is also using portable medi-carts and has provided desktop software to its remote communities. “We have the IP cameras in a certain number, usually the bigger sites where you can only get a plane in, you can't get an ambulance,” she said.

While work was being done on infrastructure and providing the necessary software and hardware, the main challenge of implementing telehealth are largely organisational ones at the hospital sites, she said.

“The implementation issues we've had are largely organisational ones at the sites where the specialists are, getting them to dedicate a couple of consultation times to a video conference, because they don't see the patient being picked up in a car, being driven to the clinic, and then flown to the hospital.

“The implementation issues have been around the hospital sites rather than the remote sites and getting people to change their behaviours.”

The Northern Territory has led the way with shared electronic health records, having first introduced them back in 2004. Now called the My eHealth Record (MeHR), Dr Katekar said it wasn't until 2009 that the tipping point was reached in terms of the number of people enrolled and the number of clinicians viewing the records.

“We now have 65,000 views every month, which is on a rough average one or more every minute so we have quite good utilisation,” she said.

The NT agreed last year to roll the MeHR into the PCEHR, which was due to begin in May. This has since been delayed by the change of government, but is set to begin in earnest when the PCEHR release 5 is available next month, including the necessary capability to receive pathology and imaging reports.

Pulse+IT also understands that the NT has also insisted on a health record overview on the PCEHR clinical landing page.

The NT is also leading the way in point of care testing, particularly in sites that cannot access laboratory services, Dr Katekar said.

“We are working on a business case of getting that spread across the Territory,” she said. “Currently we have 31 out of 85 sites. We also have a digital ECG program that is enabling the remote sites to send their ECGs electronically as opposed to by fax.”

Dr Katekar said the health department had determined that it needed to refresh the clinical information systems used in the public sector, and had devised an unfortunately long acronym for it – CCSRPP – which has thankfully been given the nickname of Caesar.

“We are going towards fully electronic digitisation of our hospitals at the same time as refreshing our primary care information systems and looking at getting one patient, one record so we can stop the patient having to be the system integrator,” Dr Katekar said.

“We are looking at one clinician, one view, so it doesn't matter if I'm working in a hospital or working out remote in the way that we use our systems because the interface will be the same, which will help enormously.

“We want to go beyond right patient, right time, right information to actually providing clinical decision support at the point of care, [providing] knowledge as well as information.”

Posted in Australian eHealth

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