RCH moves to browser-based consults with WebRTC platform

Melbourne's Royal Children's Hospital (RCH) has moved to a WebRTC platform based on Healthdirect Australia's video call service for providing telehealth consultations with patients and remote clinicians.

RCH has been providing telehealth services to patients for almost four years, initially using the GoToMeeting video conferencing platform, and has seen growth of upwards of 60 per cent per year in the number of consultations it provides.

More than 20 of the hospital's departments use telehealth, 15 of them regularly, as part of a commitment to making telehealth business as usual at the hospital.

The new platform will allow any patient using the Chrome browser on a desktop or Android tablet equipped with a webcam to simply click a button on the RCH telehealth website to start a video call.

No extra software needs to be downloaded by the patient except for a plug-in that allows each participant to screenshare as the video conferencing is conducted between browsers.

While the RCH's service is only available for Chrome and Android users at the moment, the development of WebRTC is supported by all of the big names in both browser technology and hardware, including Microsoft, Google, Apple and Mozilla. RCH's telehealth program manager Susan Jury said Healthdirect was currently working on enabling its platform for iPads.

Paediatric neurologist and RCH telehealth clinical lead Andrew Kornberg said that in addition to being very easy to use and with processes designed specifically for healthcare, the technology has the scope to allow the hospital to develop new uses for the service, including doing screening clinics with remote paediatricians.

“A few of our country paediatricians are very keen on establishing screening clinics,” Professor Kornberg said.

This would involve the specialist at the hospital consulting with a number of paediatricians and patients and allow them to decide whether the patient needs to be seen in person, allow some diagnoses to be managed in the community or to have some investigations completed before the child is seen at the hospital. “It essentially becomes a much more efficient process along the way,” he said.

Healthdirect Australia has been investigating the use of WebRTC as a video conferencing extension to its various telephone-based hotlines for the past couple of years and was planning to use it as part of the after hours GP hotline.

That was put on hold as the government's review into after hours care proceeded, but it is now live for parents using the Pregnancy, Birth and Baby hotline, who can now make a video call to a maternity health nurse as well as a phone call.

Healthdirect Australia CIO Anton Donker said while WebRTC was simple and easy to use technology, the actual basis of the video call platform was its management layer, not the technology itself.

“WebRTC is just a back-end video technology and we use it because this is really where the world is going in terms of standards,” Professor Donker said. “Google and Apple and Microsoft are all moving to WebRTC, but fundamentally, the management platform could use Vidyo or Skype for Business or any other of the video technologies and it wouldn't matter.”

Professor Donker said the platform needed to work with how consumers enter the health system and how organisations handle things like appointments, waiting lists and waiting rooms.

“That is the importance of the management layer,” he said. “It just happens to be that WebRTC is the most usable and accessible video technology because you don't need anything other than your browser.”

Healthdirect is not offering the platform on a commercial basis but has been given permission by its shareholders – the Commonwealth and most of the states and territories – to work with a range of organisations on making it suitable for a variety of healthcare settings.

“We are adjusting the software to work with the main service patterns that we see in healthcare,” he said.

While Healthdirect assisted with software and design, much of the work has been done by the Royal Children's, as it needed to configure the system for its own purposes. This will be the same for any organisation using the platform, Professor Donker said.

“For example, they have to work out whether they want to do all of their clinics coming into a single point or if they want different web entry points associated with different services and clinics, and it's got to be able to do that really simply and easily.

“Our job is to ensure that the software can work with the different patterns that people use for how they currently deliver care. They want to be able to add it easily to their existing appointment and management systems and billing systems. It doesn't replace all of that stuff, it just sits alongside it.”

The Royal Children's service has always aimed to manage its telehealth appointments and scheduling in the same way face-to-face appointments, making telehealth business as usual at the hospital, Ms Jury said.

Telehealth at RCH integrates with Q-Flow, the hospital's outpatients booking system, and letters, Medicare consent and billings are handled much the same. “It's not like it's all solved, but it's becoming increasingly easier.”

Ms Jury said at least 200 people had been trained in providing telehealth at RCH since the transition to the Healthdirect platform, but she said the system was so intuitive “that people just know how to use it”.

“It's really great for doctors because their brains are full of medicine and they don't want to be worried about technology. And it's great for patients as well because it is so easy.”

Prof Kornberg agreed. “It isn't about the technology but about finding telehealth a place in the care of patients. The technology doesn't really matter as you can use two cans as long as there is video between them, but I think the positives of this platform are that it is built for health, it is secure and we can partner with Healthdirect and talk to them about what we need. They are very conducive to helping with that because they want to learn just as much as we do.”

Posted in Australian eHealth

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