The document discusses a telehealth initiative between the West Coast District Health Board (WCDHB) and Canterbury District Health Board (CDHB) to support clinical networks and shared care through telehealth. It outlines problems faced by WCDHB including limited specialist services and network capacity. The initiative aims to harmonize clinical information systems, increase network capacity, upgrade telehealth equipment, and appoint a telehealth facilitator to support clinical care networks between the health boards.

1. Telehealth Across the Alps:
Supporting Clinical Care Networks
The WCDHB and CDHB initiative
Associate Professor Michael Sullivan FRACP PhD
Clinical Leader
WCDHB and CDHB Telehealth Initiative
HINZ and Telehealth Forum February 22 2012

3. Telehealth Symposium
Telehealth Across the Alps; Supporting clinical networks and shared
care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

4. Telehealth Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

5. Telehealth
Telehealth
The delivery of health care at a distance
by the remote transmission of audio and video and clinical data
Telehealth Clinical Networks
An enabling technology to
ensure equity of access to quality health care services,
regardless of where people live;
by supporting clinical care, professional development
and continuing education

6. Telehealth
• “is an enabling technology”
• “to support health care across geographic regions”
• “for clinical care collaboration ”
• “to foster clinical network development
• “for planned, prospective and anticipatory care ”
• “planned and scheduled clinical meetings and care”
• “enhance equity of access to health care”

7. Telehealth
• “is not about the technology”
• “only succeeds on when human factors are addressed”
• “always fails when it’s unsupported”
• “does not replace services that don‟t exist”
• “Telehealth is an enabling technology”

8. Telehealth Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

9. Principles of child healthcare: “Through the eyes of a child”
National Review of Specialist Services for Children (1998-1999)
1. Needs of a child and the family are paramount
2. Equitable of access to specialist care where ever a family might live
3. Specialist care should be as close to home as possible; where safe and of appropriate standard
BUT
1. Specialist Skills are inequitably distributed
• “Critical mass”
• “Centres of excellence”
• “Multidisciplinary teams”
2. Enhancing support to regions needed
3. Development of national and regional health care capacity
4. Enhanced national and regional health care capability

10. TelePaediatrics; a brief history
National Review of Specialist Services for Children (1998-1999)
1. Telehealth – need to develop a national network as an “enabling technology”
• To support the care of children and families in their home centre
• To support the local health care Professionals who provide specialist care
• To develop new collaborative networks for professional development, education and
research
2. Develop “Communities of Interest”
3. Building Capability and Capacity for care across health care sectors
4. Support education and training for staff recruitment and retention

11. TelePaediatrics; a brief history 1997-2009
• Founding partners 1999-2003
• Starship Foundation - sponsorship and funding
• Paediatric Society of NZ
• 10 District Health Boards
• NZ TelePaediatrics Service - a Non Profit independent incorporated society
• Governance Board of child health sector representation
• Membership; Eric Hienemann (Chair 1999-2000), Michael Sullivan Chair (2000-2009), Tosh
Stanley, Phil Weston, Barry Taylor, Pam Jackson, David Montgomery, Jeff Brown, Nick
Baker, Karyn Bycroft, Chris Moyes, Roger Tuck, John Garrett, Rosemary Marks, Mollie
Wilson, Peter Ross, Brian McMath; Pat Wright (Starship Foundation), Simon Hayden (NZTPS)
• Initial launch May 2003
• 10 locations in 10 District Health Boards
• Dedicated to Paediatrics and Child Health
• “Growth and Development 2005-2009”
• completion of a national telemedicine network connecting all DHBs and small centres
• multiple parallel non paediatric networks
• uniform technology platform
• Fully managed service

12. TelePaediatrics; a history 1999-2007
Health and Disability
Award for Innovation 2004

13. TelePaediatrics; a brief history 2009-2010
NZTP Trust: Trustee Board established 2009
Associate Professor Michael Sullivan( Chair NZTPS 2001-2009), Dr
Rosemary Marks, Karyn Bycroft, Dr Nick Baker, Dr John Garrett, Dr
Roger Tuck, Mollie Wilson, Peter Ross (Current Chair) and Brian
MacMath
Vivid Solutions: Board of Directors established 2009
Board: Patricia Wright (Chair), Mark O‟Donnell, Michael
Boersen, Simon Hayden (MD), Peter Ross

14. TelePaeds and the Vivid Network
• Single integrated IP network
• 220 sites
• Multiple sub-networks

15. TelePaeds/Vivid - usage
• National telemedicine network >3000 hours month
• Direct clinical care <20%
• Multiple user groups and communities
• National medical and nursing workshops
• Clinical Grand Rounds
• Specialist training
• Paediatrics, Mental Health
• Surgery
• ENT, Plastic Surgery
• Microbiology, Pathology
• Nursing, Allied Health,
• Team-to-team clinical care and outreach
• Research and special interest groups
• Hospital to home palliative care
• Mental Health clinical network
• Rural health, GP and education
• Northland Specialist Renal network
• Administration and human resources
• Ministry of Health – all MOH offices across country

16. Current usage
• Clinical; Paediatric Oncology, Child and Adolescent Psych consults, Diabetes insulin pump patient/family
assessment, Child abuse consults, Specialist nurse advice (tracheostomy, renal care, respiratory, Cystic
Fibrosis), Rheumatology Clinics, Immunology Consults, Clinical Consults
(Renal, Haem, Oncology, Rheumatology, Immunology, Diabetes etc) Northland Breast Screening
• National Broadcasts; Starship Hospital Paediatric Grand Round and Paediatric Update, Paediatric Nurses
Grand Round, Infectious Diseases Grand Round, Child and Adolescent Psych Grand Round, Adolescent
Health Seminars, Hospital Play Specialists Inservice Training, Visiting Specialists‟ Lectures
• Specialist Groups; Paediatric Oncology Group, Genetics, Cardiology, ENT, Audiology, Play Specialists, Paeds
Pharmacists, Radiation Technologists, Paedsleep, Physio Special Interest Group, Probiotics
Committee, Eating Disorders, Social Workers, RACP and RACS management and special interest
groups, Child Protection, DHB Management Groups, HIV Workgroup, Breast Care, Paedsleep, Family
Options, Neonatal Physiotherapists, DSAC (Doctors for Sexual Abuse Care), PREDICT (Emergency
Management), HIV network
• Education; FRACP Training (Paeds & Adult), Specialist Nurse Study Days, Plastic Surgery
teaching, Laproscopic Surgery Training, Gynaecology Surgery Training, Community Paediatrics
Training, Diploma of Child Health Training, Cardiothoracic Surgery Training, „Brain School‟, Child and
Adolescent Psychiatry Advanced Training, Midwifery Training and Continuing Education
• Telehealth Solutions; Hospital to Home, Breast Screening, Echo-Cardiography.
• Other; District Health Board Management Meetings, International and National Recruitment
Interviews, Medical Legal consultations, Safe Kids NZ National launch, Parent to Parent National
Launch, Live link to North Pole (Santa). Ministry of Health

17. Telehealth: Supporting Child Cancer Services
Children’s Haematology Oncology Centre; Christchurch
• One of only two Tertiary Paediatric Haematology Oncology Services in New Zealand
• Diagnosis and Treatment for all children of South Island., Wellington and Wairarapa
• Population 1.5m
• Distance: >1500 km (Christchurch to Invercargill > Wgtn to Ackl, Edinburgh to London)
• Centralised specialist service
• Critical mass of specialists and associated services
• Centralised clinical care centre
• Distributed Outreach model
• 60% or patients from outside Christchurch metropolitan region
• Clinical Outreach: 42 visiting outreach clinics per year
• Routine clinical videoconferencing:
• Weekly VC to Dunedin, Nelson, Invercargill
• 3x weekly VC to Wellington
• Multidisciplinary Team-to-team clinical network based care
• Discharge planning, ongoing clinical support to home centre, treatment planning,
• Hospital to home palliative care
• Direct clinical consultation
• Nursing education and updates

18. HINZ and Telehealth Forum Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

19. The WCDHB and CDHB Telehealth Initiative
Supporting Clinical Networks
and shared care by
Telehealth
Progress Report
2012

20. West Coast Health Services
Population – approx 38 000
• Greymouth 12 000 Grey Base Hospital and GP practices
• Westport/Buller 7-8000 Buller Health Centre/GP practice
• Reefton 2000 Reefton Health Centre/GP practice
• Hokitika 3000 Hokitika Health Centre and GP practices
• Haast 300, South Westland Health Centres and rural practices
• Fox 900,
• Franz 2000,
• Whataroa, Hari Hari
• Kumara and NgakawauBuller Health and rural practices
• Dispersed over 400 km
• Geographic barriers within the Coast and across Alps
• Unique community related health care needs – occupation based
• High participation in physical occupations; farming, mining, adventure tourism

21. West Coast Health Services
Health Services – key issues
• Fragile and vulnerable specialist services
• Paediatrics, O&G, Specialist Medical and Surgical Services, Palliative care, Cancer
Care, Primary Care and Emergency Care
• Critical mass – for existing specialist services
• General and Specialist Surgery
• Limited access to external specialist services
• Palliative Care, Cancer Care, Specialist Surgical Services, Medical Specialties
• Internal geographic barriers – South Westland
• Recruitment and retention issues
• Access to continuing education – medical, nursing and allied health
Health Services – key strengths
• Highly committed and resourceful
• Broad generalist skills – nursing, medical, allied health
• Collaborative and willing approach to care
• Many unique West Coast solutions

22. Supporting West Coast Health Services
WCDHB and CDHB Collaboration
• Long and established clinical and administrative relationship
• Many health services to West Coast provided in part or completely by provided by CDHB
based specialists or Christchurch private sector specialists
• Need for increased collaboration and support recognised by both DHBs
• Joint CEO and shared services agreement
Clinical collaboration
• Clinical networks
Strengthen existing networks
Develop new clinical care networks
• Shared Care
develop structured and formalised shared care processes
• Support clinical network development by Telehealth

23. WCDHB CDHB Clinical networks and telehealth
Reference Group – established 2010
Associate Professor Michael Sullivan, Project Leader
Bronwyn Petrie, Project Manager, Canterbury Initiative
Nigel Millar, CMO, CDHB
Mary Gordon, Chief Nurse, CDHB
Chris Dever, CIO, CDHB
Miles Roper, CIO, WCDHB
Wayne Champion, GM Corporate Services WCDHB
Vicki Robertson, CMO, WCDHB
Carole Atmore, Chief Medical Advisor, WCDHB
Reporting to:
Boards of WCDHB and CDHB
David Meates, CEO, CDHB/WCDHB
EMT for WCDHB

24. WCDHB CDHB Clinical networks and Telehealth
Project Group – established 2010
Associate Professor Michael Sullivan; Project Leader and Clinical Leader Telehealth
Bronwyn Petrie; Project Manager, Canterbury Initiative
Nicole Redfern; Telehealth Facilitator
Bob Ashford; Director, Medical Illustrations
Reporting to:
GM Medical and Surgical Services Pauline Clark
GM Diagnostic and Support Services Trevor English
Chief Medical Officer Dr Nigel Millar
Chief Nursing Officer Mary Gordon
Chief Allied Services Stella Ward
CIO Chris Dever and Miles Roper
CEO David Meates

25. WCDHB CDHB Clinical Networks and Telehealth Initiative 2010
• Feb-March 2010: Evaluation and review of services and needs WCDHB and CDHB
• April 2010: Sullivan and Petrie Telehealth Report to CDHB and WCDHB
• May 2010: Recommendations reported to WCDHB Board
• July 2010: Phased implementation of enhanced telehealth network endorsed
Haast meeting Whataroa Clinic

26. WCDHB and CDHB; what’s the problem
WCDHB: issues and challenges
• Different Clinical Information System to CDHB; CIS, PACS, Laboratory Systems
• Very limited network capacity and legacy videoconferencing equipment
• Paediatrics: no resident Paediatrican and fragile after hours support
• Palliative Care: no dedicated palliative care service
• Medical Oncology: improved support needed for cancer care and chemotherapy
• O&G and midwifery: fragile clinical service and need for midwifery education
• Rural Health: long distances and limited access to specialist advice
• Health Care of Elderly: no specific service
• Emergency services: limited support
• Limited access to many Specialist Medical and Surgical Services
• Limited access to medical and nursing professional development and CME

27. Telehealth Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

28. WCDHB CDHB Telehealth Initiative 2010-2012
Progress Report
1. Clinical Information systems and Network Capacity
• Harmonisation of Clinical Information Systems (CIS) commenced
• Universal secure access to Clinical Information Systems across both WCDHB
and CDHB
• Increased Network Capacity increased across Alps 50 x
• Enhanced Network capacity to specific locations – Buller, Haast, and other
South Westland sites

29. WCDHB CDHB TeleHealth Initiative 2010-12
Progress Report
2. Upgrading and installation of additional Telehealth equipment
• New and multiple additional high definition systems installed
• Grey base Hospital - 8 locations
• Buller Hospital Westport – 3 locations,
• Reefton Hospital
• Hokitika Health Care
• South Westland: Haast, Franz, Fox, Whataroa, Hari Hari
• North Westland: Karamea, Ngakawua

30. WCDHB CDHB TeleHealth Initiative 2010-2012
Progress Report
3. TeleHealth Facilitator proposal July 2010 (appointed 2011 Nicole Redfern)
• Identified need for Telehealth Facilitator role in Evaluation report
• Proposal submitted to Health Work Force New Zealand July 2010
• Support Clinical Care
• Support and co-ordinate ongoing education
• Technical interface
• CDHB and WCDHB

31. WCDHB CDHB TeleHealth Initiative 2011
Progress Report
4. Paediatrics and Child Health Network (Dr John Garrett) Desktop VC Christchurch
Paediatrican Office
• Clinical Network proposal completed
• Clinical Network meeting for Sept 2010
• New High Definition videoconference unit installed and commissioned
August 2010
• Mobile Telehealth Cart deployed in Grey Hospital (wireless Polycom)
• Virtual Daily Ward Rounds commenced with Christchurch based Liaison
Paediatrican Sept 2010
• Semi-urgent distant consultations and clinical advice
• Virtual Specialist Clinics; Christchurch to West Coast commended October
2010
• Acute Neonatal assessments and advice – planned equipment upgrade
• Continuing professional support for nursing and junior medical staff
• Nursing and junior medical education

32. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-2012
5. Obstetrics and Midwifery Network (Dr Mary Oliver and team)
• Clinical Network proposal completed 2010
• Clinical Governance processes commenced 2010 and continues
• Completed evaluation of technical requirements 2010
• High definition telepresence units for Christchurch Women‟s Hospital installed Feb 2011
• Midwifery education workshops from Christchurch Women‟s Hospital commenced
August 2010
• Virtual whole day education workshops from Christchurch attended by Grey Base and
Buller Midwives
• Routine broadcast of further whole day workshops 2011 -2012
• Semi-urgent distant consultations and clinical advice for high risk obstetrics
• Continuing professional support
• Nursing and junior medical education

33. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-12
6. Cancer Care Medical and Paediatric Oncology Services CDHB/WCDHB, Network (Dr Mark Jeffery)
• No Cancer Specialists resident of West Coast
• Paediatric Oncology – fortnightly videoconferencing to support care of child cancer patients and families
• CDHB Medical Oncology services provide fortnightly visiting clinics in Medical and Radiation Oncology
• Medical Oncology participated in Buller/Greymouth Telepresence evaluation
• Clinical Network proposal completed and technical specifications identified 2010
• Installation of additional videoconferencing equipment into Christchurch Cancer Centre; clinical office
, meeting room, and family room 2011.
• Commenced direct clinical consultations and on therapy assessments from Christchurch to West
Coast, commenced 2011
• Routine Clinical are, team-to-team care, continuing medical and nursing education
• Christchurch Oncology Conference centre and installation of dual high definition real time videoconferencing
of radiology and histopathology for multidisciplinary cancer case:Southern Cancer Network

34. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-2012
7. Palliative Care WCDHB, CDHB, Nurse Maude Community Services Network (Dr Amanda Landers)
• No palliative care Specialist resident of West Coast
• Nurse Maude has MOH contract to support community palliative care to WCDHB
• Community Care Palliative care Physician appointed early 2011
• Meeting Nurse Maude August 2010 – Jim Magee (CEO), Dr Sandy Macleod and Dr Amanda
Landers
• Clinical Network proposal completed and shared care agreement planned
• Nurse Maude installation of videoconference facility in Christchurch linked via CDHB fast
network
• Direct clinical consultation, support and advice to commence following installation commenced
2011
• Enhanced network capacity to Nurse Maude to enable access to CIS CDHB And WCDHB
completed

35. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-2012
8. South Westland Rural Health Network (Dr Martin London)
• Evaluation of needs for Rural Health Clinics: Haast, Fox, Franz, Whataroa, Hari Hari August 2010
• Network proposal completed and installed
• Real time videoconferencing into each rural health clinic in South Westland completed
(Haast, Fox, Whataroa, Hari Hari heath clinics; Real time High definition videoconferencing with
content sharing installation completed June 2011)
• Support for direct clinical care of rural health nurse specialists and rural GP to Greymouth and
Christchurch
• Enhance access to continuing education
• Support professional supervision and development
• Direct clinical consultation, support and advice to commence following installation
• Shared videoconference installation into new Franz Health Clinic commissioned 2011
• Haast rural health clinic; satellite network tested, QoS video/audio and Citrix network access to
WCDHB Information systems

36. WCDHB CDHB TeleHealth Initiative 2011
Progress Report
9. Emergency and Acute Medical Care (WCDHB AND CDHB ED departments)
• Proposal completed
• Recommend installation of wireless mobile Practitioner Cart into Grey Base completed 2011
• Use for ED, Newborn, ICU/CCU, Children‟s Ward
• Direct Buller to Grey Base emergency assessments possible
• Recommend development of enhanced clinical network with ED CDHB; staff resourcing needed
• Commenced broadcast ED education meetings to WCDHB, Timaru, Ashburton 2012
• Direct clinical consultation, support and advice no possible
• Professional support and education

37. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-2012
10. Continuing Medical Nursing and Allied Health Education (Nicole Redfern)
• Telehealth Facilitator co-ordinates access to CDHB continuing education
• Access to CDHB Grand Rounds and Winter Lectures Series commenced 2011
• Access for West Coast Physicians, Surgical, Mental health CME from Christchurch
• Support RMO staff for ongoing PGY1/2 education
• Real time videoconferencing and Store and Forward for recoding of education sessions and
later webcasting (medical Illustration)
• Recommend complete evaluation of clinical use
• Phase out CSICO technology and switch over to existing enhanced VSL platform
• Develop specific clinical protocols for direct clinical care.

38. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-2012
11. RuFUS (Rural Focused Urban Specialists Dr Martin London)
• Designated clinicians in specific urban services providing clinical leadership and links to rural
centre
• Understand resources and skills in rural regions
• Support direct clinical care
• Support continuing professional development and education
• Co-ordinate urban service provision for rural patients
• Supported by TeleHealth
• Dr John Garrett; Paediatrics
• Dr Mark Jeffery; Medical Oncology
• Dr Amadna Landers; Palliative care
• Dr Jackie Broadbent; Health Care of Elderly

39. WCDHB CDHB TeleHealth Initiative
Progress Report 2010-2012
12. New Initiatives for 2012
• Health Care of Elderly; clinical network supported by telehealth
• Telehealth clinical consultation rooms; Christchurch, Greymouth and Westport
• Specific clinically appropriate room for specialist consultation
• HD VC, PSCS, Clinical Information systems
• Planned and booked clinics
• Medical Specialties; respiratory, cardiac, renal, neurology,
• Surgical specialties
• Mental health
• Discharge planning and follow up
• Burwood, Ashburton, PMH units installed for clinical care ad administrative support
• IDFs!

40. Telehealth Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

41. Clinical Networks
• Clinical Management Network
• Clinical Care Network
• Shared Care Network

42. Clinical Management Networks
Clinical Management Networks
• Support Specific Health Services across geographic regions
• Paediatrics, Obstetrics, Rural Health, Specialist services, Surgical Services
• Collaborative service development and management
• Collaborative clinical governance
• Clinical care agreements
• Professional supervision and support

43. Clinical Care Networks
Clinical Care Networks
• Collaborative clinical care across geographic regions
• Service specific; Paediatrics, Palliative care, Medical Oncology, etc
• Peer-to-peer consultation and collaboration
• Specialist to specialist, nurse to nurse, allied health
• Clinical care for patients across a region regardless of where they live
• Clinical Conferences and Multidisciplinary Team meeting
• Clinical education and audit
• Clinical Network Agreements

44. Shared Care Network
Shared Care Networks
• Shared clinical collaboration for patients across a region
• Differential clinical scope and responsibilities
• Collaborative clinical care across geographic regions
• Specialist to Generalist, Physician to nurse etc
• Christchurch Paediatrician to Grey Base RMO and Nursing
• Delegated levels of care
• Support Clinical education
• Shared Care Agreement

45. Telehealth Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

46. Some Principles of Telehealth
Some Principles: clinical networks and telehealth
1. Quality of Care: not a replacement for non existent service
2. Capability development: enhance local care skills
3. Capacity development: develop the capacity of local service
4. Communities of interest: fosters development of health care networks
5. Symmetry of need and purpose: shared responsibility is crucial
6. Isolation barriers: overcome isolation for patients and health professionals
7. Enhanced professional development and education
8. Human factors fill gaps and enhance quality
• Even where data, audio and video quality are suboptimal,
• Human factors; clinical experience, data interpolation and fuzzy logic
• Compensate for the limits of technology
• Otherwise known as good clinical judgment

47. Telehealth Symposium
Supporting clinical networks and shared care by telehealth
1. What’s Telehealth and why
2. TelePaediatrics: a brief history of a national telehealth network
3. The West Coast; what’s the problem
4. Defining Clinical care networks and telehealth
5. The West Coast and Canterbury Telehealth Initiative; solutions
6. Some Principles of telehealth
7. Putting telehealth into Practice

48. Telehealth Practice
Putting Telehealth into your practice
Do you?
• Provide or participate in specialist care at a distance
• Provide or participate in “shared care”
• Provide a specialist or subspecialist service to patients at a distance
Network and Shared Clinical Care
• Shared care - a single clinical care environment across geographic locations
• Care beyond the “consultative” - ie traditional “phone consultation to single
specialist led service”
• Multidisciplinary care and multi-location care
• Sustain and supporting longitudinal care for serious chronic and complex health
needs
• Notion of collective care; active and transparent networks beyond informal care

49. Putting it into telehealth into Practice
In practice: telehealth and clinical network
• Use simple, robust and reliable technology; Vivid and Poltycom
• Proximity to the clinical work environment is crucial - 50 m rule
• Remove cost barriers and incentivize
• Actively manage the telehealth service and the clinical network
• Co-ordination of clinical care essential for sustained telehealth networks
• Co-ordination of the content and delivery of education enhances capacity building
• Integration within existing specialist services; part of routine clinical care
• Identify classes of clinical encounter suitable for Telehealth
• Security of technology and data important but is not a barrier to use
• Medicolegalnot a barrier; but responsibility for clinical care must be clear.

50. Putting it into telehealth into Practice
Putting Telemedicine into your clinical network
Personnel and work practice for successful telemedicine and network support
• Integrate distance care and shared care into your specific clinical service
• Develop acute and non acute telemedicine networks
• Clinical network agreements
• Shared Care agreements
• Multi-disciplinary meetings
• Team-to-team consultation for regional patient practice groups
• Develop designated virtual telehealth clinics
• Nurse led telehealth clinics - ie diabetes, cancer care, renal medicine, wound
care, burns, palliative care
• Allied health support; dietetics, physiotherapy, rehabilitative therapists

51. Supporting clinical networks by Telehealth
Clinical care networks and telehealth
• Quality of Care; quality needs support and active management
• Communities of interest; develop and build professional networks
• Continuing medical and nursing workforce development
• Asymmetry of need; integration of telehealth into specific services
• and “bottom up” clinical networks
• Identify “clinical leaders and early adopters”
• Pragmatic outcomes - just do it
• Beware of “adopter fatigue”
• Quality of service - video, audio, easy of use
• Pilotitis
Evidence suggests “clinical leadership” is the defining component for the adoption of
telemedicine and the successful development of sustained clinical networks

52. Putting it into telehealth into Practice
The Practice: clinical networks and telehealth
Telehealth is about “human interaction” and “the content”
It is NOT about “the technology”
Telehealth only succeeds when barriers are addressed and overcome
human factors
service barriers
Failure to address barriers = telehealth failure (technology gets the blame!)

53. Clinical Networks and Telehealth
Telehealth
Synchronous: Real time videoconferencing
Asynchronous: Store and Forward
Telemedicine services:
• Formal managed clinical service focused
• Informal unmanaged,
• Informal networking

54. Telehealth - real time videoconferencing
Simultaneous transmission of video, audio and or data
• Synchronous
• Dedicated videoconferencing systems
• Point-to-point
• Multipoint
• preplanned and scheduled clinical encounters
• Fixed locations
• Collaborative; team-to-team
• “unlike the phone - person-to-person
• Non verbal cues and body language
• Standard definition = Videoconferencing
• High definition = Telepresence

55. Telemedicine - real time videoconferencing
Direct clinical care
• Acute clinical care - ED, Paediatrics, Newborn
• Consultative clinical care - palliative care, cancer care
• Medical surgical specialties, allied health
Clinical network and shared care
Shared care: team-to-team
Diagnostics; real time diagnosis, tele-echocardiography
Education
• Continuing medical and nursing education
• Postgraduate education
• Specialist education - intra-operative
Administration and governance, professional supervision and support

56. Telehealth - Store and Forward
Asynchronous or delayed transmission of data, video
• None acute clinical care and specialist consultation
• Data acquired at the distant site
• Uploaded to secure clinical information system
• Elective data review/interpretation and opinion at referral centre
• Clinical diagnoses and opinions ENT and Eyes
• Pathology review and opinions
• Radiology - distant consultation and review

57. Telehealth - Real time vs Store and Forward
Real-time Store and Forward
• Simultaneous transmission of video, audio and or • Asynchronous delayed transmission of
data, video
data -synchronous
• Anytime - no scheduled meetings
• Dedicated videoconferencing equipment
• Narrow bandwidth, requires broadband internet
• Minimum broad bandwidth for effective access only
communication - 512k - 1Meg
• Network infrastructure not required
• Scheduled meeting times • Specific web interface preferred
• Direct and immediate personal communication • No direct clinical contact possible
between health care providers • No immediate emergency assessment possible
• Direct patient contact • Minimal interpersonal contact between health
• Direct clinical assessment care providers
• Collaborative • Person-to-person
• Supports multidisciplinary care • Non collaborative
• Team-to-team