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2012


 Telehealth and Health Informatics -
 How Should They Work Together?

                   Workshop 7 November 2012
Workshop Leader – Pat Kerr, Principal Consultant, NZ Telehealth Forum
Today’s Workshop


         Introduction & NZ
         telehealth update

         Arizona Telemedicine
         Program

         Knowledge systems
         framework

         Discussion
                                2
Telehealth context

                                  eHealth

Narrow definition:
                                       Telehealth
web based services
Broader definition:
healthcare practice
supported by electronic    ... the technology and
processes &                infrastructure that enables
communication - health     healthcare (& related
informatics, EHRs,         processes) to be delivered
           PMS, etc                   at a distance



                                                         3
Telehealth – a disruptive force




                      It is not about the
                         technology!


                     It is about enabling
                      changes in clinical
                           practice


                                            4
Telehealth – a disruptive force


              Used well it can help deliver:
              • Workforce flexibility
              • Improved patient services
              • Improved interventions (LTCs)
              • Provide services convenient to
                clinicians and patients, at lower
                cost




                                                    5
Telehealth in NZ –
slow progress since early 1990s

      • Fragmented approach

      • Clinical awareness & support not cohesive

      • Strong on innovation (pilots); weak on
        sustainability

      • Low priority at funding and planning level –
        lip service only in most places

      • Slow uptake, especially for our size and
        population, compared to other like
        jurisdictions such as Australia, UK, Alaska,
        Canada
                                                       6
Purpose of the Forum

 • Promote telehealth as a change agent
   for health services

 • Ensure telehealth on agenda for
   national & regional strategies

 • Instigate, support & participate in
   trailblazing telehealth deployments

 • Maximise Ultrafast & Rural BB

 • Promote sustainable services (move
   from pilots to broad deployments)
                                          7
The Forum’s landscape

                                                 eHealth

                                                      Telehealth




            Applications                                               Priorities
                                                           Support for
 Telemedicine
(interactive / store            Telemonitoring             • small hospitals and integrated
     & forward)                                              family health centres (IFHCs)
                                                           • in home monitoring
    mHealth
                                 Interactive               • better quality videoconferencing
                                   Portals
                                                             for clinicians and clinical networks

 Robotics          Help Lines
                                      Telecare             Standards development /adaptation
                                      (alarms)


                                                                                                    8
Governance & work programme

    Governance               Workstreams
                                                       Forum support:
                                                        planning, QA,
                                                     mentoring,evaluations
         NHITB
Sponsorship and leadership



                                Clinical initiatives (projects)


         NZTF
  Chair and Executive
Strategy, decision making,
       commercial
                                Capability
 Telehealth Leadership                                    Stakeholder
                                 building:
         Group                                            engagement:
  Advice and execution          converting
                                                           education /
                                barriers to
   Operations Centre                                       awareness
  Secretariat, consulting,       enablers
    communications

                                                                             9
NZ Telehealth activity



     A broad range across
     both islands:
     • Established services
     • Emerging services
     • Pilots
     • Randomised control trials


                                   10
Telemedicine – store & forward


                             Teleradiology
                             imaging and diagnosis - public
                             and private, incl. support for rural
                             centres & out of hours


                             Teledermoscopy
                             imaging and diagnosis
                             • public-private collaboration
                               (Molemap NZ & Waikato DHB)
                               for Virtual Lesion Clinics
                             • private (Molemap)
Source: Molemap NZ

                                                                11
Telemedicine in NZ – videoconferencing

              Northland DHB Whangarei to Bay of Islands, Kaitaia
                Clinics - renal, paediatrics, methadone, nutrition
                case reviews with ADHB, clinical network meetings

              Waikato DHB Teledermatology clinics Waikato Hospital
                to Taranaki DHB (New Plymouth Hospital)

              Bay of Plenty DHB Speech language therapy

              Canterbury DHB to West Coast DHB Outpatient
                clinics - paediatrics, oncology, etc

              West Coast DHB Outpatient clinics Greymouth to
                Westport, Haast etc - gen’l
                surgery, methadone, nutrition, speech therapy etc



               Ministry & DHBs Education and admin
                 meetings

              Multi-vendor / network environment emerging for VC
                                                                     12
Telemedicine in NZ – videoconferencing

                        Multidisciplinary Meetings (MDMs)
                        regional cancer networks and others -
                        multi-point VCs for case management
                        using high spec VC/AV room systems


                        Mobile Health
                        mobile operating theatre, virtual
                        assistance, rural teaching




          Source: MSS

                                                                13
Telemedicine into the home


            Speech Language Therapy
              using Skype, Cisco / Jabber & larger
              enterprise VC network tools for:
              − therapy with patients in their
                homes
              − review, training, multi-disciplinary
                team evaluation and supervision


            Telerehabilitation Working Group
              (mainly SLTs & dieticians)
              collaborating on technology
              solutions, protocols, etc


                                                       14
Telemonitoring


                        Current focus is on long term
                        conditions e.g. COPD, CVD,
                        diabetes

                        Operational service Eastern
Source: One News        Bay of Plenty, Te Whiringa Ora

                        Trials
                           Taupo / Turangi
                           ASSET (ADHB, Counties
                        Manukau, Ngati Porou)


                                                         15
mHealth and interactive Portals




                                  16
Progress on enablers

         • VC interoperability &
           standards

         • VC collaboration tools

         • Mobile technology

         • Education / awareness

         • Resourcng

         • Professional g’lines

         • Innovation funding

                                    17
Work in progress & being considered

        • Northland – Kaitaia (Oncology), Dargaville
          (ward, maternity, addiction, outpt), ICU
        • Auckland – strategy + foundation projects + programme mgr
        • Waitemata – bus case for mobile technology for
          Community Allied Health
        • Waikato – bus case for ED services between Waikato and
          Taumarunui, local telehealth forum and clinical group
        • Bay of Plenty – outpatient Services (possible trials
DHBs      sponsored by MBIE), ED support
        • Hawkes Bay - teleconsults - hospital to Wairoa
        • Canterbury / West Coast – continued growth in clinical
          networks and specialist teleconsultations
        • Shared Services – scoping for Elective Services, possibly
          FSAs included
        • MDMs – Northern Cancer Network                              18
Work in progress & being considered




             •   St John and others
                 telemonitoring (adding proactive service to current
                 reactive / responder alarms services)
 Primary /
Community
             •   Community based NGOs
                 many looking at telemonitoring and support for
                 community workforce




                                                                       19
The Health Informatics link


• Value proposition / bus   • Operations – patient
  cases                       records (shared),
• Evidence                    results of monitoring,
• Infrastructure –            booking, reporting...
  technology and tools      • Evaluation




                                                       20
National Health IT Board’s
        integrated care initiatives

    Telehealth touchpoints & enablers

                                                Patient Vitals
                                Shared          E-events
                                 Care           Care Plans
                                                Decision Support



Phase 2 (5 years)

Phase 1 (2 years)             Clinical Data
                               Repository                               Medicine
                                                                      Reconciliation
   GP2GP                        Referral
                Primary -                               Secondary
                            Continuum of Care                             National
               Community                                 - Tertiary
                                                                          Speciality
                               Discharge                                  Systems
     ePrescribing


    Clinical content is needed for effective Telehealth
                                                                                       21
Evaluation


• Quantitative        • Formative (during)
• Qualitative         • Summative (learnings)

Must demonstrate quality of care and sustainability




                                                      22
Arizona Telemedicine Program
Speaker: Dr Ronald Weinstein, Director




                                         23
Telehealth Knowledge Systems Framework
     Speaker: Samuel Wong, ProCare




                 Patient




                                         24
Discussion

       Comments by: Miles
       Roper, CIO West Coast
       DHB and Grant
       Ardern, Chief
       Architect, Connected
       Health

       Developing the framework
       (planning and operations)

       Health Informatics –
       examples and issues?

       What is needed to make
       real progress?              25
For more information visit:

http://www.ithealthboard.health.nz/content/new-zealand-telehealth-forum

            Or just Google “New Zealand Telehealth Forum”


Contacts:

Principal Consultant    Pat Kerr           pat @telehealthnz.co.nz

Interim Chair           Malcolm Pollock    m.pollock@auckland.ac.nz

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Telehealth and Health Informatics - How Should They Work Together?

  • 1. 2012 Telehealth and Health Informatics - How Should They Work Together? Workshop 7 November 2012 Workshop Leader – Pat Kerr, Principal Consultant, NZ Telehealth Forum
  • 2. Today’s Workshop Introduction & NZ telehealth update Arizona Telemedicine Program Knowledge systems framework Discussion 2
  • 3. Telehealth context eHealth Narrow definition: Telehealth web based services Broader definition: healthcare practice supported by electronic ... the technology and processes & infrastructure that enables communication - health healthcare (& related informatics, EHRs, processes) to be delivered PMS, etc at a distance 3
  • 4. Telehealth – a disruptive force It is not about the technology! It is about enabling changes in clinical practice 4
  • 5. Telehealth – a disruptive force Used well it can help deliver: • Workforce flexibility • Improved patient services • Improved interventions (LTCs) • Provide services convenient to clinicians and patients, at lower cost 5
  • 6. Telehealth in NZ – slow progress since early 1990s • Fragmented approach • Clinical awareness & support not cohesive • Strong on innovation (pilots); weak on sustainability • Low priority at funding and planning level – lip service only in most places • Slow uptake, especially for our size and population, compared to other like jurisdictions such as Australia, UK, Alaska, Canada 6
  • 7. Purpose of the Forum • Promote telehealth as a change agent for health services • Ensure telehealth on agenda for national & regional strategies • Instigate, support & participate in trailblazing telehealth deployments • Maximise Ultrafast & Rural BB • Promote sustainable services (move from pilots to broad deployments) 7
  • 8. The Forum’s landscape eHealth Telehealth Applications Priorities Support for Telemedicine (interactive / store Telemonitoring • small hospitals and integrated & forward) family health centres (IFHCs) • in home monitoring mHealth Interactive • better quality videoconferencing Portals for clinicians and clinical networks Robotics Help Lines Telecare Standards development /adaptation (alarms) 8
  • 9. Governance & work programme Governance Workstreams Forum support: planning, QA, mentoring,evaluations NHITB Sponsorship and leadership Clinical initiatives (projects) NZTF Chair and Executive Strategy, decision making, commercial Capability Telehealth Leadership Stakeholder building: Group engagement: Advice and execution converting education / barriers to Operations Centre awareness Secretariat, consulting, enablers communications 9
  • 10. NZ Telehealth activity A broad range across both islands: • Established services • Emerging services • Pilots • Randomised control trials 10
  • 11. Telemedicine – store & forward Teleradiology imaging and diagnosis - public and private, incl. support for rural centres & out of hours Teledermoscopy imaging and diagnosis • public-private collaboration (Molemap NZ & Waikato DHB) for Virtual Lesion Clinics • private (Molemap) Source: Molemap NZ 11
  • 12. Telemedicine in NZ – videoconferencing Northland DHB Whangarei to Bay of Islands, Kaitaia Clinics - renal, paediatrics, methadone, nutrition case reviews with ADHB, clinical network meetings Waikato DHB Teledermatology clinics Waikato Hospital to Taranaki DHB (New Plymouth Hospital) Bay of Plenty DHB Speech language therapy Canterbury DHB to West Coast DHB Outpatient clinics - paediatrics, oncology, etc West Coast DHB Outpatient clinics Greymouth to Westport, Haast etc - gen’l surgery, methadone, nutrition, speech therapy etc Ministry & DHBs Education and admin meetings Multi-vendor / network environment emerging for VC 12
  • 13. Telemedicine in NZ – videoconferencing Multidisciplinary Meetings (MDMs) regional cancer networks and others - multi-point VCs for case management using high spec VC/AV room systems Mobile Health mobile operating theatre, virtual assistance, rural teaching Source: MSS 13
  • 14. Telemedicine into the home Speech Language Therapy using Skype, Cisco / Jabber & larger enterprise VC network tools for: − therapy with patients in their homes − review, training, multi-disciplinary team evaluation and supervision Telerehabilitation Working Group (mainly SLTs & dieticians) collaborating on technology solutions, protocols, etc 14
  • 15. Telemonitoring Current focus is on long term conditions e.g. COPD, CVD, diabetes Operational service Eastern Source: One News Bay of Plenty, Te Whiringa Ora Trials Taupo / Turangi ASSET (ADHB, Counties Manukau, Ngati Porou) 15
  • 17. Progress on enablers • VC interoperability & standards • VC collaboration tools • Mobile technology • Education / awareness • Resourcng • Professional g’lines • Innovation funding 17
  • 18. Work in progress & being considered • Northland – Kaitaia (Oncology), Dargaville (ward, maternity, addiction, outpt), ICU • Auckland – strategy + foundation projects + programme mgr • Waitemata – bus case for mobile technology for Community Allied Health • Waikato – bus case for ED services between Waikato and Taumarunui, local telehealth forum and clinical group • Bay of Plenty – outpatient Services (possible trials DHBs sponsored by MBIE), ED support • Hawkes Bay - teleconsults - hospital to Wairoa • Canterbury / West Coast – continued growth in clinical networks and specialist teleconsultations • Shared Services – scoping for Elective Services, possibly FSAs included • MDMs – Northern Cancer Network 18
  • 19. Work in progress & being considered • St John and others telemonitoring (adding proactive service to current reactive / responder alarms services) Primary / Community • Community based NGOs many looking at telemonitoring and support for community workforce 19
  • 20. The Health Informatics link • Value proposition / bus • Operations – patient cases records (shared), • Evidence results of monitoring, • Infrastructure – booking, reporting... technology and tools • Evaluation 20
  • 21. National Health IT Board’s integrated care initiatives Telehealth touchpoints & enablers Patient Vitals Shared E-events Care Care Plans Decision Support Phase 2 (5 years) Phase 1 (2 years) Clinical Data Repository Medicine Reconciliation GP2GP Referral Primary - Secondary Continuum of Care National Community - Tertiary Speciality Discharge Systems ePrescribing Clinical content is needed for effective Telehealth 21
  • 22. Evaluation • Quantitative • Formative (during) • Qualitative • Summative (learnings) Must demonstrate quality of care and sustainability 22
  • 23. Arizona Telemedicine Program Speaker: Dr Ronald Weinstein, Director 23
  • 24. Telehealth Knowledge Systems Framework Speaker: Samuel Wong, ProCare Patient 24
  • 25. Discussion Comments by: Miles Roper, CIO West Coast DHB and Grant Ardern, Chief Architect, Connected Health Developing the framework (planning and operations) Health Informatics – examples and issues? What is needed to make real progress? 25
  • 26. For more information visit: http://www.ithealthboard.health.nz/content/new-zealand-telehealth-forum Or just Google “New Zealand Telehealth Forum” Contacts: Principal Consultant Pat Kerr pat @telehealthnz.co.nz Interim Chair Malcolm Pollock m.pollock@auckland.ac.nz