Chris Ryan and James Ferguson: Video call access to health care services at scale

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Chris Ryan, Video Consulting Program Director, Healthdirect Australia and Professor James Ferguson, National Clinical Lead, Scottish Centre for TeleHealth discusses rolling out video consultations at scale to provide rapid access to clinical services.

This presentation was recorded at our Digital Health and Care Congress 2017 on 11 July 2017.


JF:    For the last ten to fifteen years in Scotland we’ve been trying to change things in terms of how we deliver care, still in 2017 I have large numbers of patients passing through my department who don’t need to be there.  We did a study about three years ago looking at how could we support care of children in more remote areas.  If children presented to a remote rural general hospital and whereas they would normally have ferried them off to Inverness or somewhere else on a four/five hour journey, they were able to call NHS 24, NHS Direct here, and then they would be patched through by video conferencing to a paediatric emergency medicine specialist.  It increased the quality of care in 33% of cases and that was a minimum number and avoided transferring about 25% of cases.  This trial was our test bed for using the same idea of rapid access to clinical support for everybody.  So then we thought, well, what do we want?  We really want to scale this up and the problem is we could actually reduce large numbers of patients coming if we could have a system whereby patients could directly video consult with clinicians.  Two years ago, yes Chris, you contacted me and he wanted to show us this, this new platform he had that would allow video conference to occur using Google Chrome and that’s what we’re going to talk about what happened after that. 

CR:    Healthdirect Australia is government owned, it’s sort of like NHS 24, bit of NHS 24, bit of NHS Direct.  We started in 2014 to add video call access to Healthdirect’s own services so a video call to a nurse instead of a telephone call.  In 2015 we were asked to roll that out and we actually had our own vanguard type projects exemplar program that we called in 2015 with ten health care settings and that’s now been expanded across Victoria, New South Wales and Western Australia in a wide range of settings.  So three factors played a really big part in our design thinking: the telephone as a benchmark for ease of use, access, ubiquity, cost, we had to support incoming unplanned episodes of care so we don’t know where people are coming from so this is three o’clock in the morning, sick kid, you can’t ask them to install stuff, mess around with the technology, plug things in, have echo cancelling speaker boxes all that sort of stuff and the need to be seen by one of any number of health professionals.  We focused on three layers so the service operation, resourcing and video call access design, obviously the legal financial issues, what’s different in a video call in this particular discipline compared to seeing someone physically.  Management issues are really around how you get the right people and the right web browsers nowadays at the right time with the right information in the right way, securely, privately all those sorts of things and then what happens when you hit go which is the video technology.  Now video technology is freely available in a web browser and our focus is really on those two management service/operational areas.  What we’ve needed to focus on is a whole platform which includes all of the materials and resources to support adoption through the thinking about it, through the preparation stages, the discovery, the set up phases, the using phases, the evaluation phases, which are all different in different health care settings and contexts.  Then we have this management layer software which we write ourselves which, as I say, manages all the waiting areas and we’ll have a quick look at that.  We have these thirteen also principles one of them is to replicate the way that people access health care today; familiar work flows for clinicians, they just go to their online waiting area, familiar work flows for patients they’re just directed in their outpatients letter to the front door on their hospital website as opposed to walking through a physical front door and from there on it’s pretty much the same experience except you’re online.  So you come and start your call.  So we collect again customisable per area where what information you collect whether it’s mandatory or not, some of our services are anonymous.  Importantly this information is only to identify the patients that are in the waiting area there’s no patient identifiable information stored in the system whatsoever and that’s really it from a patient’s perspective.  So can’t do much about wait times.  So I’ve arrived at my appointment and I might be sitting here for half an hour while the clinician is running late but I’m at home or I’m working, I’m listening to the hold music I’m getting messages on the screen that are customised from the service etc.  I will log in as a service provider.  From my dashboard I can see how many people are in the service waiting areas that I’ve got access to and I've got access to three.  You can set service levels around time to answer and all that sort of stuff, when patients come in I’ve got a text and a ding and you can set various notifications to let you know people are in your waiting area.  So better go and answer Hazel, but Hazel importantly is sitting in her own private video room you can see who has also been seen before, she could have been transferred from another service, there’s lots of details I don’t have time to go through now, but the clinician essentially has seen the note, my next appointment is via video, goes to their online waiting area which can be built into the patient administration system or the EMR or whatever it might be and then just joins that patient and proceeds with the consultation.  So hello Hazel.  

F:    Hello, greetings from sunny Edinburgh.

CR:    So we use this all the time for our own case conferencing you can have up to four to six people in there without any central infrastructure.  One of the cool things compared to a WebEx or GoToMeeting is that everybody can share all the time so four  people  can all be sharing you don’t have to hand over moderator or whatever.

M:    Thank you very much.