IV.3 COBERTURA Y FOCALIZACIÓN
IV.4.1 ANÁLISIS DE LOS PROCESOS ESTABLECIDOS EN LAS ROP O NORMATIVIDAD Describa mediante Diagramas de Flujo el proceso general del programa para cumplir con los
Specialty Endocrinology – diabetes care
Service provider Sydney Children’s Hospital Network’s The Children’s Hospital at Westmead (CHW) – paediatric endocrinologists
Service receiver Paediatricians and diabetes teams in regional areas of NSW
Target group Children and young people with diabetes, and their families/carers
Technology Videoconferencing (Lync)
Commencement 2012
What does the telehealth-enabled model of care comprise?
Paediatric endocrinologists from CHW provide specialist consultation services to children and young people with diabetes in regional areas of NSW via videoconferencing. Regional areas involved in the service include Orange, Bathurst, Dubbo, Port Macquarie, Nowra and Kempsey.
The paediatric endocrinologists provide diabetes assessment, diagnosis and management services to children and young people, and their families/carers, their local paediatrician and their local diabetes team. A local paediatrician is required to be present at every consultation.
Prior to the launch of the telehealth model, paediatric endocrinologists from The Children’s Hospital at Westmead travelled to regional and remote locations to deliver specialist care.
What enablers support success of the model?
Key enablers of the telehealth-enabled paediatric diabetes model related to the areas of governance, purpose/strategy, service and value delivery, business processes, workforce, culture and physical assets, as outlined in Figure 35.
Figure 35: Enablers of the telehealth-enabled paediatric diabetes model
What are the benefits of the model?
A range of benefits associated with the use of the model were identified across patients and their families/carers, health care workers and the health system (as outlined in Figure 36).
•Telehealth is part of the SCHN strategic plan and every supporting strategic document
•Telehealth is part of the clinical services plan for paediatric diabetes care
Purpose / Strategy
•Smooth and effective administrative support and organisation at both the tertiary and remote sites
•Processes to ensure the technology and all consultation participants are set up correctly prior to the consultation •Clinician driven design
and development of the model •Availability of central technical support Business processes •Diabetes care is
clinically suitable for telehealth
•The technology is cost effective
Service and value delivery
•Buy-in from patients - patients feel they can get the same level of service via telehealth as face-to- face
•Buy-in from clinicians Culture
•Appropriate, reliable and flexible technology
Physical assets •Staff were already familiar
with the technology (they had already been using Lync for other purposes)
Workforce •Support from the Chief
Executive and senior management •Clear direction from
management Governance
Figure 36: Benefits of the telehealth-enabled paediatric diabetes model
What lessons have been learnt?
The implementation and operation of the telehealth-enabled paediatric diabetes model has given rise to a number of key learnings, as outlined in Figure 37.
c
c
Patients and their families/carers
improved clinical care more convenient
increased access to specialist services
capacity building of clinicians at the remote sites, particularly paediatricians who are required to participate in all consultations
productivity and efficiency gains for the clinicians at the provider end – the telehealth model saved 62% of the paediatric endocrinologists’ time that was previously spent delivering the same services face-to-face*
reduced travel for specialists
better agreement on treatment plans by members of the care team and the patient/family
Health system
c
more reliable health care services (specialists are less likely to be delayed due to bad weather, late planes etc.)
potential for more patients to be seen (either via telehealth or at SCHN) due to reduced travel burden on specialists – the telehealth model enabled 13% more patients to be seen*
cost savings – the telehealth model cost 78% less to run than the face-to-face * model
Health care workers
Figure 37: Lessons learnt
External alliances and partnerships
Service and value delivery •Effective appointment scheduling
and reminding patients of their appointments by staff at the remote sites is necessary to ensure the greatest benefit it derived from the telehealth clinics because they are run at maximum capacity – currently, these clinics are not operating at full capacity
•If the model was expanded to meet existing demand, it is likely the current requirement for the local paediatrician to be present during all patient consultations would need to cease due to an unsustainable increase in the local paediatricians workload. This would create a risk that patients may receive poorer quality care due to not receiving an adequate physical examination during the consultation.
•The use of different models to deliver paediatric diabetes outreach services across LHDs (e.g. HNE LHD’s model heavily utilises face-to-face consultations while SCHN’s model exclusively utilises telehealth in place of face-to-face consultations) can create resistance to using telehealth in staff at remote sites who prefer face-to-face
consultations
Culture
Business processes •Telehealth clinics generate
additional preparatory work at the remote sites which can lead to staff resistance to using the telehealth model
•Provision of all necessary patient information (particularly data downloaded from insulin pumps) to the paediatric endocrinologists prior to consultations enables quality care and ensures an efficient use of time for the clinicians, patients and their families/carer
•Local paediatricians experience greater pressures on their workloads due to the telehealth clinic model as they are required to be present during all telehealth consultations (but were not required to attend the face-to-face consultations previously undertaken by the visiting paediatric endocrinologists)
•Overcoming resistance of diabetes educators and paediatricians at remote sites to using telehealth enables the model to operate – resistance may be due to a
perception the telehealth model is a withdrawal of services compared to the previously undertaken face-to- face consultations and a perception telehealth increases the workload of staff at remote sites
Physical assets
•Effective operation of the model relies on:
•appropriate technology •reliable technology
•adequate bandwith at the remote sites
•an adequate contingency plan to ensure consultations can go ahead even when the technology fails (e.g. via telephone rather than videoconference) •Interoperability issues between
LHDs/SHNs must be overcome to enable the model to be utilised to greatest benefit
Workforce
•Effective and efficient telehealth clinic operation requires locally available technical support at the remote sites
•Availability of staff at remote sites who are appropriately trained to undertake clinical tasks required for consultations (e.g. downloading data from insulin pumps) is necessary for the smooth operation of the clinics