JF: For the last ten to fifteen years in Scotland we’ve been trying to change things in terms
of how we deliver care, still in 2017 I have large numbers of patients passing through
my department who don’t need to be there.
We did a study about three years ago looking at how could we support care of children in
more remote areas.
If children presented to a remote rural general hospital and whereas they would normally have
ferried them off to Inverness or somewhere else on a four/five hour journey, they were
able to call NHS 24, NHS Direct here, and then they would be patched through by video
conferencing to a paediatric emergency medicine specialist.
It increased the quality of care in 33% of cases and that was a minimum number and avoided
transferring about 25% of cases.
This trial was our test bed for using the same idea of rapid access to clinical support
for everybody.
So then we thought, well, what do we want?
We really want to scale this up and the problem is we could actually reduce large numbers
of patients coming if we could have a system whereby patients could directly video consult
with clinicians.
Two years ago, yes Chris, you contacted me and he wanted to show us this, this new platform
he had that would allow video conference to occur using Google Chrome and that’s what
we’re going to talk about what happened after that.
CR: Healthdirect Australia is government owned, it’s sort of like NHS 24, bit of NHS 24,
bit of NHS Direct.
We started in 2014 to add video call access to Healthdirect’s own services so a video
call to a nurse instead of a telephone call.
In 2015 we were asked to roll that out and we actually had our own vanguard type projects
exemplar program that we called in 2015 with ten health care settings and that’s now
been expanded across Victoria, New South Wales and Western Australia in a wide range of settings.
So three factors played a really big part in our design thinking: the telephone as a
benchmark for ease of use, access, ubiquity, cost, we had to support incoming unplanned
episodes of care so we don’t know where people are coming from so this is three o’clock
in the morning, sick kid, you can’t ask them to install stuff, mess around with the
technology, plug things in, have echo cancelling speaker boxes all that sort of stuff and the
need to be seen by one of any number of health professionals.
We focused on three layers so the service operation, resourcing and video call access
design, obviously the legal financial issues, what’s different in a video call in this
particular discipline compared to seeing someone physically.
Management issues are really around how you get the right people and the right web browsers
nowadays at the right time with the right information in the right way, securely, privately
all those sorts of things and then what happens when you hit go which is the video technology.
Now video technology is freely available in a web browser and our focus is really on those
two management service/operational areas.
What we’ve needed to focus on is a whole platform which includes all of the materials
and resources to support adoption through the thinking about it, through the preparation
stages, the discovery, the set up phases, the using phases, the evaluation phases, which
are all different in different health care settings and contexts.
Then we have this management layer software which we write ourselves which, as I say,
manages all the waiting areas and we’ll have a quick look at that.
We have these thirteen also principles one of them is to replicate the way that people
access health care today; familiar work flows for clinicians, they just go to their online
waiting area, familiar work flows for patients they’re just directed in their outpatients
letter to the front door on their hospital website as opposed to walking through a physical
front door and from there on it’s pretty much the same experience except you’re online.
So you come and start your call.
So we collect again customisable per area where what information you collect whether
it’s mandatory or not, some of our services are anonymous.
Importantly this information is only to identify the patients that are in the waiting area
there’s no patient identifiable information stored in the system whatsoever and that’s
really it from a patient’s perspective.
So can’t do much about wait times.
So I’ve arrived at my appointment and I might be sitting here for half an hour while
the clinician is running late but I’m at home or I’m working, I’m listening to
the hold music I’m getting messages on the screen that are customised from the service
etc.
I will log in as a service provider.
From my dashboard I can see how many people are in the service waiting areas that I’ve
got access to and I've got access to three.
You can set service levels around time to answer and all that sort of stuff, when patients
come in I’ve got a text and a ding and you can set various notifications to let you know
people are in your waiting area.
So better go and answer Hazel, but Hazel importantly is sitting in her own private video room you
can see who has also been seen before, she could have been transferred from another service,
there’s lots of details I don’t have time to go through now, but the clinician essentially
has seen the note, my next appointment is via video, goes to their online waiting area
which can be built into the patient administration system or the EMR or whatever it might be
and then just joins that patient and proceeds with the consultation.
So hello Hazel.
F: Hello, greetings from sunny Edinburgh.
CR: So we use this all the time for our own case conferencing you can have up to four
to six people in there without any central infrastructure.
One of the cool things compared to a WebEx or GoToMeeting is that everybody can share
all the time so four people can all be sharing you don’t have to hand over moderator or
whatever.
M: Thank you very much.