Once again, I was humbled by the contributors of our latest online discussion hosted by InfoMedix.   Moderator Dr Tim Smyth cut straight to the chase and kept the conversation moving with the aid of questions submitted by the 80+ attendees. It’s no coincidence that all the panellists in the discussion are involved in various models of care driven by technology, truth be told it was important that we selected experts who have been there and done it and continue to do it, resulting in a candid conversation.  The themes discussed were varied from telehealth being described as a clinician standing by a patient’s bedside with their hands in their pockets to age not being a barrier to telehealth delivery, I recommend you watch the recording but in the meantime I have summarised some key findings. 

Dr Erkan Hassan, Co-Founder and Chief Clinical Officer | Sepsis Program Optimization shared his top three factors that contributed to a successful initiative coined ‘Telehealth ICU Network’ and Tim Smyth pointed out that none of these success factors featured technology. 

Let’s start by looking at the impressive stats shared by Dr Hassan before I summarise the key success factors, his telemedicine initiative simply put is telemedicine for ICU patients’ beds to leverage a limited resource. He explained that ICU beds account for just 10% of bed capacity in his hospital yet costs four times as a bed on the hospital floor. The impact of incorporating telehealth into their delivery of care has had a significant impact:

• 26% drop in mortality 
• 30% drop in length of stay using Telehealth ICU bed 
• Clinicians were reporting 1 to 2 patients per week x 700 ICU’s were walking out alive who would have previously died before their system

Dr Hassan highlights his top three factors driving the success of Telehealth ICU beds. 

1. Driving best practices; standardization and decreasing the variability of care
2. Earlier identification and intervention to prevent deterioration, this is where the future is, being able to have an earlier notification that a patient is starting to veer off track and being able intervene to bring them back.
3. Communication –  often time in the US an intensive care specialist sees a patient for 10 minutes and spends the rest of their day in the office,  although a care plan has been developed no formal communications has been established to expedite the care plan.  With 24 hour telehealth coverage we can do this, through better communications between that everyone touches the patient, and being involved in the care plan which drives better outcomes.  It is for this reason that I am now part of a team at InfoMedix whose main aim is to deliver solutions to healthcare multi-multidisciplinary teams enabling a cohesive and shared care plan.

98% of Australian health care providers are using technology in their daily lives

Dr Mukesh Haikerwal GP, Medical Republic explained that in Australia, when telehealth was introduced the first time it was not done right as people had a very minimal interface. He referred to his paper released in January, that shows a country who suffers greatly from national disasters and how important it is that we get it right and do it properly, by being more rigorous in record keeping and ensuring interoperability between devices.  He emphasised that the benefits of telehealth are huge such as timely healthcare and patient outcomes being improved by ensuring the right clinician can consult with the patient at the right time

He also shared a sobering stat that 98% of Primary Healthcare and GPs are using technology in their daily lives – so what is stopping us indeed! 

Profile of clinicians using telehealth 

Donna Parkes, Telehealth Manager, NSW Agency for Clinical Innovation explained that she embraced telehealth out of necessity. Moderator Tim asked Donna, the type of clinicians (without revealing names) that have jumped on the telehealth journey and if some are more progressive than others? She explained prior to Covid-19 there was a scattering of users across many specialities, it was common that not every paediatrician in every LHD was using it, but now because of Covid they are. She points out that telehealth lends itself to integrate with primary care, in particular outpatient clinics that are often chaotic and have long waiting times for patients.  She is hearing from clinicians today who are embracing telehealth and mentioned they would have used it five years ago.  She agrees there is still a long way to go but at least she is witnessing advancements. 

Putting Some Skin in the Game: RPA Virtual Hospital 

Personally, I was looking forward to getting an update from Richard Taggart, CIO of the Sydney Local Health District, as team leader of the RPA virtual hospital. Just as a side note keep an eye out for the Menzies Institute for Medical Research study on the impact of RPA virtual hospital. 

Richard mentioned that like other panel members he has been dabbling in telehealth for a long time but RPA virtual hospital is putting some skin in the game.  

The initial ambition of RPA virtual hospital was to see 1,000 patients in the first 12 months, but by mid-February because of its location to the airport and Sydney, and because they took over the quarantine hotels they handled well over 4,000+ patients including 1000 Covid 19 positive patients. This was far beyond what they had planned but the results were astounding.   Without taking away from the success of telehealth adoption among clinicians, he highlights that allied health professionals have embraced telehealth fully and are using more wearables in allied health such as video apps. 

Emergency Care Can Be ‘A Medieval Paradigm’ 

Dr Justin Bowra, Founder and Medical Director, My Emergency Doctor; Senior Emergency Specialist (FACEM) at Royal North Shore Hospital provided insight into the drivers behind his telehealth journey.  His service My Emergency Doc is contracted by the primary health network to support and supplement after hours care. His passion which came from a place of frustration was visible during the discussion, he reflects on a time when he had a young patient who had a meningitis scare, who waited five hours before Dr Bowra could see the patient in the Emergency department, it took him just two minutes to diagnose that it was not meningitis. To Dr Bowra this was ridiculous, a ‘medieval paradigm’, without even touching the patient he could rule out meningitis and diagnose a harmless virus rash. 

For me this is an excellent example of how telehealth can complement emergency healthcare delivery and accelerate patient flow. Dr Bowra admits that there is no absolute substitute for face to face and hands on consultation. He points out not every patient in a rural emergency department needs to spend three hours or more getting there.   This is where a system that incorporates telehealth as part of their care delivery service can help. 

Tim shifts the focus on other burning questions received from our delegates around recalibration, privacy and cyber security.  I urge you to watch the full webinar discussion to capture the true essence of what was discussed on these important topics.  In summary it includes:

• Dr Erkan Hassan made the point that his intention was to always use telehealth as an extra layer that takes nothing from the patient’s bedside.  There was a common belief among patients and clinicians who perceived telehealth as big brother watching and a staff ratio cutting tool. Neither he said were true, it was never about replacing but leveraging technology. 
  
  Dr Hassan mentioned that he has heard clinicians have refer to Telehealth as:
  It’s like being by the bedside with my hands in my pockets.
  
• He also highlighted we are entering a new stage post Covid, the patient is now more comfortable using technology, they appreciate it and participate it and perceive it as effective.  They are worried about privacy, but a recalibration is happening between what is the right proportion between virtual consultations and in person consultations.  

• Dr Haikerwal feels that age is most certainly not a barrier.  In his practise they take the time to walk through their platform and many clients now love it and have rich deep consultation with images. 
  
• Another theme discussed was how to leverage telehealth across aged care. Richard references RPA virtual in aged cares facilities and how telephone and video conferencing is used to engage with residents for triage.  Covid has lifted the game in terms of using technology in aged care, currently that have reached into 60-70 aged care facilities and strengthened relationships with staff to help with triage.  In addition, they can work on including multidisciplinary teams such as GPs who also play a vital in aged care.
  
• Donna provides her perspective on the key areas of focus in telehealth for NSW Health. She expressed that NSW Health sees telehealth as a great opportunity, now lots of key influencers and other components within NSW are working together to make sure that it is something that is embedded as part of clinical care moving forward – looking at infrastructure, workforces, intuitive systems and supporting innovations.   Ultimately, she said, looking at things that will give people great access and flexibility in care. 
  
• The risks around patients becoming too reliant on telehealth was also raised and Dr Hassan provided another great example of how it’s important to be careful with asynchronous telemedicine, he explained a scenario of a clinician with 500 diabetic patients using a remote monitoring tool, let’s say 15% are red, this translates to 75 patients needing clinician attention, with a possibility of no. 68 as the sickest.  The system needs to be able to alert this somehow so it prioritises the sickest patients to the clinician. 
  
• Justin refers to Victoria’s safe script software checking system in response to Tim’s question regarding regularity framework, in particular to prescribing via telehealth. 

I have really only touched the tip of the iceberg in terms of summarising what was discussed during the webinar, we could have done with another three hours because there is so much more to explore.

There are many more questions that need addressed such as interoperability and the balance between enhanced access and continuity of care.  There is a longer discussion in the waiting and this is something I’m determined to make happen.