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
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