Telemedicine lifts remote health burdens

Caring for people with chronic disease in regional and remote areas is getting easier for Loddon Mallee Health Alliance thanks to telemedicine technology. Joshua Gliddon reports.

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The Challenge: Loddon Mallee Health Alliance needed to provide healthcare and allied services to people with chronic diseases living in rural and remote parts of Victoria.

The Approach: The Alliance rolled out telemedicine units to 100 patients suffering from chronic disease. The units look somewhat like a laptop, and can measure six vital signs, including blood pressure, spirometry and weight.

The Outcomes: Patients have become more aware of their own health, particularly what is normal for them, and what some of the triggering factors are if their measurements from the telemedicine device come back abnormal. It has also lead to better and more efficient use of nurses’ time and travelling schedules. Finally, there has been a reduction in hospitalisations among the people taking part in the study.

Lessons Learned: In order to provide telemedicine and related services, broadband with a high degree of availability is required. Other learnings include the fact that people are willing to take control of their own health when they are given the information and the means to do so. Finally, clinicians and other health professionals need to buy-in to the service if it is going to reach its potential.

The Upside for:

Clinicians: Remote monitoring of patients means that doctors can spend less time on the road and more time reviewing patient results and data. Doctors, as a result, are more efficient and able to spend more time on the patients that really need it.

Nurses: Nurses would frequently have to travel long distances to take simple patient measurements such as blood pressure and weight. Remote patient monitoring means that nurses can be more efficient with their time.

Patients: Patients learn more about their own health through remote patient monitoring. They learn about what is normal and abnormal for them, and they learn to communicate more effectively with their doctors and nurses.

The organisation: Remote monitoring means that the Loddon Mallee Health Alliance is able to allocate its resources more efficiently. It also means that fewer patients are admitted to hospital. 

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Loddon Mallee Health Alliance's story
Providing health services to rural and regional Victoria is a big job. The Loddon Mallee Health Alliance, one of five Health Alliances in rural Victoria, covers around 25 per cent of the state’s landmass, encompassing a region that begins around 100 kilometres out of Melbourne, and takes in large swathes of the North and North-Western region, right across to the South Australian border.

Two years ago, the Loddon Mallee Health Alliance began rolling out telemedicine units to people with chronic disease living in its remote and rural jurisdictions. “There are 100 units and they look a little like a laptop,” says Bruce Winzar, chief information officer for the Alliance.

The units can measure six vital signs, including blood pressure, spirometry and weight. Depending on whether the patient has broadband or a conventional land-line, the units can also handle video-conferencing with a clinician back in Melbourne.

The advantage that the units offer to the Alliance is that they increase the number of patients that the duty nurses can take care of. “We are monitoring how it works in terms of reducing hospital admissions,” says Mr Winzar, “but the key advantage is that it means nurses don’t have to drive an hour to take blood pressure, and then another hour back to base. All the results are sent to a central portal where case workers and doctors check them and make an assessment as to whether they need direct follow-up or not and whether the results are within, or out of, boundaries that have been set.”

The pilot has finished, and now Mr Winzar says the system is in full swing. It’s obviously reduced the cost of servicing patients in remote areas, but the big question is what has the system done for the patients?

In general, says Mr Winzar, the telemedicine system has helped patients focus on their own wellness, and has increased the knowledge that they have of their own bodies and their own conditions.

He draws the example of a farmer who has had cardiac surgery and is unsure about whether they can get back onto the tractor. In the past, the farmer would have to wait for a nurse to come and see them, take the appropriate readings and then advise the farmer on what sort of activity they could undertake. The telemedicine system has changed all of that. Thanks to the technology, the farmer has a better understanding of what readings fall into the normal range, giving them the confidence to get back into the swing of their own lives.

The Alliance is also trialling advanced telemedicine from rural and regional hospitals that links the establishment back into specialist services in the metropolitan area. The system consists of a Polycom video conferencing system that can send back high resolution images from CAT scans and X-Rays, as well as enabling specialists to virtually examine trauma patients from a distance.

What used to happen, says Mr Winzar, is that a GP would be called in, realise that a trauma patient’s injuries was out of their scope, and then arrange to have the patient transferred by either road or air, depending on how time-critical the injury was. “As you can imagine, that’s quite an expensive process,” he says.

Now a specialist from the metropolitan hospital can be patched in to advise on ways of treating the patient, reducing patient stress due to transportation, and speeding treatment.

Naturally, however, there’s a downside. It requires always-on broadband, and it means that the telemedicine devices have to be easy for a rural clinician to operate. “One or two buttons,” says Mr Winzar. “You can’t expect a GP to sit down and start reading a manual while they are trying to treat a patient.”

More importantly, however, the system requires that clinicians in regional and rural hospitals “buy-in” to the system, which can be a difficult undertaking when clinicians typically move in and out of rural service on a regular basis.

“We are very much at the frontier,” he says. “And we’re seeing where this will take us.”

For more information, visit Loddon Mallee Health Alliance.