Clinical Operations Strategy Implementation (COSI) MNHHS Telehealth portal use for pre-admission consultations in in Queensland: : benefits, challenges and cri ritical enablers Amina TARIQ a , Bernd PLODERER b , Michelle GRANT-IRAMU c , Linda CUSKELLY c, Elizabeth Ann DAVIS c a School of Public Health and Social Work, Faculty of Heath, Queensland University of Technology b Faculty of Science and Engineering, Queensland University of Technology c Clinical Operations Strategy Implementation (COSI), Metro North Hospital and Health Service, Queensland Health Informatics Conference 2018, Sydney, Australia
Clinical Operations Strategy Implementation (COSI) MNHHS Tele lehealt lth in in Queensla land Telehealth Support Unit provides support, technical expertise and funds to purchase equipment Queensland Health have taken a strategic whole state Centrally funded Telehealth Coordinators approach to and Medical Leads in Telehealth each Hospital and Telehealth Health Service Incentive payments on top of existing So Telehealth staffing and ABF funding equipment infrastructure at each HHS. In 2016 introduced the Telehealth Portal HIC 2018 2
Clinical Operations Strategy Implementation (COSI) MNHHS QHealth’s Telehealth Portal… Android Apple Pexip Infinity Connect Easy, safe and secure way to videoconference with our patients & external healthcare partners from any location using PC, MAC, laptop, tablet or smart device as long as they have adequate internet… 3 Chrome Opera Safari Firefox HIC 2018
Clinical Operations Strategy Implementation (COSI) MNHHS How the Telehealth Portal works… Step 2 Patient is asked to do a test call to a designated test site Step 1 the day before their Telehealth appointment MNHHS staff contact patient and provide them with information on how to download the Telehealth Portal as well as a Virtual Meeting Room (VMR) number Step 3 On the day of the Telehealth appointment everyone dials the same VMR number at the same time to connect (external dial number + address) … Patient dials GP dials 400500@telehealth.health.qld.gov.au 400500@telehealth.health.qld.gov.au Andro id Patient family member if not in QHealth clinician dials same location as patient dials 400500 400500@telehealth.health.qld.gov.au 4
Clinical Operations Strategy Implementation (COSI) MNHHS Metro North HHS • Population over 900,000, from north of the Brisbane River to north of Kilcoy. Population expected to reach over 1.1 million people by 2026 • Over 15,000 staff and a budget over $2.4 billion. Over 250,000 patients admitted to its facilities in the 2016-2017 financial year, Over 52,000 OPD Occasions of service per month • All major health specialties and more than 30 sub-specialties. • Five hospitals – Royal Brisbane and Women’s, The Prince Charles, Redcliffe, Caboolture and Kilcoy Hospital • Large community and mental health services • RBWH and TPCH both tertiary and quaternary services as well as secondary services for the local population. Some statewide services as well as tertiary services up to Central Queensland • Queensland Health has a major focus on reduction of OPD long waits. MNHHS long wait OPD’s have reduced by over 75% since 2014
Clinical Operations Strategy Implementation (COSI) MNHHS Tele elehealth th Occ ccasions of f Ser ervi vice have explo loded in in MNHHS in in th the e la last t th three ee yea ears 14,818 14000 12000 10,136 10000 8,055 8000 6000 2015/2016 4000 2016/2017 2017/2018 2000 0 6 HIC 2018
Clinical Operations Strategy Implementation (COSI) MNHHS Why use the Telehealth Portal Newly available Enables Telehealth (mostly At home /Aged Care facility Visualisation plus at Visualisation (complements where usual telehealth delivery and phone service home plus Flexible in hospitals was difficult to existing service) wasn’t appropriate timing organise) • Replaces existing • Peri procedural Support • Patients who are unable to • Lactation consultations scheduled phone service – Unit – pre op clinics travel or for patients who when baby ready for a • Tertiary services for find it difficult to travel – post discharge pharmacy breast feed • RACF ED avoidance clinics patients across Queensland MND patients, OPD • Replaces/ Complements – adult Cystic Fibrosis, • Out of town relatives appointments for patients in existing local home visit – RACF’s Genetics, complex sleep involved in Inpatient Ward • TPCH Post Children’s ED Rounds – Neonatology rehab, palliative care, patients. • Also opportunity to provide • Haemophilia patients Complex Chronic Disease attendance clinic • Involving relatives in Team online group patient experiencing complications education/liaison that can different locations in OPD be difficult for this cohort clinics with rarer conditions and wide geographical split.
Clinical Operations Strategy Implementation (COSI) MNHHS A Formative Evaluation of Queensland Health’s Telehealth Port rtal: Four unique settings were identified for collecting data - each tested a different context for Telehealth Portal use : • Periprocedural (PREAC) Support Unit, RBWH • Patients from across Queensland, all ages, clinical team that were already good users of telehealth, difficulty accessing hospital based telehealth • Maternity Outpatients, RBWH • Young cohort with smart devices, lactation services so would wait until baby was awake for flexible service • Motor Neurone Disease Clinic, RBWH • Cohort of all ages, very difficult for patients to travel to a local hospital or Brisbane to see their consultant and CNC, benefits of visualisation to the clinical team over phone clinic • Children’s Emergency Department, TPCH • Next day post ED attendance for ED staff to assess patient at home – young cohort with smart devices, flexible timing, much less distress for children to be cared for at home, even small children very familiar with videoconferencing HIC 2018 8
Clinical Operations Strategy Implementation (COSI) MNHHS Case Study Aim im • Evaluate the Queensland Health Telehealth Portal use for pre- admission consultations (PREAC) with state-wide patients that were being admitted for surgical procedures at a metropolitan hospital in Queensland. HIC 2018 9
Clinical Operations Strategy Implementation (COSI) MNHHS Case Study Context xt: PREAC Unit • Conducts pre-admission consultations with the patients approximately 2 – 6 weeks before the patient is admitted to hospital for a surgical procedure • Prior to the introduction of the Telehealth Portal, pre-admission consultations took place either face-to-face, via telephone • The Telehealth portal allowed patients to join the consultation from their own homes. • At the time of this evaluation, the unit had conducted nine Portal consultations. Eight were consultations with patients in their own homes and one was with a family member who participated in her elderly father’s telehealth consultation by using the Portal HIC 2018 10
Clinical Operations Strategy Implementation (COSI) MNHHS Methods • Semi-structured interviews with clinicians (4), administrative staff (1), and patients (4) using the Telehealth portal. • Focused on examining the benefits, challenges and key enablers of the Telehealth Portal as experienced by these principal users of the system. HIC 2018 11
Clinical Operations Strategy Implementation (COSI) MNHHS Fin indings: Key Setup Success Factors • A new booking process for the administration team that incorporated Portal bookings • Technology readiness (equipment available) and collaboration readiness by clinicians • Leadership from the unit director to bring team onboard with Portal HIC 2018 12
Clinical Operations Strategy Implementation (COSI) MNHHS It’s one of the Just that time criticisms that a delay, when the lot of the other anesthetist For me it’s not a anesthetists Less stress - mentally spoke or when I waste of time… I have, that they and physically, spoke but I was a didn’t have to take a like to be able to because of travel. I little bit like oh, day or two off my listen to their would say that is the that would be normal schedule. heart and lungs, biggest hurdle, the difficult for a Because obviously so it does turn stress that’s involved patient that’s travelling from some of them off. for us, getting down hard of hearing. Townsville it depends (A) there and then sitting (P3) on what the flights in a hospital for that are, and what I think the Portal many hours. I think appointments that interview, it always it’s fantastic. I would you can get at the comes down to who think that’s the best time (P1) the patient is, what the thing out of all of it. patient looks like and (P2) needs (medically) and also how capable are they . (RN) HIC 2018 13
Clinical Operations Strategy Implementation (COSI) MNHHS HIC 2018 14
Clinical Operations Strategy Implementation (COSI) MNHHS Key Lessons This case study highlighted the following best practices: (1) Laying the foundations for successful service through strategic processes and leadership (2) Ensuring ease of access in using the Telehealth Portal (3) Promoting clinician readiness and (4) patient readiness through training and support materials; (4) Promoting awareness about the Telehealth Portal among patients and families. HIC 2018 15
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