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Knowledge Systems Framework for Sustainable Telehealth Services
1. Knowledge Systems Framework for
Sustainable Telehealth Services
Samuel Wong
Population Health and Workforce
Research Manager
2. The problem with current telehealth
Currently, many telehealth initiatives are
influenced by:
• Isolated clinical needs that do not integrate well
with existing funding models
• Vendor marketed product or technology
focused
• Policy makers wanting a short term solution
• Supporting evidence and outcomes not clear
3. The Healthcare Reality
• Growing/Ageing populations and workforce
• Higher demands of chronic and complex care
patients, including use of new therapies
• High societal expectations of health services
• Workforce shortages across healthcare sectors
• Increased cost of service delivery, cost of living & lifestyles
• Year-on-year increases in demands for health services: across
pre-hospital, primary, secondary (acute and electives) and
community care without any increases in funding
5. The Knowledge Systems Telehealth
Framework
Knowledge systems framework is designed from research of best
practices and experiences to provide a holistic approach to
managing key dependencies for telehealth services.
The framework will work on selected groups which can
demonstrate an effective improvement in service care or
avoiding costly recurrent admissions, such as managing complex
care patients.
6. For example, Patient Provider
Tele-monitoring Patient: empowered
Self Care Effort: convenient to patient
Cost maintenance: low
Assisted Health status Patient: supported
home visits Effort: requires mutual
co-ordination
Cost maintenance: mild
Clinic Visits
Patient: seeking therapy
Effort: set appointments,
travel/wait time
Cost maintenance: moderate
Hospital Patient: Treated
Effort: Highly inconvenienced
Cost maintenance: high $ daily
7. The Knowledge Systems Approach
The Tangibles The People and Processes
• Monitoring & control • Clinical mandates
infrastructure • Staff & qualifications
• Hardware set up • Training processes
• Reporting infrastructure • Clinical intelligence
• Telecommunications • Technical support crew
maintenance • Clinical pathways
• Funding streams • Support integration
• Transition pathways • Continuous improvement
and quality
8. Current initiatives in the sector
Current projects aimed to reduce hospitalisations:
• Integrated transition of care (Risk score from discharge)
• POAC (primary options for acute care)
• Extended hours (after hours access for patients)
• 20,000 bed days reduction initiatives
• Very High Intensity Users (VHIU) programmes
9. By Comparison
Telehealth: Another way to reduce
hospitalisation by greater shift towards
patient focused, well supported but
independent enabled self-care
10. The Interdepencies
Monitoring Training Clinical
and requirements mandate
controlling
infrastructure
Community-
based ground Staff and
Telehealth qualifications
provider mobile support
(Primary Care) clinical staff
Support (Primary Care)
integration
Patient Community
General health co- Funding
Practice ordinatiors or streams
Team non-clinical
Whanau/Families
Telecommun- support
ications (Primary Care)
maintenance
Hardware/ Reporting
Software set Continuous infrastructure
up improvement
and quality
11. The Checklist Components
Health
informatics
(Health ICT
systems) are
a key enabler
for the
framework
12. Considerations (of this framework)
Infrastructure &
People
Patient types for
managing unplanned Financial
admissions
Information Systems
14. ProCare’s Experiences in Telehealth
ProCare’s HML services - 24/7 Nurse triage service with
35 nurses, co-ordinators and support staff
• Services 2.4 Million enrolled patients across NZ in 500+
General Practices
• Provides after hours nurse triage service for Auckland
Regional After Hours
• Can be scaled up quickly and efficiently by 20+ ProCare
clinical members
(Pharmacists, GPs, Nurses, Paramedics) in the case of
emergencies
• Clinical notes can be linked with ProCare’s 860,000+
enrolled population including complex care patients
• Day-to-day operations are telephone-based with video
capability possible
15. The evidence – Case 1 – 2009 H1N1
swine flu epidemic - NZ GP flu-line
• Primary Care managed telehealth service
• Telehealth model with two levels
– Public Health Units to Health Services
– Health Services to GPs (clinical support)
• Operational for six weeks from June-July 2009
• Covered all of New Zealand, handled 1130 GP flu
enquiries
Outcome: Comprehensive primary care co-ordination and
clinical networks across primary/secondary healthcare
nationally for all influenza-like illnesses patients
17. The Evidence – Case 2 – Canterbury
Earthquake 2011 Response
• Primary Care managed – Three levels
• Telehealth models:
– Health Management to Health Management
– Healthcare advice and services to patient
– Health Service to ground team co-ordination
Operational for four weeks from start of earthquake to
Christchurch Memorial – 16,800 patient and provider calls
handled
Outcome: Establishing a real-time ICT interface of health
service delivery status, healthcare informatics and regional
clinical triage with ground team co-ordination
19. Theory Practice
What does this all mean?
PRINCIPLES FOR APPLICATION OF
THE MODEL
20. Teleconsultations
Monitoring Training Clinical
and requirements mandate
controlling
infrastructure
Staff and
qualifications
Patient
Support
integration
Lead Clinician Supporting
(Primary/ Clinician
Secondary/ (Primary/
Community) Secondary/ Funding
Community streams
Telecommun-
ications
maintenance
Hardware/ Reporting
Software set Continuous infrastructure
up improvement
and quality
21. Teledermatology
Monitoring Training Clinical
and requirements mandate
controlling
infrastructure
Staff and
Patient qualifications
Support
integration
Specialist
provider
General Funding
Practice streams
Team
Telecommun-
ications
maintenance
Hardware/ Reporting
Software set Continuous infrastructure
up improvement
and quality
22. Telemonitoring
Monitoring Training Clinical
and requirements mandate
controlling
infrastructure
Staff and
qualifications
Telehealth
provider
Support (Community/
integration Primary/
Secondary
Care)
Patient
General Funding
Practice streams
Team
Telecommun-
ications
maintenance
Hardware/ Reporting
Software set Continuous infrastructure
up improvement
and quality
23. Care co-ordination/Clinical networks
Monitoring Training Clinical
and requirements mandate
controlling
infrastructure
Lead provider Health Service Staff and
(Community/ Management qualifications
Primary/ organisations
Support Secondary Care)
integration
Patient
General Funding
Practice Secondary care streams
Team services
Telecommun-
ications
maintenance
Hardware/ Reporting
Software set Continuous infrastructure
up improvement
and quality
24. Telehealth Knowledge Systems
Framework
Understanding and planning for the total cost of
ownership prior to establishing telehealth
services, that will enable sustainable services
and value-adding capabilities to intended
stakeholders.
Editor's Notes
As you are well aware, the healthcare environment and society as a whole have increasing pressures to deliver high quality outcomes, while our population, workforce age, costs, expectations and range of therapies keeps increasing also. However, this is in the backdrop of minimal additional funding. For example, ambulance services have seen a year-on-year increase of 4.4% utilisation over the last five years, but have seen no new funding to support this. We know this is not sustainable, therefore other approaches are necessary to help address this.
The knowledge system framework is designed from research of best practices, and our own experiences to provide a holistic approach to managing key dependencies for telehealth services.The framework, while it is originally developed for managing complex care patients, can be applied to any groups that demonstrate effective improvement in service care or aimed to avoid costly recurrent admissions.
The framework comprises of 10 domain interdependicies that needs to be considered to support the providers, the patients, their families, primary care community based teams and general practice teams. These interdependencies can be applied to most services for telehealth.