Validation studies on a gene panel interrogating paediatric growth disorders and tumour predisposition.

Associate Professor Elizabeth Algar BSc Hons M.Phil. PhD FFSc RCPA

Principal Scientist, Genetics & Molecular Pathology, Monash Health

The Genetics and Molecular Pathology laboratory at Monash Health is the predominant Australian testing laboratory for paediatric overgrowth disorders associated with increased cancer risk in childhood, including Beckwith Wiedemann syndrome (BWS) and Hemihypertrophy (HH). Cascade testing typically involves SNP microarray, methylation analysis of imprinting centres on 11p15.5 and CDKN1C (P57) mutation screening. Rare point mutations in NSD1, NLRP2, DNMT1 and ZFP57 have been described in BWS and like disorders as well as deletions and insertions within the 11p15.5 imprinting centres IC1 (H19/IGF2) and IC2 (KCNQ1OT1/CDKN1C). Tumour risk is increased in most genetic and epigenetic subtypes of BWS and HH however degree of risk and tumour type varies between groups. Parents of affected children are often understandably anxious to know the recurrence risk for these conditions and as the number of childhood cancer survivors’ increases, the possibility for transmission of a causative mutation is becoming an increasingly important issue. To improve our capacity to detect predisposing mutations in BWS, HH and in the paediatric tumours that have been described in these conditions, we have designed a gene panel comprising 37 genes as well as intergenic regions spanning imprinting centres on 11p15.5 and 11p13. We have used the Haloplex target enrichment system with sequences run on an Illumina MiSeq. We have performed pilot testing to show that the panel has clinical utility and demonstrates excellent sequence coverage of the 11p imprinting centres. Analysis of results to date has revealed novel mutations including OCT-4 binding site disruption in IC1 and subregions of homozygosity.

Moving Forward with Virtual Health Care

Health care systems around the world are evolving and virtual health care is an important means for achieving this transformation.   Dr. Williams will compare the health care systems between Canada and Australia and review the health care transformation currently occurring in Ontario, Canada.   The Ontario Telemedicine Network is evolving to support the new paradigms.   New models of care are central to the transformation and their successful implementations can only be achieved with the seamless integration of traditional care and virtual care.

MECARE – Solution Overview of how West Moreton HHS Deployed the Technical Solution and a Discussion on our Technical Challenges and Successes

Nasa Walton1, D. Anderson1 B. Peloquin2, M. Angove2, R. Newell1.

1 West Moreton Hospital and Health Service

2 Philips Healthcare – Hospital to Home Division

 

Introduction – West Moreton’s Mobile Enhanced Care (MeCare) is a working clinical service that integrates community and hospital based chronic disease management for complex chronic disease sufferers in their home via a point of care solution. This model of care was developed as five per-cent of our current patient population consumes 50 per-cent of the hospital clinical budget.  200 of our highest acuity chronic disease patient in the 2014-15 finical years consumed $12m of which $9M was directly attributed to chronic disease management related costs.

MeCare is a hybrid clinical care model that has eHealth technology at its core, enabling a multidisciplinary service to proactively manage and support the care of a patient during their healthcare journey by coordinating care delivery with patients in their home. The technology solution delivers psycho-social and physiological monitoring and home videoconferencing capability co-developed in partnership with Philips. The service emphasis is on patients with Chronic Respiratory Disease, Diabetes, Chronic Heart Disease and Chronic Kidney Disease.

 

Methods – The point of care solution in the patient’s home enables patients to upload vital signs; blood pressure, heart rate, oxygen saturation, blood glucose, temperature, INR and weight, via Bluetooth, to a dedicated tablet. The tablet application, Philips Healthcare’s eCareCompanion (eCP), facilitates patient interactions, via patient surveys and video conferencing.  The metrics are transmitted to the Philips hosted eCareCoordinator (eCC) application.   eCC supports population health management by providing the multidisciplinary team (RN, Pharmacist, psychologist, health coaches and Physicians) with a dashboard based daily review of each of their patients, allowing them to prioritise patients and adjust care plans or intervene as needed. MeCare team members are able to view daily summaries and biopsychosocial trends of the patients enrolled in the service, schedule appointments, education, surveys and participate in video conferencing calls directly with the patient and GP.  Other non-QH clinicians, (GP’s, NGO’s and other care givers), are also able to securely access the system via a web client, contributing to the care plan, case conference with the service and maintain an integrated longitudinal record.

 

Results – The Philips eCC and eCP Intensive Ambulatory Care as a Service (PaaS) solution are cloud based applications hosted on Salesforce.com and Amazon platforms. The data is securely stored in non Australian jurisdictional datacentres. The program has worked with various Qld Government agencies and Qld Government data security, privacy requirements and has approval to deploy the solution in the various cloud providers around the world.

The technology offers significant support to enhance patient empowerment through simple and robust integration between the monitoring devices/ patient tablet, the MeCare unit and community based care. Our presentation will discuss the challenges and our success in delivering the technical point of care solutions in patient homes and the telehealth hub.

Orthopaedic Telehealth – Specialist care closer to home

Christina McInally 1

Telehealth Coordinator, Rockhampton Hospital, North Rockhampton, QLD, Australia

 

Background

The Orthopaedic Outpatient Telehealth Service in the Central Queensland Hospital and Health Service (CQHHS) provides specialist orthopaedic care to patients throughout Central Queensland and Central West areas. The Orthopaedic Outpatient Telehealth Service has shown innovation and determination to meet the ever increasing patient demand by providing Telehealth to orthopaedic patients. Orthopaedic Medical and Nursing staff identified there are patients from outlying areas requiring ongoing access to Specialist Orthopaedic care and the distance patients were travelling for this service was immense.

Methods

The Orthopaedic team commenced a Telehealth model of care to ensure equitable access to specialist care for patients in rural and remote areas of Central Queensland and Central West. The Orthopaedic Outpatient Telehealth Clinic with Rockhampton Hospital as the provider uses large wall hung screens, which provide a high definition view of the patient and their fracture or wound. With the recipient sites having similar equipment, this then enables the Orthopaedic Medical Officer and nurse in Rockhampton to control the camera at the recipient site to view the wound, sutures or functionality of the patient’s body.

The clinic can see patients who are review postoperative fractures, postoperative joint replacements, external fixations, ongoing rehabilitation assessment and range of movement checks.

Results

The number of patients seen through the Orthopaedic Outpatient Telehealth Service in 2015/16 has grown to a phenomenal 3437 patients. The service has established a positive reputation within the communities so much so that patients contact the department directly to see if their appointment can be performed through telehealth. Many of the reasons for their request include work restrictions, inability to drive due to type of injury, too much time off school for the child and children who suffer from travel sickness or too much expense purchasing fuel for such a long distance drive.  We have had a significant impact on the cost savings through patient travel subsidies, which has shown a $2 million worth of savings across the CQHHS for 2015/16 financial year.

Orthopaedic patients can experience pain and discomfort because of their injury, which can be very distressing if the patient needs to travel in a car for up to 4 to 5 hours. Telehealth is one of the options available to these patients when travelling long distances is very challenging and expensive for the patient.

Discussion

The Telehealth Service of Central Queensland is striving for excellence through effective and sustainable delivery of Telehealth services to patients throughout Central Queensland and surrounding districts. This presentation will explore how the service was initially set up, the requirements of clinical/non-clinical staff involved in the clinic, equipment required, the referral process, types of patients clinically appropriate for Orthopaedic Telehealth, why the clinic is so successful and ongoing maintenance required ensuring the Orthopaedic Telehealth Clinic is run in accordance to policy and procedures.

Telehealth – Bringing it home

Dr Ewen McPhee 1

President, Rural Doctors Association of Australia

Telehealth is seen as a solution to the delivery of care to rural and remote Australians. The implementation of a myriad of systems, processes and actions to deliver on a set of diverse outcomes has seen a rapid growth in innovation and ideas as to the scope of Telehealth enabled care. But does this enthusiasm for Telehealth translate to better outcomes? How does Telehealth and Telecare align with Patient Centred care? Can we build a virtual medical home that connects clinicians and empowers patients? The presentation reports on recent primary care policy measures in eHealth and Primary care and asks some key questions of the audience.

What factors determine healthcare professionals’ (HCPs) acceptance of mobile devices for telehealth: A qualitative study conducted in Queensland, Australia

Vasundhara Rani Sood1, Prof. Raj Gururajan2, Dr. Abdul Hafeez Baig3

 

1 USQ, Toowoomba, 4350, Qld, Vasundhara.Rani@usq.edu.au

2 USQ, Toowoomba, 4350, Qld, Raj. Gururajan@usq.edu.au

3 USQ, Toowoomba, 4350, Qld, Abdul.Hafeez-Baig@usq.edu.au

 

Background

The introduction of telehealth has transformed the way of health delivery. Using telehealth, travel time and distance barriers are virtually eliminated for patients who live in remote areas where access to a hospital or clinician is limited (Coach 2013). Despite the various benefits of telehealth, the static model of telehealth services is preferred globally. In Australia, for telehealth consultations, the patients arrive at the health facility 30 minutes before the teleconsultation begins so that staff can take the necessary observations and can send the results to the hospital, even though mobile device based telehealth has potential to monitor patients in the home bed side environment. Yet most of mobile device based telehealth services are used in text messaging and in calling globally. The use of mobile device based telehealth services in many health activities such as telemedicine, patients’ records, treatment and monitoring is slow. Tamrat and Kachnowski (2012) claimed sustainable adoption of prenatal and neonatal mobile device based telehealth services remains under-developed.  Therefore, the aim of this research is to explore the perceptions and experiences of health care professionals’ (HCPs) for the acceptance of mobile devices in telehealth.

 

Methods

This research is conducted using the qualitative approach. Six focus group discussions, each group having 5-7 members and 2 interview were used to collect qualitative data. The target population was healthcare professionals such as occupational therapists, physiotherapists, dietitians and oral health practioners involved with the provision of telehealth services.

 

Results

In Queensland, health care professionals intention, self-efficacy, compatibility, relative advantages, education and training, management support, network coverage, privacy and security,  resource issues, trialability, age and experience with technology use were found to be important factors for the use of mobile devices whereas social influences, functional features of mobile devices and complexity were found to be conflicting factors among various HCPs for the use of mobile devices in the Australian telehealth environment.

 

Discussion

This study findings add to the stream of knowledge and provided factors that has policy an empirical implications. In policy and practice terms, this study makes a significant contribution towards an understating of factors for the use of mobile devices in telehealth. These factors can serve as a guide to policy makers and mangers to implement mobile devices in telehealth.  Further, the results obtained from this research study can be applied in other states of Australia and the rest of the world to understand the use of mobile devices in the telehealth environment. The paper also indicated age and experience as moderating variables which can further be considered and can be investigated in other studies such as survey.  Further, the factors and the items obtained in this research study can be used to design a survey questionnaire to conduct this research study using the quantitative approach.

Vasundhara is a PhD candidate in health informatics research at the University of Southern Queensland (USQ), School of Management and Enterprise. Vasundhara graduated from the Himachal Pradesh University (HPU), Shimla, India with a master’s of technology in computer science. Her research interests are health care utilization, quality, outcomes and communication. In addition to pursuing her PhD, she has been working in the BELA department of USQ as a causal staff. She has also worked as an assistant professor in HPU. During her PhD she has also presented her research in ACIS 2015 and ECIS 2016 top ranked conferences in information system. Vasundhara has also published a book chapter with IGI publication for the Healthcare Administration and Management book.

The Darling Downs Telehealth Team – our formula for success

Carolyn Bourke1, Shayne Stenhouse 2

 

1 Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba, 4350 carolyn.bourke@health.qld.gov.au

2 The Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba, 4350, shayne.stenhouse@health.qld.gov.au

 

Established in 2014, the Darling Downs Telehealth team consists of a Clinical Nurse Consultant and a Business Coordinator and together they have created a momentum for change with great teamwork.

Non admitted Telehealth service events have grown significantly in the past 3 years in the Darling Downs Hospital and Health Service, with a 15% increase in the past 12 months.

Their success can be attributed to great communication and a capacity to do things that can’t be done by challenging the norm and asking why not?

The benefit of the blended team has given rise to different ways of thinking – think like a clinician and thinks like a business manager to achieve our results.

 

Processes undertaken include:

  • Monitoring and streamlining data collection
  • Review clinical & administration processes
  • Monthly report to HHS Board members
  • Regular rounding with all specialities and all facilities
  • Establishment of sound relationships with the Administration and Clinical teams
  • Working on the business and not in business
  • Consultation with clinical and business leads
  • Creation of a telehealth action plan
  • Data review, measurement and analysis

 

New models of care under development:

  • Tele-chemotherapy
  • Tele-stroke
  • Tele-geriatric

 

Opportunities to bridge the gap:

  • Expand Tele-dental into school dental vans and private nursing homes
  • Collaboration with DDWMPHN – integrating public & private health care
  • Ongoing clinician engagement within General Practice
  • PTSS Project to decrease patient travel and achieve more care locally via Telehealth
  • Contribute to development of the Nurse Navigators role and telehealth capacity

Telehealth service in rural Australian Hospitals and its impact on key performance indicators in the health care service

Queen OkerekeA*, Nirjhar NandiA

ADepartment of Medicine, Cairns Hospital, Cairns, Australia

Aim: To assess if telehealth can be useful in delivering high quality of care to inpatients in our peripheral hospitals while ensuring patient safety is not compromised

 

Objective:

To evaluate the effectiveness of telehealth services  in 3 Australian rural hospitals at reducing the length of stay and interhospital transfer of reviewed patients.

 

Background:

The availability of telehealth services in rural and remote Australian hospitals have been found to be useful in increasing the clinical expertise of the rural health practitioners. They also provide opportunities for professional development with the continual contact with the specialists during their service delivery1. Furthermore, telehealth services at such communities were helpful at bridging the health gap in our rural and remote communities.

However, not too much interest had been directed on the beneficial effects of this service especially in the key performance indicators such as length of stay or the cost benefit of preventable interhospital transfers.

 

Results:

A one year review was made of all the patients seen through our telehealth service to 3 peripheral rural hospitals in the Cairns and Hinterland region in Far North Queensland. A total number of 1142 patients were seen during the study period from July 2015 to June 2016. The majority of the patient were from Mareeba hospital (1074) followed by Mossman and Babinda hospital with the number of reviewed patients being 50 and 18 respectively. The uneven distribution of patients was because Mossman and Babinda hospitals were included in our service later on. The Overall length of stay was reduced in 412(36%) of the total patients. The overall number of admissions to Cairns Hospital prevented was 808 (71%).

 

Conclusion:

This study suggests the effectiveness of telehealth in reducing length of stay of inpatients in rural Australian hospital setting. It has also proved useful in preventing interhospital transfers which is advantageous to the patients as well as has a cost benefit to the hospitals. This finding supports other studies2-4, which showed that telehealth helps in reducing preventable hospitalization and hence providing cost saving.

Further studies would be needful to assess the impact of telehealth and its cost benefits in the outpatient general medicine setting.

neoRehab service delivery trial within TCP Toowoomba

Samantha Donohoe1, Brioh Guffin2

 

1 Transition Care Program, Baillie Henderson Hospital, Browne House, Level 1 PO BOX  Toowoomba, QLD, 4610, samantha.donohoe@health.qld.gov.au

2 Transition Care Program, Baillie Henderson Hospital, Browne House, Level 1 PO BOX  Toowoomba, QLD, 4610, brioh.guffin@health.qld.gov.au

 

Background:

Within the Toowoomba Transition Care Program (TCP), the use of neoRehab clinically validated videoconference software is enabling real time service delivery via iPads. Within this model, the multidisciplinary community-based rehabilitation team of allied health professionals, nursing, case management staff, and allied health assistants, are alternating weekly home visits with videoconference consults, for appropriate clients. A staff member sits with the client and operates the neoRehab software on the TCP iPad in the client’s home, whilst the clinician is able to provide his/her review consult from the team office, with purpose-designed clinical measurement tools on-screen to assist in monitoring progress.

A three month pilot study was undertaken to review and update the existing Toowoomba TCP neoRehab service delivery resources (user guide and clinical guidelines) and review the implementation and service delivery of neoRehab within Toowoomba TCP. This innovative change to service delivery for clients in Toowoomba and surrounds has, in its initial stages, demonstrated time, resource and cost effectiveness.

 

Method:

Data focussed on capturing occasions of service (OOS) and additional parameters to identify the overall clinical service advantages of the integration of neoRehab into our existing service delivery model has been collected and analysed from a period including March, May and June, 2016. In addition, we have obtained staff feedback during informal interviews within the TCP team.

 

Data collection results (summary):

  • 23 of 26 sessions in three months substituted face-to-face consultations (~88.46%)
  • In 12 weeks, TCP saved approximately $1,574.35 using neoRehab as an alternate to face-to-face consultations
  • In 12 weeks, Toowoomba TCP completed 26 neoRehab sessions which saved an overall amount of $1,893.41
  • Overall, TCP saved $735.05 in staff costs
  • Overall, TCP saved $1,158.36 in car travel costs
  • In 12 weeks, the overall saving per OOS was approx. $69.43, with an average of 58.58km saved per OOS
  • 16 out of 26 neoRehab sessions had no episodes of disconnection or disruptions

 

Aspects that made the TCP team less inclined to use neoRehab included; technical difficulties, reception black spots particularly in the rural areas. Further, neoRehab isn’t as hands on as regular service delivery, and the poor sound quality at times when full reception isn’t available has been a barrier to use with our older clients at times.

All staff members were able to identify how neoRehab is useful in their area of practice and identified that it saves both staff and client time, and reduces the travel time, thus making the service more efficient and more responsive. Additionally staff indicated that neoRehab was beneficial for building teamwork by being a useful learning tool for both clients and staff. The team has identified that they would like to know more about the application of features of neoRehab.

 

Future Direction/consideration:

Please note: due to the preliminary nature of our data, we are aware that the following is representative of data collected as part of a series of first steps in a longer-term plan to integrate neoRehab into our team’s service delivery model. In future, we hope to conduct formal research to obtain reliable evidence in support of the feasibility of neoRehab within a community-based rehabilitation setting. We anticipate this data will be applicable to health services beyond our own, across our district, and further afield.

 

Conclusion

NeoRehab is showing promising potential as a feasible, cost effective advancement with further integration into our existing model of service delivery. Further scope for formal research over a six months period exists to quantify the feasibility, cost and clinical effectiveness of this service model within our team.

Maintaining Mature Mouths utilising tele-dentistry

Debra McKenzie1, Eilleen Shepherd2, Jacinta Pitt3, Carolyn Bourke4

 

1 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

debra.mckenzie@health.qld.gov.au

2 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

eilleen.shepherd@health.qld.gov.au

3 Rural Health and Aged Care, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 jacinta.pitt@health.qld.gov.au

4 Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 carolyn.bourke@health.qld.gov.au

 

Background:

Maintaining mature mouths utilising teledentistry is an innovative model of care enabling Darling Downs Hospital and Health Service’s (DDHHS) Residential Aged Care Facility (RACF) residents to have oral checks and dental reviews via a live streaming videoconference appointment with a Dentist. This integrated approach is between DDHHS’ Oral Health Clinic (OHC), Telehealth Team, seven RACFs, as well as RACF residents and their families.

Methods:

DDHHS’ TeleDentistry program was initially trialled in January 2014 using a dental probe connected to video conference equipment. The trial highlighted some technical issues which had to be overcome and also provided the opportunity to fine tune operational, administrative and nursing processes. Once the issues were addressed, the trial was recommenced at DDHHS’ Mt Lofty Nursing Home in Toowoomba in November 2014.

The Oral Health Therapist (OHT) visits the RACF and performs a chart audit, reviewing dental care plans. Each consenting resident receives an oral review in the privacy of their own room. The oral health therapist records the dental review and management plan in the resident’s record in collaboration with the Registered Nurse (RN).  If the OHT finds an issue that requires further investigation, a referral is made by the RN for the resident to be reviewed by a Dentist via Tele Dentistry. A time is scheduled where the Oral Health Therapist uses live streaming of the RACF resident via an inline camera. The Dentist views the live feed from their office and advises on appropriate treatment to commence locally, or advises that the resident is required to be seen in person at the OHC.

Results:

The following outcomes have been achieved:

  • 204 residents have had a dental assessment, 57 have had a tele-dental referral/consultation and 16 have required further appointments at the dental clinic.
  • Increased awareness of residents’ oral health needs and oral health requirements
  • Reduction in QAS and nurse escort time and costs for transporting residents to Oral Health Clinics
  • Addresses a major barrier for residents accessing appropriate oral health care
  • Reduction in the number of inappropriate referrals to a dentist by first screening residents
  • More efficient use of Dentist time
  • Minimum disruption to resident’s daily routine
  • Patient comfort maintained
  • All residents are up to date with yearly visits
  • Proactive approach finding areas of concern before they become a problem to the residents i.e. pain
  • Staff are becoming more in-tune with technological advances

Discussion:

TeleDentistry has allowed residents to receive optimal dental care while remaining in their own surroundings and eliminated the need for frail residents to be transported to the OHC via ambulance with a nurse escort. To improve the knowledge, skills and attitude of RACF staff in oral health, each nurse working in a RACF is required to undertake mandatory online training regarding oral health via the DDHHS online learning portal “Darling Downs Learning Online” (DDLOL). Future objectives include introducing the program into private aged care facilities and investigating different technology.

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