“Since the service began in November 2000, more than 10,000 telehealth consultations have been carried out for children living in 97 regional and remote areas in Queensland. This amount of activity makes it the largest telepaediatric service ever reported throughout the world,” Dr Smith said.
37 paediatric sub-specialties are offered through the service, including burns care, cardiology, dermatology, diabetes, ENT (ear, nose and throat), general paediatrics, neurology, orthopaedics, psychiatry and surgery.
The service makes use of technology like the Integrated Services Digital Network (ISDN) and Royal Children’s Hospital’s Wide Area Network (WAN) – which is where the centre is located – to carry out online consultations via videoconferences, emails and telephony. Alternatively, some consultations are done using custom-designed telemedicine systems on the university’s private network, which is able to reach transmission speeds up to 1MB/s. Basic ADSL connections to webcams also enable doctors to communicate with and support patients and their families, he said.
User satisfaction is generally very high, he added. The telepaediatric service greatly reduces travelling time and expenses for patients, many of whom may have otherwise travelled hundreds and thousands of kilometres to Brisbane to see a paediatric specialist. Telemedicine may also reduce costs for the state health department, which sets aside AUD$45 million (US$40 million) a year for patient travel subsidy schemes.
However, while such technology has its benefits, the limitations of telemedicine are also respected, said Dr Smith. “In cases where a specialist feels that they are unable to make a clinical decision based on the information available, the option to transfer the patient for a face-to-face appointment is always available,” he said.
“Occasionally, certain tests and procedures can only be performed in Brisbane. If this is the case, telemedicine consultations serve as valuable opportunities to educate patients and prepare them for the procedure/transfer to Brisbane,” Dr Smith added.
The majority of referrals, however, can be managed at a distance with the support of regional clinics at the referral sites, said Dr Smith. This likelihood has increased with the development of wireless (robot) systems which can be wheeled around and used in areas where clinical services are most likely to be needed, such as at patients’ bedsides or in the immediate ward areas.
However, Dr Smith stressed that telemedicine is not purely a technology-driven enterprise. “While technology is important in that you need to have the appropriate communication equipment and telecommunications available, significant effort needs to be invested in the development of support and administrative systems to support telemedicine operations. Essentially, introducing telemedicine requires change management strategies as the conventional method of delivering health services is being re-engineered,” he said.
His advice to clinicians contemplating telemedicine applications? “Take it one step at a time and avoid making expensive mistakes. Carefully design telemedicine services in response to clinical needs and make sure it is user-friendly and supported by the appropriate administrative and clinical support services.”