State by state: eHealth at the bush bedside in WA

WA Country Health's executive director of medical services, Tony Robins, outlined the four core elements of connecting healthcare in the state at the RMA conference: people, the human-ICT interface, data transmission and software applications.

Dr Robins said it needed to be remembered that in the bush, both patient and clinician moved between health settings.

“It is not the same as the metro-centric view of general practitioners in general practice and specialists down in the hospital – it is often the same individual moving between sites,” Dr Robins said. “But in some of those sites we may have one PC available for multiple clinicians.”

He used as examples of the difficulties faced in providing eHealth and telehealth solutions to remote areas the town of Crocodile Hole in the Kimberley, which has one public Telstra phone box, and the Kalumburu mission on the far north-west of the Kimberley, where “there's no copper, there's no fibre optic, there's no microwave”, but there is the possibility of satellite options.

“Our systems need to have business continuity and redundancy,” he said. “They need to stand up to extremes of temperature, intermittent power supply and climatic events such as cyclones and flooding, where we see fibre optics flooded out for a month. We also have interference from flora and fauna out in the bush.

“We need long distance reliability. We need to ensure that the complete data package transfer over extremes of distance occurs, both as packets and real time over thousands of kilometres.

“In small country hospitals where we mainly have two staff working across inpatient, emergency and aged care, we need the technology to be mobile with them. It needs to be simple and intuitive to use.”

One initiative WA has taken is the establishment of the Emergency Telehealth Service, which was trialled in in eight Wheatbelt hospitals in 2012 and has since extended to 28 predominantly small hospital EDs in the Wheatbelt, Midwest and Kimberley.

Funded by the state's Royalties for Regions program, it is due to be extended into the Goldfields region as part of plans to have most WA Country Health Service hospitals using the system by 2015.

The service is led by emergency department specialists (FACEMs) based in metro hospitals or at home but has not gone down well with some rural GPs, who believe they have been bypassed and could provide the service themselves if funded.

Dr Robins defended the service, saying GPs were becoming involved. “It is not designed to replace GPs – let me be clear,” Dr Robins said. “It is designed to support them, in particular one and two-GP towns where the GP may be absent for the weekend or there may be no GP in that community.

“It provides support for nurses, it is delivered by emergency medicine consultants primarily, however we also have credentialed GPs involved.”

He said the service had delivered over 10,000 consultations across 45 sites, with only one serious adverse event.

“Nowhere is connected eHealth and telehealth more relevant that at the bush bedside, and nowhere is the challenge to ensure equity of access for country patients to eHealth and telehealth, greater than in rural Australia,” he said.

While he did not cover how WA was progressing with the PCEHR, Royal Perth Hospital began uploading discharge summaries to the system from its Shenton Park campus in July. NEHTA CEO Peter Fleming said Fiona Stanley Hospital was on the agenda, as were some of the other metro hospitals.

“WA has had a lot of attention with Fiona Stanley Hospital, but we are now working closely with them,” Mr Fleming said. “We will probably start in the Albany region and a couple of metropolitan hospitals with the intention once again to get the hospitals up. We need to set dates there.”

Posted in Australian eHealth

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