A telehealth service provided by the WA Country Health Service (WACHS), a Digital Health CRC participant, is going from strength to strength in using digital technology to boost access to healthcare in rural and remote Western Australia. Last year, it saved country patients the equivalent of 37 trips to the moon and back by supporting rural clinicians to deliver care closer to home.
Since its introduction in 2012, WACHS’ award-winning Emergency Telehealth Service (ETS) has assisted local clinicians at emergency departments and nursing posts across 80 rural and remote sites in WA, providing them with support from experienced emergency doctors via video-link for difficult presentations.
The service also provides telehealth support to clinicians working in country communities for the private health and aged care services provider, Silver Chain.
By supporting the provision of emergency care in these locations, the ETS is saving rural patients 28 million kilometres of travel (or retrieval) to distant centres each year; ensuring less days away from their families, workplaces and farms; and saving $4.6 million in fuel costs (while also delivering environmental benefits) in the process.
New Command Centre to benefit rural patients
The ETS is currently being integrated into a new WACHS Command Centre, which will bring together a range of telehealth services in a 24/7 ‘virtual’ medical hub.
Located in a former hospital ward in Perth, the Command Centre will encompass:
- the Emergency Telehealth Service
- an expanded Inpatient Telehealth Service to help WA’s country clinicians care for admitted patients when the local GP is unavailable
- a Mental Health Emergency Telehealth Service
- an Acute Specialist Telehealth Service
- Acute Patient Transport Co-ordination to facilitate the safe, timely and efficient transport of patients to and from country and metropolitan hospitals in WA
- an Advanced Patient Monitoring System, utilising Artificial Intelligence (AI) to assist country clinicians to detect, recognise and respond to very unwell patients
“We’re still a little way away from the Command Centre looking like a NASA control room, but that’s where we could be heading!” says Robyn Sermon, WACHS Executive Director, Innovation & Development.
Inside the Command Centre, a number of specialists and other experienced emergency doctors sit in smaller private rooms in front of multiple screens, accessing the vital health data of patients, analysing patient information, and interacting with rural clinicians via live-streamed video feeds.
In another room there is a virtual nursing hub, which is akin to a normal nurse triage area but with all the information appearing on a bank of screens – and the patients located hundreds of kilometres away.
A new room – currently being fitted out – has another six screens where, in the future, the Command Centre team will be able to see a map of WA and click on icons to check in real-time the location of available beds, clinicians, patients, retrieval aircraft and ambulances across the state.
“That’s one of the challenges that we’re interested in exploring with Digital Health CRC – how best to track the healthcare journey of patients” Robyn says. “We are looking at a range of software and technical options for that.”
Emergency Telehealth Service
The new Command Centre is building on the success of the ETS, which is now averaging more than 20,000 consultations a year from rural and remote sites across WA.
“The ETS is used mostly by some of our smaller country sites that may have limited medical coverage at various times, or may have a doctor who wants additional support or a second opinion” Robyn says.
“They can dial in to the ETS, are triaged, and get advice via video-link from doctors who are Fellows of the Australasian College for Emergency Medicine (FACEMS) or very experienced GPs who have clinical rural and remote hospital experience themselves.”
“These doctors can be based at our Command Centre, at a variety of regional locations around WA, or connected via video-link from their own home.”
One of the ‘golden rules’ of the ETS is that it is there to support clinicians on-the-ground, not take over management of the patient.
“At all times, the local clinician retains clinical governance for the patient” Robyn says. “But having our ETS clinician ‘with them’ in the room enables them to reach out for specialist advice and support, and even get post-care support themselves if they have been involved in a difficult presentation.”
“We hope to see more doctors choosing to stay in remote communities because they feel they are getting great support from the ETS and continuing their clinical learning – they will continue to be the backbone of rural healthcare in WA.”
She adds that the ETS has also helped to standardise care across WACHS’ multiple sites.
“For example, we have implemented standardised emergency carts across all our sites so that when the ETS doctor asks the on-the-ground team to go to the third drawer and grab a particular drug or an intubation kit, they know it will be there – regardless of the location they are assisting.”
Inpatient Telehealth Service
In July, WACHS expanded its Inpatient Telehealth Service (ITS) to enable the remote monitoring of patients at rural hospitals when local clinicians are away.
“In small communities, the local GPs often provide services at the hospital” Robyn says. “If that doctor has to go away for a weekend, falls ill or something else comes up, some patients – including palliative patients – may need to be moved 150 kilometres or more to a larger hospital for care and monitoring.”
“That usually involves getting a volunteer ambulance crew to transfer them, and it means taking the patient away from their home and family.”
“With the ITS, though, we can keep the patient at their local hospital – when clinically appropriate – and monitor them remotely via camera when the nurse or another clinician does their ward rounds. If the patient’s condition deteriorates, we can move them to another facility.”
“This service has now been rolled out to 36 sites, and we will be expanding it in the future.”
WACHS also commenced a Mental Health Emergency Telehealth Service in July, employing psychiatric nurses, psychologists and psychiatrists on 24/7 call to assist mental health patients via video-conferencing across its rural and remote sites.
Additionally, the Command Centre will soon start to play a key role in ensuring the timely transportation of remote patients around WA.
“We have to move patients all about the state, and we work closely with the Royal Flying Doctor Service and St John’s Ambulance in doing this, but retrieval and patient transport can be complex and take time given the distances involved and the multiple demands on available aircraft and ambulances” Robyn says.
“Through the Command Centre, we aim to use our real-time monitoring of available beds, aircraft, ambulances and appropriate specialists to determine the best way to get a patient from A to B. At the moment this involves lots of phone calls.”
AI as a clinical tool
While it is only ‘early days’, the use of Artificial Intelligence (AI) in monitoring rural patients and assisting with clinician decision-making is a key area of interest for WACHS as part of its Command Centre operations.
“AI has real potential to enable the remote monitoring of our 80 high acuity beds across WA, so we can detect the deterioration of patients early and make decisions about leaving them in their local hospital or moving them to more acute settings elsewhere” Robyn says.
“AI can detect patient deterioration about six hours before the human eye, so if you’ve got the ability to know that far in advance if a rural or remote patient is not tracking well, that is very useful.”
“We are currently looking at software options, and how this will work in practice – it will depend on which patients and conditions we are going to target. For some conditions there are established algorithms, for others there are not, but we envisage that we will commence initial trials and simulations using dummy patients in the coming months.”
“We need to make sure that whatever we set up is going to work properly, so we’ll be trialling AI for some time before we start to use it on real patients.”
“It’s not something we will jump into quickly – but from radiology through to vital signs, research is showing that AI is now starting to provide very accurate information to support health decision making.”
Expanding the reach of care
Beyond the Command Centre, WACHS is expanding its telehealth service to encompass a range of other areas of health.
“A lot of the work we have undertaken around telehealth has been clinician led” Robyn says. “We might have a really enthusiastic clinician who highlights a particular service that would benefit one of our rural or remote communities, so we are often very responsive to this.”
“We held an Ear, Nose and Throat (ENT) clinic recently, and five patients from Halls Creek were video-linked into a clinic in Kununurra.”
“We used ENT equipment to investigate the patients on-location in Halls Creek, and the images were beamed through to the clinicians sitting in Kununurra. This saved the patients having to get on a 3.30am bus to travel four hours to Kununurra for their appointment. You can imagine the flow-on effect for patients and their families in not having to travel that distance – particularly when the patients are feeling unwell – and not having to take as much time off work to get there and back.”
“Following a positive trial, we are now also commencing a tele-stroke service that links clinicians in Perth with doctors in our rural and remote communities. We’ve had amazing stories of remote stroke victims being assessed and treated quickly through this approach, and getting back to a normal life within weeks of their stroke occurring. We are looking at expanding this service across the state.”
“We are also soon going to commence a tele-chemotherapy trial in the Kimberley. If you are a Kimberley patient, it’s a three hour flight to get chemo in Perth. A lot of rural people spend months flying back and forth doing chemo, so while tele-chemo has to be clinically appropriate – and depends on the type of cancer and treatment required – it can make a huge difference in a patient’s life by having that treatment available locally and monitored remotely.”
Backing it with research
Robyn says working with Digital Health CRC and the university sector will help WACHS fully understand what cutting-edge technology is available to support its telehealth initiatives going forward – particularly when it comes to sharing clinical images and patient records across both WACHS and the wider health system in WA, and also expanding the use of AI.
She adds that WACHS has enlisted PhD students to help them monitor and assess the effectiveness of their programs.
“For example, we have a PhD student from Curtin University (another Digital Health CRC participant) embedded at our Command Centre, gathering evidence around what we are doing.”
“We’re interested to track what really works for clinicians and patients, and what doesn’t, and also look at what future technologies will enable us to expand our service even more.”
“That’s where our involvement with the universities and Digital Health CRC will really pay dividends in the years to come.”
For more information on WACHS’ telehealth program, visit www.wacountry.health.wa.gov.au
(see Our Health Programs, then Telehealth)
Email Robyn Sermon at [email protected]
Article by Patrick Daley