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Telehealth in Practice the Agency for Clinical Innovation (ACI) Is the Lead Agency for Innovation in Clinical Care

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Telehealth in Practice the Agency for Clinical Innovation (ACI) Is the Lead Agency for Innovation in Clinical Care GUIDE Telehealth Network Telehealth in practice The Agency for Clinical Innovation (ACI) is the lead agency for innovation in clinical care. We bring consumers, clinicians and healthcare managers together to support the design, assessment and implementation of clinical innovations across the NSW public health system to change the way that care is delivered. The ACI’s clinical networks, institutes and taskforces are chaired by senior clinicians and consumers who have a keen interest and track record in innovative clinical care. The ACI strives for innovations that are person-centred, clinically-led, evidence-based and value-driven. The ACI also works closely with the Ministry of Health and the four other pillars of NSW Health to pilot, scale and spread solutions to healthcare system-wide challenges. We seek to improve the care and outcomes for patients by re-designing and transforming the NSW public health system. www.aci.health.nsw.gov.au Agency for Clinical Innovation 67 Albert Avenue Chatswood NSW 2067 PO Box 699 Chatswood NSW 2057 T +61 2 9464 4666 | F +61 2 9464 4728 E [email protected] | aci.health.nsw.gov.au ISBN: 978-1-76081-282-9 (print) ; 978-1-76081-283-6 (online); (ACI) 190551. Produced by: Telehealth Network Further copies of this publication can be obtained from the Agency for Clinical Innovation website at aci.health.nsw.gov.au Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written permission from the Agency for Clinical Innovation. Version: V1; ACI_0261 [09/19] Date amended: August 2019 Trim: ACI/D19/3320 Cover image: Three Rivers University of Rural Health (Peter Strickland, Western NSW LHD) © Agency for Clinical Innovation 2019 Contents Introduction 4 Purpose 4 Telehealth in NSW 5 Roles and responsibilities in NSW 5 Key roles to support the use of telehealth 6 Benefits 7 Enablers and barriers 8 Telehealth modalities 11 Where to start 13 Clinical function 13 Workflow 16 Participants 16 Activity 16 Features 17 Spaces 17 Communications infrastructure 18 Service considerations 22 Evaluation of telehealth services 28 Financial considerations 29 Activity reporting: Counting and costing of telehealth services 29 Cost savings 29 Workforce 30 Resources 31 Key documents 31 Development of apps 31 ACI Innovation Exchange 31 Telehealth videos 32 Patient resources 32 2018 Innovation series for the development of apps 32 Frequently asked questions 33 When can telehealth be used? 33 Consent 33 Recording 33 Credentialing 34 Providing advice to and from jurisdictions other than NSW 34 Service provision and access 36 Patient information 37 Medical documentation 37 Technology devices 37 Funding of clinical services 37 Acknowledgements 38 Glossary 39 Appendix: Telehealth readiness assessment 42 ACI Telehealth Network – Telehealth in practice Page 3 Introduction Telehealth is the delivery of healthcare at a distance Purpose using information communications technology (ICT). The purpose of this document is to provide information to Telehealth is simply the modality used to connect initiate an interest in telehealth, and to support clinicians to and provide care – it connects clinicians or any other have a deeper acceptance and understanding of the value person(s) responsible for providing care to patient/s and and impact of telehealth in their practice. carer/s. It can be used for the purposes of assessment, intervention, consultation, education This guide provides the foundations to build a dynamic and/or supervision. and adaptive workforce that can confidently integrate technology to assist all facets of service delivery. In NSW, providing healthcare is challenging, particularly given the large geographical distances and limited It should be used in conjunction with national, state or resources. The NSW Government is committed to locally developed clinical standards, protocols, policies ensuring people living in NSW have equal access to quality and procedures for the provision of care. care close to home. Integrating telehealth into clinical practice will minimise barriers to access and inequity. Key messages The use of telehealth has long been associated with rural and regional services. Whilst the distance may • Where clinically appropriate, telehealth is not be large, it is equally important for metropolitan a safe, effective and a valuable modality to services to understand that telehealth provides support patient- and family-centred care. the same benefits to their patients and workforce, • Clinicians need to be creative, responsive alongside its significant role in supporting and and flexible to integrate telehealth into providing tertiary care to rural and regional patients. their clinical practice. Advancements in ICT have revolutionised the way we • All models of care should consider how work and deliver services, and telehealth will continue to telehealth can be used to enhance access evolve with these advancements. For example, telehealth without compromising the quality and now includes enhanced capability videoconferencing standards of care provided. platforms, remote monitoring of patients through • Telehealth provides the opportunity for wearable technologies, special patient monitoring clinical teams to truly integrate health and devices and the increasing use of clinical apps. social care sectors to enhance the patient Embedding sustainable telehealth services into the journey and outcomes. NSW Health system offers multiple opportunities for • Telehealth can provide an equitable service patients, their carers, healthcare workers and the delivery mechanism for people in NSW to system as a whole. All services and models of care access quality healthcare. This includes but are encouraged to consider the use of telehealth as a is not limited to Aboriginal populations, part of normal practice. This will increase the choices people from culturally and linguistically available to clinicians and patients, so there are a variety diverse (CALD) backgrounds and people of options to provide and access care. with disadvantage or disability. All levels of the NSW Health system are responsible for • Telehealth provides more opportunities to supporting the appropriate use, growth and developing support flexible workplaces and ensures evidence of telehealth applications. From overarching health providers are well connected and strategies through to the service plans at every LHD supported in their roles. and SHN, we all need to encourage and support the • Telehealth technology alone will not bring workforce to challenge their practice, be creative, about the change in practice. A key factor flexible and unafraid to explore the possibilities. This to success will be embedding behavioural cultural shift will ensure that the use of telehealth in change in the use of the technology. clinical service delivery becomes normal practice. ACI Telehealth Network – Telehealth in practice Page 4 Telehealth in NSW Telehealth is the delivery of healthcare at a distance Roles and responsibilities in NSW using information communications technology (ICT). There are multiple organisations that play a significant Telehealth is simply the modality used to connect role and have key responsibilities for contributing to, and provide care – it connects clinicians or any managing, delivering and supporting telehealth services other person(s) responsible for providing care to a in NSW. patient and carer/s. It can be used for the purposes of assessment, intervention, consultation, education and/ In NSW, representatives of these organisations or supervision. contribute to the ACI Telehealth Strategic Advisory Group (TSAG). This collaboration is a key element of Telehealth offers benefits for patients, their carers, success in achieving the state vision for telehealth. healthcare workers and the health system as a whole through improved access, availability, and efficiency The TSAG held its inaugural meeting in December 2016, of quality healthcare. Patient-centred, clinician-led following the release of the NSW Telehealth Framework telehealth provides an efficient and effective model and Implementation Strategy (the Implementation of care that complements and supplements face-to- Strategy). The ACI was tasked with chairing this face consultation. governance group. The implementation of telehealth in the health sector The advisory group is responsible to identify and address has significant potential to address and support clinical existing barriers within NSW that impact the use and and workforce needs. uptake of telehealth. Further information about the TSAG and its support of The following telehealth modalities are telehealth can be obtained from the ACI website and addressed in this guide: NSW Telehealth Sharepoint. • telephone The ACI plays a significant role in leading innovative • video conferencing clinical uses of technology in partnership with eHealth NSW, LHDs and SHNs. This includes sharing telehealth • store and forward use cases and models of care across the health sector • remote monitoring devices network to inspire and support system-wide integration • websites and applications (apps). and implementation of telehealth. Figure 1 (next page) is an overview of the key organisation stakeholders for telehealth in NSW. Telehealth
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