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NORMAN SWAN: Telehealth isn't new to Australia.
We have a long history of using whatever technology works
to help deliver health services to rural and remote areas.
Nowadays, the growing use of videoconferencing
is enabling patients to access specialist consultations
without the delay, disruption and expense caused by the need to travel.
For those living in regional, rural and remote Australia,
these video consultations are now covered by Medicare,
and so are widely available to more people.
In this documentary,
you'll hear from specialists and primary health care teams
how telehealth is helping them to deliver the care their patients need
when it's needed,
and how it's strengthening their teamwork and care coordination.
You'll also hear from the patients themselves
about the positive impact telehealth is having on them,
their families and their communities.
The Diabetes Centre at the Cairns Base Hospital
runs telehealth consultations across Far North Queensland,
Cape York and the Torres Strait.
They've successfully developed a multidisciplinary team approach
and they also use the videoconferencing technology
for regular team discussions and training.
My name is Ashim Sinha.
I'm the Director of Diabetes and Endocrinology
at the Cairns Base Hospital,
and I've been in this position since 2005.
Since about 1999, we have been doing very intensive outreach work
in Far North Queensland, which includes the Cape District,
the Torres Health District Service
and of course the outreach communities
within the Cairns Health Service District,
which includes Hopevale, Wujal, Atherton.
When we started initially, of course,
we didn't have the MBS item numbers.
We applied for a project grant
and that project grant essentially gave us a person now
to coordinate the entire telehealth program.
WOMAN: My name's Debi Dean.
I'm the Telehealth Coordinator here at the Cairns Diabetes Centre.
At the diabetes centre here,
we already offer a multidisciplinary team approach
and we offer services via email and telephone
as well as coming here to the centre,
so telehealth just provides such a wonderful opportunity
to engage with patients on a completely different level.
We provide clinical consultations one-on-one,
which means that the team are down here in the diabetes centre
and the patient and their family and their carers
and whoever else they wish to be there
is up at Aurukun or the Cape or TI or wherever.
ASHIM SINHA: From a primary care perspective,
and as how chronic disease should be managedmore in primary care,
the specialist only plays a secondary role -
an important role, but a secondary role,
and so unless the team care approach is there,
we are never, never going to succeed.
Insulin, medications...
The good thing about telehealth consultations
is the fact that we can bring in the whole team
as and when they're needed.
We encourage the patients to sit there
with their family and their carers
and also the team that are looking after them up there,
because they're the people that normally end up
delivering the care that's been discussed during the consultation.
ASHIM SINHA: At this centre,
we have two Aboriginal and Torres Strait Islander health workers.
Virginia Coutts belongs to an Aboriginal community,
and Gina Tabuai is from the Torres Strait,
so we've got both communities.
VIRGINIA: My role is to be present with the telehealth consultations
with the GP, our specialist,
as well as our clinical nurse, telehealth nurse,
and my role is to play an important part as well for the family member
on the other side of the videoconference
so they're feeling a bit more comfortable
and are able to get the right information from the specialist
while they're in their home communities.
The only other alternative prior to these
was for these patients to come and see us,
and that would involve a lot of inconvenience to the patient.
The Torres bridge also has enabled us to link in with any other doctor
that wants to link from the outer islands.
For example, we have Dr Samuel Jones now in Badu
who links up from Badu
or the doctors from Bamaga or Yorke Island.
MAN: Afternoon, Ashim.
As you know from the referral,
I've referred through this 56-year-old lady Timena Reuben
for some advice, really, regarding her diabetes control
and perhaps the next medication we could consider.
My name's Dr Sam Jones
and I'm a GP and Senior Medical Officer
here on Badu Island.
The telehealth service has really been a great initiative
over the last... particularly over the last year.
Here on Badu, I'd say that now everybody has access
to specialist care through telehealth,
whereas before, particularly for the elderly or infirm,
for whom travelling down to Cairns was quite arduous,
telehealth has really made all these services much more widely available
to everybody in the community.
From my perspective,
I see that telehealth is really going to improve
the coordination of care,
to bring about, hopefully, a really true shared care
that puts the patient at the centre of the service provision.
We deliver professional development also via link,
which means that we have, to date, had as many as 17 different sites
linking in at the same time and over 84 participants.
This was for professional development,
and these were nurses, and health workers and doctors
all at the same time.
DR JONES: The training aspect of it is really important.
It connects us, it keeps us up to date.
And also I think it helps to connect people from the urban centres
with here on Badu.
DEBI DEAN: I think the best thing about telehealth
is the way that you can engage the patient so fully.
They can have their whole family there.
We can link in professionals and other specialists as needed.
And it just becomes a very embracing, very engaging process.
DR JONES: In a community-wide context,
it's very important that people understand
that this technology is available.
It's nothing to fear.
I think it's very important to have an Indigenous health worker
here at this end with the patients.
I think that's very, very important.
We are now maximising our billing process
using all the Medicare item numbers
that have been given for this.
So, it is generating good income for the centre.
I think it's a really exciting advance
in remote and rural health.
It's a very effective way of communication
as long as all the parties feel comfortable to do it.
NORMAN SWAN:The NSW South Coast Medicare Local
has taken telehealth to heart,
employing a project coordinator
to support and help those GP practices wishing to get started.
They work with local general practice leaders to help spread the word.
My name's David Jeffrey,
and my role is Senior Planning Officer Telehealth
for Southern NSW Medicare Local.
The Commonwealth Department of Health and Ageing
recognised that access for rural and remote communities to specialists
was increasingly difficult.
And so they've developed a telehealth initiative in July 2011.
So, my role at times is working with the general practices
that actually have started telehealth.
It's about looking at what software they've got on their computer,
whether it's a Windows-based computer
or an Apple computer,
and then installing the appropriate product.
My role covers the entire region
within Southern NSW Medicare Local
from Goulburn up in the northern-western corner
down to communities such as Eden
right down the far South Coast.
I've recently held a very successful telehealth event
in Canberra with specialists,
and Dr Jenny Wray, an early adopter of telehealth.
And she certainly is a pioneer in terms of our region as well.
WOMAN: I'm Jenny Wray, GP, Narooma and Bermagui.
I've been in Narooma for 35 years, nearly 36.
We opened a practice at Bermagui just before Christmas last year
because Bermagui was actually very light on medical services.
And it's been really quite a wonderful thing to have done.
And although it's not a remote town,
a lot of the people who live here are really quite poor,
so that for them to actually be able to access
any other services
is actually very difficult.
So, when Dr Mark de Souza
approached us through just a group email,
or fax - I can't remember now -
it was just a comment to say,
'I just want to let you know
that I'm actually available for telehealth consults.'
My name is Mark de Souza.
I'm a general paediatrician.
I am based in Nowra,
in the Shoalhaven district.
I do clinics as well
in Ulladulla, Batemans Bay,
Bega and Pambula.
So, in that role, I provide a service that extends
from Nowra down to the Victorian border.
Telehealth makes absolutely total sense for my practice
for those distant patients.
So, in terms of these consultations with the MBS items,
I've been doing them since the start of this year.
And because I am able to do it from my desktop,
from my desk,
it really fits in just like a normal consultation.
And with exactly the same quality of service
for the simple questions.
WOMAN: I'm Francis Tot and I'm from Bermagui.
This is my daughter Sarah.
With Sarah and my younger daughter,
they need to see the paediatrician.
And so, when we were visiting Jenny Wray
to discuss their health issues,
she suggested the teleconference
so that we didn't have to make the trips to the paediatrician.
To pull them out of school and go to Bega,
that's a full day wasted.
So, she suggested, let's do this teleconference here at Bermagui
where we can link up and talk to the doctor direct,
and anything that we don't understand in medical terms,
Jenny's with us in the room,
and we can also ask Mark questions.
The impact of telehealth consults on the health of our patients
has been enormous.
It has meant that they get much less fatigued.
But in addition,
I think that they've actually quite enjoyed
the three-way consultation,
having the GP there as their advocate
and talking to the specialist at the same time.
So, it's improved, not only access to patients,
shorter waiting time,
but it's also improved day-to-day communication.
Telehealth is actually becoming part of our normal clinical practice
and I think that we're limited only at the moment
by the numbers of specialists we can access.
So the more specialists we can access,
the more of this we're actually doing.
There are government incentives through the MBS,
which I think certainly make it worthwhile to give it a go.
I think it's just wonderful for the patients
because they can access services
which previously they've not been able to.
In my practice, I think that it has been a major enhancement,
and if you have not been using it as a doctor or as a patient,
I would only encourage you to think about how it might help you,
and I think you'll be surprised at how useful it is.
NORMAN SWAN:Pinnaroo is a farming community in South Australia
230km from Adelaide.
Telehealth is helping the local nurse-run hospital
access immediate support for acute and emergency cases
and helping many patients in the surrounding rural communities
stay in their own home and carry on working
whilst getting the quality and timely care they need.
WOMAN: My name's Di Thornton,
I have been working at Pinnaroo Hospital for the last 14 years.
It's a acute hospital with eight acute beds
and it's got 23 aged-care beds,
and we run a 24-hour accident and emergency as well.
We are 230 kays from Adelaide,
and our nearest referral centre is 180km away at Murray Bridge.
Farmers have mental health issues and depression and anxiety
just like you and I do and other people in the community.
So they need access.
The last thing a farmer can do at this point in time
is take a day off
to get in his car and drive to Adelaide,
wait for the specialist first up,
have the appointment, then drive home.
Whereas if all they've got to do is come ten minutes up the road,
or five minutes from their house to here,
and walk straight out of their car
ten metres into the videoconference room,
it's sweet.
MAN: eHealth, in my opinion,
and certainly videoconferencing
has an enormous capacity to
enable small communities to remain viable
from a health-care perspective.
A lot of rural and remote people
are very passionate about what they do
in their rural and remote communities,
but also deserve access and equity to higher-level care,
which shouldn't be dependent on the postcode or where they live.
Living out on a rural area,
I've felt that it's been extremely difficult.
We...
I've spent days and days early on
on the phone to, basically, all the neighbouring towns
and the larger towns heading out,
to clinics saying, 'I have a sick partner
and I need to get him somewhere - what do I do?'
We rang up looking for specialists
and they said, 'Oh, look, you've got a three- to six-month wait
or a 12-month wait,'
and we thought, 'Well, that's not really much good.'
And that was when Ken originally first said,
'Do you mind doing a teleconference?'
And when you look at a 12-month waiting list
and you're at rock bottom,
you can't really wait that long.
So, we did the conference, and, look,
I've only gone a lot further ahead since then.
We came into our local hospital here and used the telelink
and he just sat there for well over an hour, and...
..he went in broken and came out with hope.
The biggest difficulties that mental health clients face
is being taken out of their own environment.
One of the things that is very dear to them is staying close to home
and around things and people that are familiar.
MARK: Four young kids.
The last thing they'd want to see is, you know, their dad in hospital.
Especially for a long period of time.
So, yeah, to them, I could come here,
which is only 20 minutes away from where we live.
They get to see me at night still,
so, you know, you look...
You can come in for a consult, go home
and it's like, to them,
there's no disturbance whatsoever to their lives,
which can be a big thing, really.
KEN: I think most specialists just want to be able to provide
high-quality, evidence-based services
to people no matter where they live.
And to do that effectively in rural and remote communities,
we've now got telehealth
and item numbers to support practice.
MAN: I'm Brian McKenny.
I'm the Acting Clinical Director of Rural and Remote Mental Health
in Adelaide.
The numbers of patients, particularly psychiatry patients,
who you might think would react quite poorly to this,
either by being paranoid or overly anxious,
or generally uncooperative,
is remarkably few.
And I've been doing this for over ten years
and many hundreds of consultations.
Telemed conferencing is a very useful way
of getting in touch with a psychiatrist
without having to travel by air or car
down to Adelaide.
I've been seeing Michael for about five years
as his psychiatrist.
He has previously had admissions to hospital.
In recent years, we've been able to avoid him coming to hospital
through intervening fairly regularly with telehealth consultations.
Those long trips to Adelaide can be a nightmare,
whereas if I have a...
..I know that in an hour's time
may see my psychiatrist at telemed,
I can talk to him or her
and get reassurance and some skills
to deal with that particular problem.
Mental health clients
who are really ill with depression or anxiety
struggle with going out.
So, if all they have to do
is just go into a private room that's close to their home
and they know that they've got
the sanctuary of their home to go back to as soon as this is over,
it's much easier to get mental health clients to comply.
I think the biggest surprise for me
would have to have been the take-up of the clients.
All the feedback that I'm getting from people
after they've used it first time
is 'This is so easy. Why weren't we doing it before?'
Seeing someone face to face is good,
but you don't really notice much difference, in a way.
I mean, Ken's here on a big screen on telly
and you can hear everything
and I had no challenges or no regrets.
And, yeah, I'd recommend it to anyone.
So, from the word go, it was a very positive experience for us.
It was sort of what we needed in the nick of time.
It gives us access
and it saves the community the travelling that they need to do.
It's a safe way of doing things.
From every point of view,
the telemed is certainly the way to go.
Yeah. Can't really speak highly enough of it.
NORMAN SWAN: Mount Isa, in North West Queensland
is one of the regions connected to Townsville via telehealth.
Without these links,
patients have to travel, sometimes for days,
to see the specialist.
So I'm Dr Sabe Sabesan.
I'm a medical oncologist
and the Director of Medical Oncology
at the Townsville Cancer Centre of the Townsville Hospital,
and also Clinical Dean of the Townsville Clinical School
of the James Cook University School of Medicine.
And I look after all the rural and remote patients
in our Townsville and Mount Isa Health Service Districts
along with my three other medical oncology colleagues
in this centre.
In our teleoncology network
we have telemedicine facilities in all the small towns.
So, if it is about consultations,
they don't need to leave their home towns.
That includes Mornington Island and all the remote Indigenous towns.
But if they need chemotherapy,
obviously, they have to travel to Townsville or Mount Isa.
But if it is oral chemotherapy,
a lot of the time
they don't even need to travel to Mount Isa or Townsville
because we see them and then we send them the scripts.
And then we follow them up and all managed on video link.
So, Sabe, we're going to treat Steve as an out-patient.
- Are you happy with that? - Yeah, I'm happy with that.
WOMAN: My name's Sonia Bisson.
I'm the Cancer Care Coordinator / Clinical Nurse Consultant for Oncology
at Mount Isa Base Hospital and District.
Telehealth has been very significant
in increasing our services in remote areas
because we can have a consult with the doctor
and other treating specialists on screen
and they can advise us what to do
if there's any changes in treatment, any new treatments,
right there just like they're in the room.
And we can then go and deliver that care
after the videoconference.
MAN: My wife, Helen. I'm Steve.
We've been in Mount Isa 20 years next year.
And recently I've been diagnosed with cancer.
I've got SCC, squamous cell carcinoma,
which gets into your lymph glands.
So, basically, it's an untreated skin cancer
that's got into my system
and now it's very difficult to treat.
So we travelled a couple of times to Townsville
with the initial consultation
and then the treatment plan.
With the video links now we're going through the process
of determining what the next course of medication is.
I don't need to travel.
So we don't need all that accommodation and the travels
and hire cars and whatever else is required
when you're living away from home.
MAN: Because Mount Isa is 900-odd kilometres away from Townsville,
it's often very difficult for the patients
to actually make the trip for face-to-face consultations.
And so telemedicine or telehealth
has had a great uptake,
and it's a really valuable service,
I think, that the team in Townsville provide the residents here
in Mount Isa and surrounding areas.
Once patients have their first session,
they're usually very relaxed and easygoing about the whole procedure.
WOMAN: Then you just start talking. It's so natural.
It's really easygoing
and then when it's all finished
you've got dates set for whatever's gonna happen next.
SABE SABESAN: It's the same as face to face.
The only different thing is there's a screen involved.
So, in the providing end - that is, in my end -
it could be me, it could be my registrars.
And at the remote end, we'll have the patient, the family members,
and sometimes extended family members -
up to 10, 12,
especially from Indigenous communities.
MAN: I've been caring for my mother,
who's been diagnosed with cancer.
I've been caring for her for the last six years.
A big benefit of the telehealth
has been really decreasing the stress
that comes with caring for a family member,
in terms of living in a rural town, for one,
and having to go back and forth to a regional hospital
for therapy.
So it's very, very beneficial to reassure the patient
that they can probably stay here for their treatment,
have their consult over video,
reassure them that their family members
can attend the videoconference with them,
they can attend the treatment sessions with them,
they don't have to be taken away from family and loved ones.
SHAUN: We'll have conversations about local arrangements
and the local team supporting access to medication
or other palliative care arrangements that are out there,
like home care.
It's an important learning experience, I think,
from our perspective
to hear what our specialist colleagues have to say
about the diseases that the patients are presenting with.
But we're here to really support the patient through the process.
They're happy to have other family members there
during the telelink.
It doesn't just have to be Steve by himself.
I'm always welcome to be there,
and if my daughter wanted to come along,
she'd be welcome to come along as well.
If you've got family spread out
across the State or the country or in different towns,
it's a way to bring everybody together
and to support the carer role
that you might take up as a family member.
And it really offers huge benefits to Aboriginal families, I think,
and it supports the way that we do things
in that it does support family decision-making.
I have no reservations using the telelink system
because the information is right there, face-to-face.
It's not like you're on a telephone.
You can see him thinking and talking
and it's a good way to go, I think.
It's the way of the future
and it's the way we should be doing it for the remote areas.
Yeah, I would really encourage other clinicians to give it a try.
Use it. (Laughs)
ASHIM SINHA: Telehealth is going to become the way
medicine is going to be practised in the near future.
DEBI DEAN: Saves a lot of time, a lot of effort,
a lot of inconvenience and a lot of heartache.
Captions by Captioning & Subtitling International
Funded by the Australian Government Department of Families, Housing,
Community Services and Indigenous Affairs�