Telehealth Demonstration Project
Project completed: 28 February 2015
Pictured right: Graeme Osborne visiting Te Puia Springs Hospital chats on video with Dr Akin Ojo, GP, and Cheryl Johnson, rural health nurse and practice nurse at Tokomaru Bay.
A Final Update
Our Project comes to an end tomorrow, 28 February. From now, responsibility for the ongoing development of telehealth reverts back to the DHBs, PHOs and individual health practitioners with whom we have worked these past two years. This final Project Update deals with the handover arrangements, transitional points of contact, and a review of our successes and failures, as well as covering an emerging issue with the Jabber software most of our users are dependent on.
Health IT Board Checks Out Ngati Porou and Tairawhiti
The video connections the Project implemented among the 7 Ngati Porou Hauora sites and several departments of Gisborne Hospital have been a highlight of our Project. Last week the Director of the National Health IT Board, Graeme Osborne, was hosted at Gisborne and Te Puia Springs Hospitals where he met more than 30 of the key people who have put the Project together. They included TDH Board Chair David Scott and CEO Jim Green, and Ngati Porou Hauora CEO Rose Kahaki and Primary Care Manager Georgina Paerata.
There was a great deal of enthusiasm on both sides for what has been achieved, and many ideas for building upon the current services offered by video.
Issue With Cisco Jabber Software
Ciscio have dropped a bombshell by advising that the free version of Jabber software will cease to operate from 18 May 2015. This will affect almost all of our users.
There had been rumours from Cisco for some time that their plan was to convert all users onto the licensed version. The impression created was that they would give ample warning of that decision to allow for an orderly transition. Unfortunately that has not happened, with users being given less than 3 months to manage a change over and with new connections to the free version being disallowed from the day the announcement was made.
A solution for our Project users was already in development by the BoP District Health Board, with the support of Tairawhiti District Health. This is being accelerated and details will be advised to all Project users well before the 18 May date.
The only constraint for users in the short term is that no additional users can be added until the solution is in place.
Naturally a number of Cisco's competitors have seized the opportunity to contact users and offer competing video services. While these may look attractive at the outset, the danger is that this could worsen the messy situation in health where a variety of different users are on video platforms that will not connect with one another, or will do so only at very high per minute costs
If you are approached to change service providers my best advice is that you refer the vendor to the appropriate person at your DHB (Owen Wallace at BoP, and Mike West at Tairawhiti) or talk to these people yourself before pursuing this.
Directory of Video Capability
For everyone's information a list of places where the Project has installed video capability in Tairawhiti and the Bay of Plenty is circulated with this Update. Note there are numerous video facilities across the BoP DHB sites which have been installed independently of the Project and which are not shown here. The list is not necessarily 100% accurate because in some cases staff have changed, or organisations have shifted cameras that are not fully used to places where they will be used better. The list also includes a handful where the camera has been supplied but for a variety of technical or operational reasons is not yet in service.
If the list stimulates ideas as to someone you could usefully work with by video, your first step should be a phone call to them.
Telehealth Promotion
The Ministry of Business Innovation and Employment has offered funding support for me to present the learnings of the Project to relevant groups in late March or a month or two thereafter. There is scope to cover 4 or 5 of these, 2 of which have already been committed. If you know of keen groups, conferences, groups of PHOs etc who might be interested please let me know.
Reflections
A full report on the Project will be available in the next few weeks. However, in closing here are some personal reflections.
This Project has delivered some important insights about the role telehealth can play in the New Zealand context. Telehealth's role is extremely dependent on context - the geographic, economic, social and health status of any specific setting. What works in one country, or one region, will not necessarily work in another.
One application of telehealth that we have proved highly viable, is the support of health services in isolated, low decile, high needs communities. Examples include the video doctor service at Matakana Island (which may soon be replicated in other parts of the Western Bay), the Te Kaha link, and especially the Ngati Porou Hauora links with various parts of Gisborne hospital. Use of these links for support of practice nurses working without a GP, and for support in emergencies, can only grow.
Emergency support has also been well proven as a viable use by the links between Opotiki Community Health Centre and its GPs for after-hours use.
Video outreach clinics also are clearly a way of the future. The work initiated by Tauranga Hospital in replacing some renal clinics with video attendances, the diabetes clinics that are now regular in both regions, and the work by many individual clinicians in introducing or proposing video for services as diverse as mental health, sleep disorders and smoking cessation have shown the breadth of health services in which video can be a highly viable and cost effective option.
A further value of telehealth will be the ability for rural clinicians to be better supported and to maintain their professional development alongside those in urban locations. With retention of rural practitioners becoming more difficult, and the pace of medical science increasing, this will be of crucial importance in future.
So on the downside, what has been identified as not yet ready?
My greatest disappointment has been with the use of video for aged residential care facilities to communicate after hours with their contracted GP or the hospital. Perhaps this is ahead of its time. The challenge has been to align both an ARC facility and its GP, and to deal with the changes to the business model. The Project installed video in several facilities but was frustrated by a wide variety of issues. In one, the wireless signal wouldn't penetrate the internal concrete walls. In another the GPs simply could not see the business case. In a third there was a 4 month delay getting Ultra Fast Broadband into the premises despite it being at the letter box, and then Cisco withdrew the Jabber service on the day we were going to install the camera. In a fourth we found at a late stage that the weekend staff who would be using the video after hours did not know how to log onto a computer. Despite all that my personal view is that video will soon become a preferred method of communication between professional staff in ARC and their GPs. Time will tell.
The other usage that has proved to be ahead of its time is the routine use of video from patients' homes by visiting health professionals in the community. District and community nurses, midwives, palliative care nurses and many more spend their working lives in patients homes. When adequate broadband becomes ubiquitous the potential for them to change their work models dramatically is obvious. There are a number of people working on this now and I look forward to seeing results.
And sadly time has overtaken efforts to install in the Bay of Plenty the concept of RUFUS - rurally-focused urban specialists as used in Canterbury. Hopefully this opportunity can be progressed some other way.
Overall I am very comfortable that the Project has made a worthwhile contribution to the uptake and understanding of telehealth. Thank you to the many people with whom I have worked over these past two years, who have shown such enthusiasm and patience. I look forward to hearing of ongoing progress.
Ernie Newman - Transformational Leader of Network Industries - Healthcare, Telecommunications, Public Sector
If you would like more information about this project, please email us.