welcome everyone to this brief lecture that's just going to give you a little bit of an overview of telehealth a little bit of the background because this is the focus of our workshop this week so by the end of this lecture and also by the end of the workshop and tutorial and practice week hopefully you will understand and be able to give us a definition of deli health you'll understand the strengths and weaknesses of telehealth health as a mode of delivery you'll be able to highlight the key features that would enhance a telehealth con consultation so how what do we need to do to create a good environment for telehealth to be effective we need to understand the different types of technology that can be used in telehealth and all of those other relevant factors that will influence the selection of the platforms that you choose and the software and other aspects of it to apply telehealth in a in a clinical setting and in your physiotherapy practice we're also going to apply a general guide to planning and running a telehealth consultation you also will be able to recognize and evaluate appropriate and optimal practical requirements for telehealth consultations in various settings and for specific cases so firstly what is telehealth well the definition that's given out there at the moment is that telehealth is the practice of managing patients remotely using technology such as video conference digital photography instant messaging or other technology it's using technology that enables patients and clinicians to meet no matter where they are located now telehealth by definition is all-encompassing it's about the health information services it's about health care education as well as health care delivery so why telehealth well telehealth has been shown to be a safe efficient and low risk way for clinicians service providers so what's a service provider it's like queensland health the australian and federal government system health care system and state health care systems as well as private practices and private hospitals so health service providers are all of those service industries and consumers to continue important health services and particularly during this covert 19 pandemic now telehealth's been around for a long time much longer than covert 19 has been around and it's been around for a long time in australia particularly because we are such a big nation geographically with low populations that can be spread far and wide over millions of kilometers millions of areas square kilometers so the ability for individuals to access good and specialized healthcare is limited because of this distance so up until now telehealth's been limited in its uptake particularly in health services such as the state healthcare systems and things like that it's mostly been used in remote and isolated communities and groups to try and deliver some health care services to those groups but with this covert 19 pandemic and what we've seen this year in 2020 the federal government has responded to uh the lockdown states where they've uh there's been this strong emphasis on people not traveling and not coming face to face and that has quickly led to some changes in policies and changes in funding rules that has allowed help telehealth to to blossom and flourish far more quickly over the past six to seven eight months so risk it's included recent changes to medicare so medicare items describe what kind of consultations or services health services will be funded federally by the medicare system and there's been changes to these item numbers and descriptors to include telehealth in a far more diverse range of service options and that means that more and more people have been able to utilize medicare services or medicare funding to access healthcare through telehealth systems okay so it's meant that uh because it's all happened so quickly many of us patients as well as healthcare providers have had to suddenly and very quickly get to grips with what telehealth is and how best to deliver healthcare via technology included which includes phones phone video phone text or via the internet and this includes the griffith physiotherapy clinic so this this this module on telehealth is particularly important at the moment because if you are in queensland health or you're in griffith clinics or even the logan clinics then it is quite possible that you may be delivering some of your healthcare services via telehealth okay in the very near future but it besides that covert 19 pandemic there are many challenges that we face in australia as i've already mentioned in terms of the size the geographical size of our country and the thousands of kilometers the distance that patients often are from especially those specialist services so in addition to that within the public health care system we have limited resources and patients are are currently often having to wait months and sometimes even years to access services within that public health system now is it possible do you think that telehealth might be able to help solve this problem of geographical distance in terms of patients accessing services but also these excessive waiting lists that patients currently face in the healthcare system in the public system is it possible do you think that telehealth may have a role to play here we're going to explore that a little bit more in our workshop in addition to that aboriginal australian and torres strait islander peoples experience with healthcare health outcomes than non-indigenous communities okay within australia they also have more challenges accessing healthcare okay because it often means that they need to come out of their communities to come to regional centers or to metropolitan cities to access healthcare so again is that optimal that's what we need to ask ourselves is there a better way of delivering health care services to these aboriginal and torres strait islander peoples communities that is going to be more beneficial to them and less less of the negative impacts that they currently experience when they try to access healthcare can telehealth help us solve some of these problems so what services do you think might be appropriate to deliver via telehealth okay using technology well currently there are many services that are using telehealth to treat patients rurally and remotely away from those face-to-face sessions these include the specialist services allied health services mental health services by specialists i mean specialist medical services emergency services are being delivered by via telehealth maternity and pediatric services also currently exist and are being actively delivered via telehealth technology what are the modalities to delivery of telehealth what what do we need to think about if we want to try and manage patients using this remote technology so there's many options out there in terms of what you may be able to use for um for delivery of telehealth including the telephone simple telephone and currently and during covert you know yourselves that you were probably able to access a gp consultation via a telephone call video conferencing obviously gives you that live face-to-face communication that a phone call by itself won't give so it's an added bonus emails have been used for delivering telehealth the use of electronic databases and storage of data is something important to consider because we could deliver photos such as imaging x-rays mri scans things like that client medical records so there's electronic medical records system within queensland health um that uses technology and can be accessed remotely potentially um photos videos other things like that but when we're thinking about databases that store that patient data we also have to think about the security of that data so that we maintain patient confidentiality and that patients can trust their data in whatever form it comes is secure and safely stored wearable devices is another technology that can facilitate telehealth care of patients so think about all the wearable devices that are out there and emerging constantly that could be used to help us manage our patients remotely when we can't get our hands in face-to-face connections with them wearable devices are able to collect and send medical data okay remotely over distance websites and apps are another form of technology that can be used to deliver health care via this remote modality so via telehealth and there's other specialized platforms as well software platforms so we can use teams skype zoom to connect with patients um over distance but then there are other specialized software platforms such as kobe u health direct and fizzy track just to name a few that you might want to have a look at as well in terms of the other technology requirements these are other considerations you need to think about if we want to deliver telehealth there's a minimum internet connection speed that's probably required especially for video conferencing then there's other wireless connections that um have been recommended including that there needs to be either a minimum of 80 sl2 or 4g wireless connections other but the most desirable options to ensure that the connection and the interaction via video conferencing is effective satellite connections generally don't meet that minimum data transfer requirements so it's in order to get this data back and forth in in enough time and uh and satellite connections unfortunately aren't sufficient but as you know the nbn is rolling out across australia so so more and more places are able to access um other other forms of internet connectivity other than satellite connections in terms of hardware we take it for granted that we all have a computer with a webcam and audio connections but that's something that we need to ensure exists on the patient's end as well if we want to deliver these tele-health services um the cameras themselves may be with inbuilt into the computer they might be external um they may be wall mounted and permanently fixed in a room microphones and speakers are another important option they need to be effective they need to be loud enough that patients can understand hear and understand what's going on lcd screens um including a dual monitor arrangement is often good so that um patients sometimes and within a telehealth setting or or treatment session you actually may need to see the patient may need to see themselves as well as see the healthcare practitioner that's on the other end of the line and think about when that might be appropriate when do you think the patient might need to have a a video image of what they are doing um as well as be able to see the clinician that they're talking to on the other end of the line so then that if that's the case then the screen needs to be big enough that both images can be visible at the same time or you need two monitors of course you need a computer a a tablet an ipad a laptop some device that is obviously going to be used to set up and deliver this this telehealth session sometimes in healthcare services you'll find that they have independent work stations that are like on a trolley and and can be wheeled around from room to room and that means that you've got this ready set to go uh telehealth care system that can be used across multiple rooms um or or spaces including gym spaces exercise room spaces so you may find that it can be wheeled into a group session if it needs to be because it's not just about us as the clinicians it's about what's happening on the other end where our patients are mobile phones can be used of course they have video audio capability smartphones in particular so if computers aren't accessible then even a mobile phone device sometimes can be enough and then the other thing to think about is again going back going back to that audio setup uh sometimes there needs to be the additional hearing support particularly if you've got patients who are hearing impaired or um or they're elderly and then sometimes you can get hearing induction coils or headsets that just provide that added audio support in addition to those basic kind of technology requirements for telehealth there are also specialist devices so in there's the wearable apps that you might um you might use as well to collect data but there's also specialist mobile kits that have been developed that have a range of other peripherals that can attach to these kits can be sent out to remote communities or out to a patient and they can be then connected to the patient and allow real-time collection of data okay and some examples of that are endoscopes ultrasounds um intra-oral camera cameras um for medical or dental sessions or consultations there's examination glasses probes there's blood pressure pulse oximeter and digital stethoscopes and what these digital devices allow is that they interface with a data acquisition system which allows that data to be transmitted in real time to a clinician a specialist a doctor a physio whoever is doing the session on down who could be sitting somewhere remotely and they can see that patient's data coming in in real time and respond to it in real time so this you can imagine has um has opened up and broadened the possibilities for tally healthcare including in for example emergency situations where the patient is remote and can't we can't get emergency care to them immediately another thing we do need to think about is the patient's suitability not every patient is necessarily appropriate for tele health care the level of physical assist assessment that you need to do okay that will determine whether or not we can see a patient via telehealth so an initial assessment for physiotherapy where we really need to perhaps get our hands on our patients maybe that initial system assessment's not appropriate for telehealth the availability of support at the client side is another important factor so if we need our patients to perform some kind of high level either assessment technique or um or even in terms of a treatment if we're asking for example a patient who has is is at high risk of a fall and we're going to deliver an exercise class for falls risk management then it's important that there's probably somebody else at the other end of with the patient so at the other end of the line from the clinician who's with the patient or the patients so that they can support them and ensure that the patients are safe while this tully healthcare session is going on the availability and access to appropriate devices is important including these video conferencing units and systems and and data acquisitions and devices and things like that so what is available at the at the end with the patient and the client um to to ensure that it's going to be in a an appropriate and an effective session the ability of clients to participate okay they need to be able to physically mentally socially cognitively participate in a telehealth session okay which can be quite different to a face-to-face in terms of the demands on those those those capacities uh the distance between the provider and the client so is it necessary for it to be a telehealth or can the patient catch a bus for example to to the location where the cli the clinician is the dependency on the on that local availability of um of other things that need to go on so perhaps there's other adjunct adjunct imaging or lab tests and things like that are they available there or not if they are available and the local healthcare service can support the session then it may be more feasible if they're not available then those may be the times when the patient needs to be transferred into a regional or a metropolitan area for further further assessment and management does the client actually want to participate in a telehealth consultation not all patients do want to sometimes it can be a little bit daunting particularly if they are not um very tech savvy um so it needs to be in combination with the patient and also the ability to schedule it schedule a telehealth research session within the time frames that suit the service provider or the health care provider and as well as the the patient and and within a a standard program or practice guideline as well another thing we need to think about is cultural responsiveness so um we need to make sure you know that regardless of the mode of delivery of healthcare patients um from uh come from diverse backgrounds uh and and and we as clinicians need to be culturally responsive to that okay we need to be confident that we can deliver healthcare services in a culturally responsive manner okay and often local areas health areas have developed policies around this to support this culturally responsive practice okay and so when designing or implementing telehealth is something we all need to think about okay because a patient's cultural background can very much affect the way they want to communicate the way they feel comfortable communicating and the way they make decisions and manage their own personal health can be driven by these cultural considerations so we need to understand how culture impacts people's understanding on their own understanding of health well-being disease and illness okay and in regards to these telehealth modalities and it's important that we have an awareness that not all capabilities of technology will be culturally appropriate okay and we may need to individualize this to the patient okay so when we're considering a telehealth modality and and considering whether or not we think it's culturally appropriate we might want to speak to some cultural advices so people who are experts in this area and say this is what i'm thinking of doing is this appropriate there are liaison offices in healthcare industries and within public healthcare systems that can help us to understand if we need to make specific adjustments at the end of the day we need to ask the patient are they comfortable with this are they comfortable with receiving their health care in this way and the patient themselves may identify some modifications that need to happen okay that would make it more culturally appropriate for example they may not want their faces photographed okay if you need to take images and capture images they may say just don't take a photo of my face okay it might be something as simple as that so this is certainly an area we need to think about another thing we need to think about with telehealth is sustainability certainly accessing health care for our people for our for our communities who live in those rural and remote areas okay it's really important that telehealth just develops um because it's it it feels a big gap in those communities small populations where there's less than 6 000 people it's very difficult for those people to access specialist services okay another thing that telehealth can do is target specific areas of clinical practice so you may see that there's a need in a small community like this where um where there is a a large percentage of the community our elderly and that there may be and we know that there is a link to age and this increased risk of falls and and bull related to poor balance so an evidence-based approach to managing those patients may be um group classes group engineer exercise classes so so it's a way of of targeting and being very effective in in a sustainable cost efficient way by running a group exercise class to a community like that because the financial costs of falls in the community is huge when um when they break a hip they develop a fractured enough they end up having to leave their home and go into aged care and they sometimes have to leave their community because there is no aged care facilities or support network there and the flow on a negative effects of a fall can be catastrophic socially emotionally for that patient um and and and is linked to high death rates a higher mortality rate so really really cost-effective way of managing these patients and keeping them in their home maybe to deliver a service via telehealth education around patient education can be delivered via telehealth the the things we've started work looking at in 3 400 and around communication and pain education may be delivered by a telehealth one thing we need to do is probably look at the evidence of effectiveness for delivery of health care services via technology okay how effective is it what is the evidence out there that it is effective and safe another possibility is to use allied health assistance at remote sites to to help with patients so where we need somebody there to provide some assistance some physical real-time hands-on assistance and maybe that can be done using allied health assistance rather than having to fly for example a physiotherapist out to a remote community which is very expensive the other possibility with telehealth is that we can do multiple sites at one time so you may run that falls and balance class across several communities all at one time and they all link in together and it creates a little bit more of a broader community where you've got some patients in each location all working together a very highly efficient use of that physiotherapist time wouldn't you say and also it allows us to use office space instead of formal therapy space so sometimes therapeutic space is is used to its maximum capacity well this allows us to deliver more exercise more health care services from the from from an office okay which can be another very effective cost-effective use of space so one of the things that we look at is the financial impact of ali health it costs to set up there are some costs certainly associated with the setup in terms of delivering technology purchase of platforms that you might want to use but what are the savings the financial savings in delivering health care in this way so we've got a workshop this week um that we're going to look in a little bit more depth at telehealth we're going to explore the enablers and the barriers to telehealth healthcare look at some of the physical and and the logistical aspects of setting up and running for example a group class we're going to delve a little bit more into the telehealth skills so communication etiquette using telehealth also going to look at the technology and how we can use technology to maximize the effectiveness of our telehealth sessions we're going to explore the evidence base review the evidence base for telehealth and also look at some individual case studies and and some of the things we may need to consider and individualize for those particular case studies so that's a quick overview of telehealth that's setting the scene and i look forward to seeing you at the workshop