Telehealth video conferencing and live telemetrics equipment for trauma and critical will be extended to all 16 regional Victorian hospitals administered under the Loddon Mallee Rural Health Alliance following a successful, 20-month trial across four of the units.
The initial $5.2 million trial was funded under the Federal Government’s $118.6 million Clever Networks initiative and took place from June 2008 across hospitals in Mildura, Swan Hill, Machuka and Bendigo, connected to four metropolitan hospitals in Melbourne. The trial involved the deployment of eight mobile Virtual Trauma and Critical Care Units (ViTCCU) and seven fixed units across the regional hospitals, along with software and smart vitals devices from a consortium of companies including Telstra, Cerner, KPMG and Polycom.
The units were connected by a 100 megabits per second (Mbps) link provided by Telstra, running separately to the hospitals’ existing networks in order to avoid potential congestion.
Specialists at the Melbourne sites provided advice to primary treating doctors initially for critical care patients.
“There’s a lack of specialists in regional Australia,” the alliance’s CIO, Bruce Winzar, told Computerworld Australia. “So traditionally what they would do is probably get on the telephone with the specialist and have a telephone discussion. “We were trying to bring scarce resources like specialists out of the metropolitan areas and bring them into the regional and rural areas via high definition videoconferencing, coupled with broadband links and a lot of application software.
“Basically the business case was around trying to prove whether the technology works and secondly whether there was a sustainability in the sense that we can minimise transfers between country areas and metropolitan areas.”
Though initially slated as a 12-month trial, use of the devices was extended for use beyond critical care to maternity wards and children’s treatment.
The units are expected to be rolled out to the remaining 12 hospitals in the Loddon Mallee area for a further 12-month trial, during which Winzar said they hoped to determine future sustainability of the systems and connect with further specialists in metropolitan areas.
As the units only require approximately five megabits per second (Mbps) for high definition video conferencing, the units will deployed on the existing networks of the new trial hospitals with Quality of Service prioritising video and each clinic’s VoIP systems above other data. The 100Mbps links at the four trial hospitals have been scaled back to 20Mbps.
Initial attempts to tie in the telemetry, x-rays and videoconferencing with internal e-health records encountered change management issues, with clinical staff “loathe to do data entry into two systems”. The majority of the time, specialists receive the relevant x-ray through a web viewer instead.
The forthcoming second phase of the trial is expected to see a second attempt at an e-health record tie-in, instead with Victoria’s oft-delayed HealthSMART system from iSOFT, which is compatible with the Cerner software already deployed at Loddon Mallee hospitals.
Consultation with specialists will also be mediated by Adult Retrieval Victoria, which will determine whether the critical care patient requires transportation to a specialist clinic or can be treated remotely. However, Winzar said the local treating doctor always had last say.
“It’s really complementary, it’s not a replacement, and it’s providing a second opinion, particularly in remote areas where you might have doctors that have been not so much isolated but they don’t come across some of these situations very often,” he said. “We’ve got specialists who see it every second day, it’s got to be able to provide a solution for the patient.”
However, Winzar called the trial so far a success.
“We’re providing I think a much more positive way to assist patients in a critical situations by allowing specialists to have access to information they didn’t have before - the x-ray, the vital signs and video footage of the patient.
“It’s almost as if the doctor is at the end of the bed.”
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