How do you ensure that a population as large as 1.3 million, spread across an area of 650 000km2 receive the healthcare services they need?
For the state of New South Wales (NSW), the answer is an ICT infrastructure which is reliable, secure and available. Close to a quarter of NSW’s population reside outside the state’s major cities of Sydney, Newcastle and Wollongong. Hence not all of them can receive the same level of quality services their city counterparts enjoy.
Helping to erase the divide is Dr Zoran Bolevich. OpenGov Asia had the opportunity to chat with Dr Zoran. He shared with us how his team used telemedicine to overcome the challenge of distance in delivering quality healthcare.
This article is the second of a two-part article. Click here to read the first.
Telehealth Projects for Large Geographies
A major milestone accomplished by eHealth NSW is the use of the Electronic Medical Record (EMR). Mobile technology solutions are used in remote facilities to promote state-wide collaboration. 109 hospitals and 73 sites have ditched paper-paper processes to adopt EMR. At the click of a button, clinicians can view patient information from across the state, which until recently relied on couriering paper-based patient records.
As an extension of this service, Dr Zoran shared that eHealth NSW has partnered with an organisation to implement point of care laboratory testing in rural places. Local clinicians can do basic tests on portable devices and feed it into the EMR. This allows the central and local team to have a teleconference on how the patient is doing.
What underpins this seamlessness is the Health Wide Area Network (HWAN), a high-speed secure broadband network connecting all NSW public hospitals.
“We’ve connected 140 odd facilities across the state to that network. That gives each rural facility high quality, reliable broadband connectivity to our central data centre. For all our EMR systems to live in the data centre is crucially important…Since the infrastructure has been put in place, it has been transformational,” said Dr Zoran.
The alternative of running the system out of the central government centre was undesirable. Hoping for the system’s good performance and reliability from a remote facility was unrealistic. Because of HWAN, projects like HealtheNet Clinical Portal and the Rural eMeds Project have transpired.
HealtheNet links hospital inpatient data and community care patient data through a web-based portal accessed through a patient’s EMR. Based on open standards for interoperability, it sends information to the Commonwealth’s My Health Record system, supporting more coordinated care across hospital, general practitioners and community settings. Clinicians have a summary view of a patient’s available health information, without the need to chase and manage paper-based records over large distances.
Additional functionalities such as the Discharge Dispense Record enables rural hospitals to share records of dispensed medications with HealtheNet and My Health Record, enhancing the continuity of patient care across rural and remote areas by increasing content available to NSW Health clinicians.
The Rural eMeds Project delivers medication management solutions to 112 facilities (the largest of its scale in NSW). The Project further improves the safe prescribing and administration of medicines, and a key benefit is a single design resulting in standardisation across this large geographical area. The first go-lives commenced in September 2018 and are on track for completion by the end of 2019.
For now, the team is now looking to increase HWAN’s performance and reliance. They are working with telecommunication providers to have more redundant links and increase coverage in areas where redundant links are not possible. Although physical networking is a possible solution, they are exploring the use of mobile network alternatives.
Reliable wireless networks are becoming increasingly important as clinicians become more mobile. Moreover, the wireless networks support the use of other supporting mobile technologies. For example, in several rural health facilities a telehealth trolley helps nurses to facilitate a remote consultation with base hospitals in the cities. The trolley houses a camera and a fully functional clinical work station.
Telehealth for the Future
The innovation does not stop here. At present, the organisation is working on a telemedicine trial called Telestroke in two districts and are looking to scale it state-wide.
Telestroke allows a neurologist to provide remote treatment for patients with a suspected stroke. Designed to reduce the time between diagnosis and treatment, the program connects a rural hospital to a neurologist in the nearest tertiary referral centre.
Despite the distance, relevant clinical information and diagnostic images are transmitted efficaciously. Neurologists remotely determine if the patient should begin thrombolytic treatment. Or if a transferral to a tertiary clinic is necessary, the process becomes seamless. Doctors have a good estimate of when the patient will arrive and can hit the ground running since they have the necessary information beforehand.
“We are seeing really good outcomes. Because the sooner you treat patients, the better the outcome. Time is absolutely of essence,” shared Dr Zoran. “With this kind of technology, we have no doubt that it can save lives.”
Connectivity for community health nursing service is another big project they are working on. In the rural areas, the nurses who conduct home visits require mobile technology to conduct their regular checks.
“This is where we have challenges still,” admits Dr Zoran. “Because not all parts of our state have good mobile coverage. It is getting better over time, but there are still blind spots around the state. A lot of time, our community nurses cannot establish the connection.”
For example, they might want to record a video of the patient but fail to establish a mobile connection given the blind spots. Working with telcos becomes important.
Hence, there is good opportunity for the private sector partnerships. Many partnerships have already been formed in NSW, said Dr Zoran. One area they are looking at is bringing telemedicine into people’s homes.
“If you extrapolate what you are doing between the larger hospitals and the smaller hospitals, similarly, you can go into people’s homes and enable a remote monitoring of patients with chronic illness, so they don’t have to come to the hospital all the time,” shared Dr Zoran.
“Our health service is able to provide really good service no matter where you live – that’s what it’s about,” said the CIO.
Ending off with a word of encouragement, Dr Zoran offers, “One of the key success factors in our Rural eHealth Program was that the six local health districts which are predominantly rural, were in the driver’s seat. The Chief Executives of those local health districts formed a local eHealth steering committee…. They’ve developed a very good collaborative partnership…So I recommend partnership collaboration and good governance – that’s the key.”