When you run a consulting business that services over four million people and your practice spans 1.7 million kilometres you are going to need some help, especially if, in addition to cities and towns, that area includes a mix of wilderness, remote locales and islands. When your business is an essential public service, the problem is compounded by the need to provide equitable access for all regardless of their location.
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This is the situation that faces Queensland Health every day. Since 1996, however, the department has been easing the difficulties through the innovative delivery of health services using videoconferencing technology.
Queensland’s initial moves into health videoconferencing began with just two sites and a focus on psychiatry.
The organisation responsible for managing the videoconferencing service - including the infrastructure, support and development of services - is Queensland Health’s Statewide Telehealth Services.
In June 2008, Statewide Telehealth Services had 507 separate videoconferencing sites under its management, predominantly located in public health facilities including hospitals, community health centres, Aboriginal medical services and the offices of the Royal Flying Doctor Service.
These facilities were used to carry out 13,000 videoconferences for patient consultation and diagnosis, and peer supervision. More than 4000 separate videoconferences were held between three or more sites for the purposes of training, education, workshops and meetings. This culminated in more than 41,500 hours used by clinicians and support staff in the delivery of health education seminars and professional development.
Over the years, each different facility had been allowed to make its own videoconferencing equipment purchases. This meant that the type and make of equipment at each end point varied markedly. It was a situation that made support over the network increasingly difficult. To introduce some standardisation and to remove ageing equipment from the network, Statewide Telehealth Services decided on a major upgrade.
It began by appointing Tandberg as videoconferencing equipment supplier through a new ‘Standing Offer’ arrangement. Dr Craig Kennedy, Director, Statewide Telehealth Services explains that one of the key reasons for the appointment was the vendor’s remote management capabilities.
"Over the years, we have had many different brands of videoconferencing equipment. Tandberg has always been very good in terms of quality of image and functionality. It also allows us to remotely manage all the end points and, when your service is as widespread as ours, this becomes very important."
Since then almost half of the old videoconferencing systems have been replaced with new equipment comprised of Tandberg set-top 990 MXPs and 3000 MXP codecs. Bandwidth and networks at more than 300 hospitals and health centres have been upgraded. In addition, 53% of sites have migrated from ISDN to IP videoconferencing, a move that has provided a more cost-effective service to many facilities and increased the return on investment due to negligible costs for use of the technology.
A content server enables video streaming so that conferences and training can be recorded and made available on demand across the network. Additional equipment has been deployed within the bridging infrastructure to provide functionality such as ‘border control’ for users who need access to the system via an external internet service provider - such as when working from home.
Kennedy notes, "The improved quality of videoconferencing equipment across the organisation has resulted in more reliable and positive communication exchanges."
The upgrade has given patients and clinicians the increased video and image quality necessary for clinical consultations. It has made it possible for patients and staff to communicate from home. Plus, it has delivered the ability to remotely manage, monitor and maintain systems performance in remote areas such as in the Torres Strait where Statewide Telehealth Services has equipped 15 islands with videoconferencing equipment. Departmental travel has also been greatly reduced.
Since the upgrade, use of the service by clinicians and patients has increased by 30%, involving more than 4300 patient appointments and an estimated 8500 case conferences across Queensland.
Some examples of how Queensland is harnessing telehealth include:
Multiple emergency departments are now linked to a clinical coordination centres in Townsville and Brisbane, enabling more informed decisions about emergency retrievals and reducing unnecessary retrievals. This service is being provided in 34 emergency departments in rural and regional communities across Queensland, and will be installed in over 50 emergency departments by the end of 2009.
Ear, nose and throat outpatient sessions are being provided to remote areas as a follow-up after surgery. Similarly, preadmission assessment outpatient sessions are provided prior to surgery for patients that would need to travel.
Townsville to Mount Isa Intensive Care Unit (ICU) is using a combination of videoconferencing, remote vital signs monitoring, delivery of pathology and digital X-ray images to allow experienced ICU specialists in Townsville to support clinicians and patients in Mount Isa.
Tele-rehabilitation services have been developed using real-time videoconferencing, video recording and capture of still images over the Next G wireless network so that patients can receive specialist rehabilitation services while remaining in their local community.
Many more services are currently in development, but Kennedy believes that an expansion of home-based care represents one of the greatest areas of potential for telehealth services. It’s a less intrusive way to provide the service and one that enables the patient to remain where they are most comfortable. At present, the main limitation is the need for ADSL connections to the house, however the Telehealth Services team has begun testing wireless routers and in early 2009 hopes to establish a home care trial using 150 personal videoconferencing units and/or Movi desktop videoconferencing.
As the technology has evolved, it has become a key tool for achieving one of the Department of Health’s major values: "Timely access to the right health service at the right time in the right setting," says Kennedy.