New Zealand Telepaediatric Service Update

New Zealand TelePaediatric Service Update March 2005 Simon Hayden – National Manager Dr Michael Sullivan - Chairman

A great start to 2005 with the excellent level of use continuing and a number of key projects and upgrades taking place.

Introduction Since the last update in 2004 business has been moving at a very fast pace. 2005 was always going to be a pivotal year for TelePaeds and it is not disappointing us. The update will cover a number of important issues.

1. Upgrade of existing infrastructure. This has been on the agenda for some time and I have been investigating the technology and funding options to facilitate this. 2. Financial sustainability. The Executive Team of Mike Sullivan, Pat Wright and I have focussed a great deal of attention on these questions as our initial sources of funds have been depleted and a long term sustainable model has to be developed. 3. Adding new members to the network. There are a number of issues to be addressed in this area. 1) The upgrade of the infrastructure. 2) Finalising the new financial model and 3) providing a standard user contract for all. 4. Additional sources of income. Following the discussions at the AGM we have been seeking to support some additional but compatible networks to help keep the costs down for members. 5. Expanding the content options for the network. Eg. Nurse study days, allied health use, clinical use and educational options. 6. TelePaeds involvement in the Ministerial Committee looking into TeleMed option for New Zealand.

The workload involved in the above has stretched us to the limit but we also excited by the prospects for the network and for the wider TeleMed possibilities.

New funding from Starship Foundation for network upgrade. The Starship Foundation has agreed to donate the funds to allow TelePaeds to upgrade the media control unit (MCU). This is the smarts behind a video conferencing network; it enables the connectivity and support of end-points. The main issue with users around the country has been the quality of service that we have been able to provide especially during multi-point sessions. This coupled with the limitation of the existing infrastructure to only allow eight end-points into a multi-point session has meant we have not been able to actively sign up new users. The new infrastructure will allow virtually unlimited numbers of multi-point calls, connection to ISDN networks, the ability for persons to participate in VC meetings via telephone and a magnitude of other advanced options. The upgrade is part of the new operating model for the network allowing us to include a number of new members. All users will be part of a standardised service. To ensure that this runs smoothly and that all users are aware of the options we are developing a services agreement.

Preferred supplier and platform. In late 2004 TelePaeds put out an RFP to three major video conferencing suppliers to enable the standardisation and future proofing of the TelePaeds infrastructure and end-points. This agreement allows for TelePaeds to purchase VC equipment, on behalf of all members, at a significantly reduced cost.

Managed service agreements The first eight DHBs to connect to TelePaeds purchased their own VC units with the help of philanthropic trusts such as the Lion Foundation.

Through Telecom and Starship Foundation sponsorship, we have been able to supply connectivity and support services free of charge. Telecom to date has sponsored TelePaeds to the value of $225,000 and the Starship Foundation in excess of $400,000 over the 5 year period. As the Telecom sponsorship is about to come to an end and the initial operating funding from the Starship Foundation has all but been exhausted, we are in the process of moving to a more financially sustainable business model. While it was an advantage for a start up organisation to be able to offer these very favourable options it was never envisaged that this would continue beyond an initial period of 12 months. Careful management over this time has enabled us to stretch it out for a much longer period.

We are in the process of negotiating with Telecom a very favourable bulk rate for the members, the cost will be a monthly set fee that will allow unlimited access to all other connected sites within the network and any other IP based networks. This will be enshrined in the service agreement. The service agreement will provide one point of contact for helpdesk, faults, reporting and connectivity issues. The cost will be approximately $750/month including the Telecom network connection regardless of how much or how little the network is used. So it is in everyone’s interest to use it as much as possible.

Roll out of upgrade. We are finalising the purchase of the MCU at present and intend to have it purchased in mid-April. Service agreements are also being finalised and will go to existing users at around the same time. All other Paediatric centres will receive supply proposals and the associated agreements by late April. I will be available to visit and discuss the purchase and implementation of VC services in May if required.

Network growth and sustainability To ensure TelePaeds can continue to grow and survive we have accepted requests to assist with the creation and management of VC network solutions for DHBs and other specialties. As was decided at the TelePaediatric Service AGM last year, to manage the technology effectively and to ensure TelePaeds can concentrate on it’s core focus of supplying Paediatric content and services, the technology component of the network is to be separated. Allowing different users to make use of the platform will help keep management and infrastructure costs to a level that is not possible with a single user group. These will be run on a separate virtual private network and will have not connection with TelePaeds unless specifically requested.

Barriers to connection Once the new infrastructure is in place, issues regarding connection are greatly reduced. Network users will have access to the latest VC technology and connectivity which can be manipulated according to requirements. Cost is always a factor within the health sector, the more users the network has the cheaper usage becomes. The agreements we have with suppliers allow us to greatly discount the cost of purchasing a VC unit. Bandwidth, which is the major cost of IP based networks, reduces in cost when more is purchased. The cost savings for having VC connectivity can be measured in time and dollars.

Ministry of Health Both Michael Sullivan and I are on the MOH Telehealth workgroup. Mike has been asked to steer the usage sub-committee and I, the network sub- committee. This group as a whole has a number of key tasks;  Review recent documentation available pertaining to Telehealth in New Zealand – including the report commissioned by the Ministry of Health in December 2004  Discuss, analyse and document the pathway forward for Telehealth in New Zealand including the development of options for models of service delivery  Develop a governance model for Telehealth in New Zealand  Provide options for telecommunications solutions that best meet whole of sector requirements, with considerations to cost versus benefit and the future feasibility of any technological solutions. An outcome from initial meetings is the inclusion of telehealth services within the health intranet infrastructure. This would reduce the cost of connection to the service.

TelePaeds Usage Network usage on the existing TelePaeds network is running at close to the current infrastructure’s capabilities. We are getting more and more requests for connection to external networks and un-connected hospitals. Murray Silverstone was appointed in May 2004, since this time monthly usage has consistently been averaging around 100 hours/month. With the addition of better connectivity infrastructure and more sites the forecast is for this usage to rise by 40-50% by year end. 160 Total Network Hours 150

140 139.11 135.19 130 129.24 120 110 107.01 100 95.17 90 85.35 86.40 80 78.12 70 60 57.28 50 48.56 40 33.16 30 30.39 24.5 20 10 0 Feb- Mar- Apr- May- Jun- Jul-04 Aug- Sep- Oct- Nov- Dec- Jan- Feb- 04 04 04 04 04 04 04 04 04 04 05 05

Conclusion TelePaeds is at a crucial stage of its development process. 2005 marks the year that we move from a start up organisation to a long term sustainable business model. This will take a great deal of effort and hard work but we are all very optimistic about the possibilities. We are aware of the challenges, financially, technologically and politically but with the ongoing support of the paediatric community we will be successfully in establishing the first viable Telehealth network in New Zealand. It is only as a team that we will make this happen. Speaking on behalf of Mike Sullivan, Pat Wright, Murray Silverstone and myself, thank you all for supporting us through the trial and error period and being a part of the ultimate success.

Regards Simon Hayden National Manager