Telemedicine – the Good, the Bad & the Future? by @murphieRNC & @Louisefclark

Phyllis Murphie

Phyllis Murphie

Louise Clark

Louise Clark

This week’s blog is by Phyllis Murphie – Respiratory Nurse Consultant and Dr Louise Clark – Consultant Diabetologist and is intended to share the experiences and views of Clinicians and service users regarding Tele-clinic Consultation in NHS Dumfries and Galloway.

 

Telemedicine 2The term “telehealthcare” involves healthcare delivery at a distance, enabled by information and communication technology and driven by national and international trends in healthcare needs (an ageing global population, care closer to home, low carbon economy, etc). Telehealthcare incorporates telehealth, telecare, telemedicine, assisted living, remote clinical monitoring and supported self treatment. In remote and rural regions tele-clinic review can offer significant benefits for all those involved in this model of health service delivery.

Scotland’s 2011-17 eHealth Strategy advocates there is a clear role for telehealth and telecare technologies in delivering health care for the people of Scotland. When implemented appropriately as part of clinical service redesign, telehealthcare can:

  • Afford people greater choice, control and confidence in their healthcare care;
  • Enable safer, effective, timely and more person centred care and offer better outcomes for the people who use our healthcare and support services;
  • Assist in delivering efficiencies with the added value of more flexible working and best utilisation of staff skill mix and by reducing wasteful processes, travel and minimising access delays.

The distance to travel to remote and rural clinics within NHS Dumfries and Galloway is considerable in terms of mileage and time spent for clinicians and service users if they have to travel to the main centre of Dumfries for review. A trip to Stranraer for clinicians or patients to the D&GRI is a 150 mile round journey that can take up to 4 hours of travelling time. NHS D&G Respiratory Sleep Medicine, Diabetes, Neurology and Weight management services have established tele-health clinics in the Galloway Community Hospital – Stranraer and Creebridge Medical Centre- Newton Stewart.

Telemedicine 5A review of the experiences and opinions of those using tele-clinic consultation using video conferencing technology and Office Communicator/Lync technology – clinicians, clinic staff and patients – was conducted and the outcomes are reported here.

 

 

Benefits of Teleclinic review for Patients/Service users:

  • Formal patient feedback/surveys by participating clinical teams have demonstrated high levels of service user satisfaction with this model of health care review;
  • Reduced waiting lists and a shorter waiting time for review are reported;
  • Care is delivered closer to home and supported by local staff in line with the NHS Quality strategy;
  • A reported clinicians concern was an initial scepticism about developing the clinician /patient relationship via a tele-clinic link. However, the tele-clinic model seemed to facilitate a more open, honest and transparent consultation that enhanced the clinician patient relationship.

Benefits of tele-clinic review to delivery of participating Clinical Health Services:

  • All clinicians reported reduced travelling time and travel expense for people utilising this model of clinical service delivery;
  • Timeous patient review that has enhanced patient experience and assisted in developing positive patient and clinician relationships;
  • Reduced travelling for clinicians has freed up time in terms of clinical sessions to reinvest this in other aspects of service delivery;
  • The number of clinical sessions freed up by delivery of teleclinic model for all specialties involved:
    • Consultant Diabetologist – 12 sessions;
    • Consultant Neurologist – 6 sessions;
    • Consultant Biochemist – 24 sessions;
    • Respiratory Nurse Consultant – 18 sessions;
    • Diabetes specialist Nurse – 12 sessions.
  • Clinicians also reported that for return review patients this provides a very good quality equivalent service compared to face to face review;
  • Having a prior face to face clinical relationship before the participating in tele-clinic review was also reported to be advantageous;

Benefits of tele-clinic review to the Healthcare organisation:

  • Again clinicians reported a reduction in waiting times, reduced costs in terms of travel and fuel cost impacting positively on the environment;
  • More patients can be seen in the tele-clinic model by reinvesting travelling time saved in delivering more telemedicine clinical sessions.

Environmental impact of delivering tele-clinic reviews with the participating specialities in the last year:

  • Mileage saved by all clinicians is estimated at 9,300 miles;
  • Travelling time saved for all clinicians is estimated at 244.5 hrs;
  • Travel costs saved for all tele-clinics to date is estimated at £5,766;
  • Carbon Car footprint impact is estimated at a reduction of 3.03 tonnes of Carbon dioxide emissions based on a standard 1.8 diesel engine car.

Negative aspects reported with tele-clinic review:

  • The reliability of the broadband connection can be challenging with connectivity issues that can disrupt the flow of the consultation. The issues of communicating via this technology with service users with hearing difficulties were raised and this needs to be considered in future service planning to overcome this problem;
  • There was agreement that the clinicians themselves should be the ones to decide if tele-clinic review is appropriate for their service delivery and not necessarily be driven primarily by the National telehealth agenda;
  • A very small number of patients felt uncomfortable with teleconsultation and would prefer face to face review if offered.

Undertaking this review of current tele-clinic services offered in NHS Dumfries and Galloway has demonstrated many benefits to patients/service users, clinicians and the organisation. Telehealth technology and solutions are advancing and evolving at a rate that exceeds the current pace of change within the NHS and Scotland is recognised internationally as a leader in the development and deployment of telehealth and telecare. In undertaking this collective review of tele-clinic delivery in NHS Dumfries and Galloway we have demonstrated the real benefits of adopting this model of service in the Respiratory, Diabetes, Neurology and Weight management services and we are contributing to the delivery of the National Telehealth and Telecare Delivery Plan for Scotland 2015. Other clinical specialities and service users may benefit from this model of clinical care in the future and if delivered at scale the reduced travel costs, fuel consumption and impact on the environment are significant.

Thanks are extended to:

NHS Dumfries and Galloway IT department

Jill MacIvor – Diabetes Specialist Nurse

Jill MacIvor – Diabetes Specialist Nurse

Karen MacKie – Health Care Support Worker - GCH

Karen MacKie – Health Care Support Worker – GCH

Dr Fiona Green – Consultant Diabetologist

Dr Fiona Green – Consultant Diabetologist

Dr Ondrei Dolezal – Consultant Neurologist

Dr Ondrei Dolezal – Consultant Neurologist

Dr Ewan Bell – Consultant Biochemist/Associate Medical Director

Dr Ewan Bell – Consultant Biochemist/Associate Medical Director

10 thoughts on “Telemedicine – the Good, the Bad & the Future? by @murphieRNC & @Louisefclark

  1. I plan to share this with my supervisor who is VP for Quality Support Services at Cottage Health System in Santa Barbara, CA. Great article Phyllis!

    • Thanks Karen, I would be keen to hear any feedback, thoughts from SBCH teams on videoconsultation role in respiratory service or other clinical service delivery in your healthcare system.

      • I’ll share with the Medical Staff Leaders and Chair of Pulmonary/Critical Care if okay with you?

      • Karen, just returned from ERS in Munich today and presented our work yesterday morning. It’s was well received and it appears we are one of the very few healthcare are organisations who are presenting and publishing our findings at national and international conferences.

  2. As one of the patients involved in this project, almost from the very start, I have to commend all those involved in the project. At the start, I was approached by an outpatient nurse, who, with some trepidation, asked if I would like to take part in an experimental communication method. As a retired logistics manager and Director of an internet auction house, the computer held no fears for me. The questionnaire which followed, however, was another story altogether!!!!

    With the rapid spread of Skype, many, especially elderly, people in this rural idyll we live in, are used to being able to easily communicate with friends and loved ones across the world. Louise and Phyllis have extolled the virtues and savings for the NHS most eloquently and from a patient point of view, increases the number of appointments available are very welcome.

    Those who know me realise that I have probably attended every outpatient clinic with the exception of pre natal (and it’s on my bucket list!!!) and I look forward to the further use of telemedicine in the near future, possibly in Health Centres and Doctors surgeries, so that patients can benefit from the cost and time savings in travelling to appointments.

    Ken Donaldson and myself have experimented with using Skype appointments and, if security and other issues can be ironed out, imagine what a difference this would make to those patients, like myself, in more rural locations. In July and August, I had 10 outpatient appointments requiring 784 miles of travelling. Keep up the good work and let’s expand the system

    • Thanks for your comments David. It’s essential that we clinicians take into consideration all service users views regarding the use of technology in health care delivery. Having now done a fairly large number of tele sleep clinic reviews the feedback from patients has been very positive. If other services accross Scotland were to offer this service then many people living in remote areas would benefit.

    • David can I catch up with you about another project regarding tele sleep clinics that I have been approached about. It’s for a journal called BREATHE – European Lung Foundation. They are looking to interview me and a service user and then write the article and send for approval. Let me know if you are interested.

      Regards

      Phyllis

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