Doctors in the South Island will pioneer a fresh approach to telemedicine after deciding to abandon a hi-tech telepresence system set up on the West Coast that became a flagbearer for ultrafast broadband.
In what Michael Sullivan, telehealth clinical leader for West Coast and Canterbury district health boards, said would be the biggest implementation of telemedicine to date, nurses and GPs on the West Coast will instead be provided with a low-cost system that will let them consult other GPs and specialists in the South Island via video from their desktops.
There was only one GP in the whole of South Westland, who saw patients in Hari Hari, Whataroa, Franz Josef, Fox Glacier and Haast, Dr Sullivan said.
“That’s an enormous area. He might be doing a clinic in Hari Hari and 300 kilometres away there’s a nurse down in Haast who’s got a patient she’d urgently like the doctor to see. They often have to consult over the phone.”
Health practices at those five sites would be kitted out with 22-inch high-definition video conference units that doubled as computer screens.
“The nurses there will be able to dial into the system and talk to Greymouth or the GP or get a palliative care opinion or a cancer opinion from Christchurch.”
Buller, which already had one videoconferencing site, would get at least one more, and existing sites in Reefton and Hokitika would be upgraded.
West Coast DHB installed Cisco telepresence suites worth hundreds of thousands of dollars in Grey Base Hospital and Westport in late 2008 so clinicians could consult with patients in Westport, but Dr Sullivan said that system was used very little in the first year and would no longer be needed.
“The equipment was installed and available but a number of things did not happen, or took a long time to happen.”
Limited training was provided to a limited group, virtual clinics hadn’t been co-ordinated and were not given the same priority as normal clinics, and doctors were reluctant to work outside their normal clinical environments.
“If you have to leave the room and go off somewhere else … you aren’t going to use it. Passive telehealth, when you put the equipment in place and expect people to use it, is a recipe for failure.”
Some of those cultural problems had been addressed and results had shown telemedicine could work in the right setting.
“It’s safe … patient satisfaction was very high and very few of the patients said they preferred the doctor being in the room, and it decreased the need for transfers Greymouth.”
Cisco New Zealand managing director Geoff Lawrie said the system worked perfectly technically, but it had needed to do a better job of working with the people using it. “It took us a couple of iterations to get there.”
Cisco’s technology had moved on since it installed the equipment, and it could now offer more cost-effective units suitable for smaller, remote sites.
Successful telemedicine would ultimately rely on having a mix of equipment from high-end suites to desktop units to mobiles, he said. Dr Sullivan said DHBs would spend hundreds of thousands of dollars on the new system, which will involve buying extra internet capacity and installing a satellite broadband connection at Haast.
Videoconferencing facilities have also been set up at Grey Base Hospital and in Christchurch.
The DHBs would use a virtual private fibre network provided by Auckland firm Vivid Solutions and PolyCom equipment for the system and in future could use fibre under the Government’s ultrafast broadband initiative.
CLAIRE ROGERS
Fairfax New Zealand