Telehealth

New Zealand’s Northland District Health Board (DHB) is trialling an oral telehealth service for children and adolescents with plans to expand it to adult services over time. The DHB is piloting the use of Zoom video conferencing technology and a specialised intraoral camera to allow dentists at Whangarei Hospital to do examinations and consultations on children at remote locations. The first trial involved an oral health therapist operating the camera at Kaitaia District Hospital. The therapist sees the images live so is able to adjust the camera as needed and on instructions from the dentist. Previously, the dentist would have travelled to Kaitaia and seen the patients in person. Oral health therapist Kirstie Culpan says that by having teledentists, children can have their consults on time. If needed, they can also be placed on the general anaesthetic waitlist as soon as possible. Northland DHB telehealth and mobility programme manager Roy Davidson said, “The live clinical quality imaging provided by the specialised intraoral camera is the key technical component that makes these clinics possible.” He says the telehealth setup has at times proved to be a positive distraction in the clinic as children are generally interested in the technology. The service is targeting children and adolescents initially but will expand to adult services in time. A second pilot clinic was held on April 5 linking to Kerikeri, and an assessment will now be undertaken and a decision made on scale and timing of rolling out the service. “At this stage, there appears to be strong potential to link up the oral health locations throughout Northland, including the mobile dental clinics,” said Davidson. “Linking the more rural mobile dental clinics would provide a significant improvement to access of care for those families unable to travel to centres.” He says the telehealth service also provides support and peer contact engagement from dentists to dental and oral health therapists who are working in the community service. “Telehealth enables assessment in real time and discussion with whānau members who are with the patient and is a collaborative tool, enabling knowledge up skilling for the clinical teams involved,” Davidson said. “Telehealth reduces travel for clinicians, reduces travel for families and provides faster access to specialist dental care.” This article first appeared on eHealthNews.nz.

Ochsner CMIO Dr. Todd Burstain, likening the ongoing epidemic to cigarette smoking before cessation programs, says society as a whole must address this public health issue by creating tools patients need.

At Renown Health, genomic testing and remote consulting meet for what's billed as a first-of-its-kind population health initiative.

Telehealth is increasingly being used to connect clinicians within and between New Zealand’s hospitals and to reach into people’s homes, a new survey revealed. The Telehealth Leadership Group’s most recent stocktake questionnaire was sent to all 20 District Health Boards (DHBs) in October 2018. Telehealth Leadership Group programme lead Patricia Kerr says the group is still doing a detailed analysis of results, but initial findings show there has been a general increase in the use of telehealth within DHBs since the last survey in 2014, as well as between DHBs. Also, there are more telehealth services going directly from clinics into people’s homes and a wider range of technologies being used. “There’s not only an increase in the volume of use, but also in the number of clinical services using telehealth,” she said. The number of DHBs with telehealth programme managers has increased and more DHBs are also providing telehealth training to staff. The examples of excellence identified previously – Auckland, Northland, Waikato and Canterbury – have continued to grow and others have emerged. “There are more pockets of excellence, where individuals are taking up use of telehealth because they can see it delivers benefits for their service delivery,” Kerr said. Telehealth is increasingly being used for multidisciplinary meetings with streaming of pathology and radiology images, allowing clinicians who previously could not attend to participate and reducing travel times. New Zealand Telehealth Resource Centre telehealth advisor mobile health Andrew Panckhurst says improved interoperability between providers of video conferencing services has made it easier for people using a variety of different platforms to link up. New entrants to the video conferencing market are often open and interoperable by nature, and better connectivity has also boosted growth. Ministry of Health sector portfolio manager data and digital services Judy Eves says that “virtual meeting rooms”, a concept that was not widely used in the 2014 survey, now enables people to easily join video conferences from a laptop or mobile device. The increased use of telehealth supports the Ministry’s goal of more cost-effective care delivered closer to people’s homes. “There are huge cost and time benefits for both patients and clinicians,” she said. Telehealth also improves access to education and training. “We’re hoping to use the results of the survey to promote communications and share areas of excellence that are happening and further support the uptake of telehealth,” explained Eves. The Telehealth Leadership Group is a clinically led independent group, supported by the Ministry of Health. The group plans to survey GPs and Primary Health Organisations (PHOs) on their use of telehealth later this year. This article first appeared on eHealthNews.nz.

A digital behavioral health app can interrupt the downward spiral that leads 400 physicians each year to take their own lives, claims Meru Health Vice President Emily Hines. Add link here.

With telemedicine evolving, efforts are underway to provide medical care to refugees in camps using a cloud-based electronic health record built on blockchain, says Brian de Francesca, CEO of Ver2 Digital Medicine.

Last week, Thailand began development of its telemedicine programme at 32 hospitals located in rural areas in eight provinces, according to an article by the Bangkok post. The eight provinces are Chiang Rai, Kamphaeng Phet, Kanchanaburi, Kalasin, Phetchabun, Surin, Songkhla and Surat Thani. The telemedicine programme is a joint effort of the Public Health Ministry and the National Broadcasting and Telecommunications Commission (NBTC). The integration and promotion of the use of appropriate digital technologies for telemedicine is also part of the Thailand 4.0 plan to increase access to healthcare with digital technologies, as stated in the eHealth Strategy by the Ministry of Public Health (2017-2026). A budget of 180 million baht has been allocated to purchase and install digital equipment for telemedicine in the initial phase, according to NBTC secretary-general Takorn Tantasith. The budget is part of the NBTC’s five-year funding for the operation of hospitals. Mr Takorn added that telemedicine services will be offered by the initial 32 hospitals by the fourth quarter of 2019. The programme will also focus on four main illnesses: high blood pressure, diabetes, heart disease and skin disease as they account for more than 70% of hospital cases. The initial 32 hospitals involved in the telemedicine programme consist of 15 subdistrict health-promoting hospitals, five community hospitals, eight provincial hospitals and four primary health clusters. Elsewhere in Thailand, the Khon Kaen Smart Health project, which was a winner under the Public Health and Social Services category for the 2018 IDC Smart City Asia Pacific Awards (SCAPA), saw a collaboration between local hospitals, businesses and academia with support from government agencies to provide better health services, especially for elderly residents with chronic conditions. Earlier this month, Samitivej Hospital Group, a private hospital brand in Thailand with a network of eight hospitals and owned by Bangkok Dusit Medical Services (BDMS), launched a one-stop Virtual Hospital app, which provides services such as teleconsultation and medicine delivery. The services of the Samitivej Virtual Hospital do not require appointments to be made in advance.

The creation of the Burke Mental Health Emergency Center, which focuses on telemedicine, gives rural healthcare organizations and law enforcement new choices where few used to exist.

Unsigned prescriptions are now legal when created with an electronic system that is integrated with the New Zealand e-Prescription Service (NZePS). The Director General of Health Ashley Bloomfield has approved a waiver for unsigned prescriptions to be recognised as legal prescriptions when strict criteria are met, including the use of an electronic system that is integrated with NZePS. Ministry of Health Group Manager of Digital Strategy and Investment Darren Douglass said the Ministry is working with partners across the health system on pilot implementations to “ensure that processes fully comply with the legislation and maintain patient safety and confidentiality." “The Ministry recognises the opportunity to move to a paperless system in the future, and the waiver for unsigned prescriptions is one step in that direction,” he said. The ePS allows prescribers to generate a barcoded prescription to give their patients to present at a pharmacy. The barcode is scanned, and all the prescription information is made available electronically. Royal NZ College of General Practitioners Medical Director Richard Medlicott envisions a paperless future where repeat prescriptions ordered via a patient portal app could be sent to people’s phones as a barcode to present to a pharmacy for scanning. However, he acknowledges that uptake of the service by GPs has been slow. Rollout began in 2013, and all community pharmacies have access, of which 75 percent are now scanning barcoded prescriptions but only 150 general practices are using the service. Medlicott said early on there were some sector leaders arguing that because GPs had to pay for ePS, it was not worth it. With a practice population of 12,000 to 13,000 patients, Medlicott pays $120 a month and estimates savings of around $1,500 a month. Not having to do triplicate controlled-drug forms is a particular timesaver. “It’s really easy, it will save you money, it will decrease fraudulent scripts and you can see whether medications are being dispensed or not,” he said. “It’s a no-brainer. There’s this idea that GPs are business-savvy, but they just see the cost and not the benefit.” Pharmacy Guild CEO Andrew Gaudin says the NZePS reduces a pharmacy’s administrative workload and increases efficiencies in the dispensary, allowing pharmacists to spend more time with patients. “As uptake of the service by general practice has been slow, pharmacies are not yet able to fully utilise the benefits the NZePS system could deliver,” he said. “Currently only 14 per cent of general practices are generating electronic prescriptions. It would be great to see this number increase.” Ministry of Health figures show that more than 1.2 million e-prescriptions have been generated by GPs in the past six months. This article first appeared on eHealthnews.nz.  

David McSwain, interim CMIO at Medical University of South Carolina, says the tech has evolved enough that virtual visits now include entire care teams in ways that just aren't possible when clinicians are using phones.