Home Tele-Monitoring · WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017 INTRODUCTION...
Transcript of Home Tele-Monitoring · WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017 INTRODUCTION...
Home Tele-Monitoring:
Experiences in NSW Western Local Health
District and Bila Muuji Aboriginal Health
Services
Report Version 3
November 2017
A digitally enabled & integrated health system delivering patient-centred health experiences & quality health outcomes (NSW eHealth Strategy 2016-2026)
2 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
We recognise Aboriginal & Torres Strait Islanders as the First
People of this land.
We pay our respects to Elders past and present, and to a culture
rich in history and traditions
This work is copyright. It may be reproduced in whole or part for study or training purposes subject
to the inclusion of an acknowledgement 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 Western NSW Local Health District.
© Western NSW Local Health District November 2017
Artwork by Jasmine Sarin Definition of terms used in report: Aboriginal Health Practitioner /Aboriginal and Torres Strait Islander Health
Practitioner - is a person who has completed a Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health
Care Practice (or equivalent as determined by the Board) AND holds current registration with the Aboriginal and Torres
Strait Islander Health Practice Board with Australian Health Professional Registration Agency (AHPRA). Aboriginal
Health Workers have completed training but do not have registration with AHPRA. Trainees are still undertaking their
qualification.
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Contents Executive Summary……………………………………………………………………………………………………4
Introduction……………………………………………………………………………………………………………….7
Literature Review………………………………………………………………………………………………………7
Background……………………………………………………………………………………………………………….8
Purpose & Objectives…….………………………………………………………………………………………….9
Method……………………………………………………………………………………………………………………..9
Results………………………………………………………………………………………………………………………12
Discussion…………………………………………………………………………………………………………………16
Conclusion………………………………………………………………………………………………………………..21
Appendix 1: Suggested Integrated Home Tele-Monitoring Model of Care……………….22
Appendix 2: Patient Story - Angus’s Story………………………………………………………………..23
Appendix 3: Patient Story – Kay’s Story……………………………………………………………………24
References……………………………………………………………………………………………………………….25
Authors and/or information for Report supplied by;
Monica Murray – Project Manager – WNSWLHD HITH/Ambulatory Care Rural Sites
Morgan Wilcox – Project Lead, WNSWLHD Integrated Care Project Lead
Kath Skinner – Project Lead Bila Muuji ACCHS
Data interpretation advice provided at end stage of report by Daniel Belshaw, Western NSW Health Intelligence Unit
Document Control
Revision Date By Comments Draft Version 1 10.07.2017 M. Murray Initial draft – HIU, Integrated Care, Bila Muuji
Project Lead Nurse,
Version 2 04.08.2017 M. Murray Draft for consultation to Integrated Care Steering Committee executive (WNSWLHD, Bila Muuji & PHN) HTM Trial Sites, DMS Rural Facilities,
Version 3 November 2017 M Murray WNSW District Executive Leadership Group, Rural & Generalist Clinical Stream,
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Executive Summary
Western New South Wales Local Health District’s (WNSWLHD) vision under the fourth Key Achievement
‘One Health Service across Many Places’ is to become Australia’s first digital health region by
implementing eHealth technology and systems with our key community partners (18). Remote home tele-
monitoring allows patient biometric information to be gathered at home so that it can be reviewed in
conjunction with other information held in the patient record or shared collaboration tool.
Recent research (2) suggests that telehealth evaluation can be complex with a great variety of potential
inputs, outputs, outcomes and stakeholders, which may explain the lack of an established telehealth
evaluation protocol and hindering decision-making to implement wide scale initiatives. Systematic review
evidence (3) demonstrates that supporting people with heart failure using information technology can
reduce rates of death and heart failure-related hospitalisations, improve people’s quality of life, knowledge
about their condition and self-care. Telehealth outcomes (4) with Aboriginal and Torres Strait Islander
people recommend that telehealth models of care facilitated through partnerships between Aboriginal
community controlled health services (ACCHSs) and public hospitals have potential to improve both patient
outcomes and access to specialist services for Indigenous people.
In 2016, NSW Ministry of Health provided eHealth funding to enable the testing of remote home tele-
monitoring in four rural Health Districts. WNSWLHD commenced two trials with existing clinicians and
patients across rural and remote sites;
1. WSNWLHD Trial: Hospital in the Home (HITH), Community Health and Integrated Care
2. Bila Muuji Trial: Community Controlled Aboriginal Health Services (CCAHS)
Trial goal was to test implementation of THM technology into rural health workplaces to inform NSW
Health, WNSWLHD and Bila Muuji Executive, Integrated Care Strategy and others doing similar work.
Trial objectives include testing and process evaluation of;
1. Acceptance and relevance of tele-home monitoring with clinicians and patients.
2. Useability of tele-home monitoring within existing service delivery models
3. Improvements in patient knowledge and capacity to self-manage
Guidelines, professional tools and patient resources, training and support strategies were developed, tested
and adapted over a period of eighteen months.
Results
During the WNSWLHD trial period to 30/6/2017, a total of (20) patients were involved in the HTM trial over
twelve months, of which (17) had been discharged and (3) were still being actively monitored in June 2017.
Community outpatients with one or more chronic conditions were the highest enrolments (11), followed by
HITH inpatients (7) and Integrated Care enrolled outpatients (2). The average age of a HTM patient was (68)
years and the average number of days per patient spent enrolled was (32). 20% were referred to community
providers for long term monitoring.
During the later Bila Muuji trial, in the eight month period to 30/6/2017, a total of (25) patient enrolments
occurred across eight ACCHS’s, of which (14) had been discharged and (11) were still being monitored in
June.
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Of the WNSWLHD Trial enrolled patients survey respondents;
100% of patients either strongly agreed/agreed that HTM improved their knowledge of symptoms
and 93% of patients felt very confident with using the HTM technology
80% of patients strongly agreed/agreed that they were better able to manage their health condition
73% strongly disagreed/ disagreed that being involved in the daily vital signs increased their anxiety
and 13% agreed that their anxiety was increased.
Overall, 93% of respondents indicated they would like to continue with the HTM and
89% of clinicians believed, as a result of HTM, their patients were better able to identify symptoms
and 94% would recommend HTM for other patients.
During training and in pre and post-trial surveys, WNSWLHS and ACCHS clinicians displayed a highly positive
perception with the concept of remote HTM, both in perceived patient benefits and recommending to
patients – however found the implementation process a challenge. The main challenges identified by
clinicians were maintaining skills to set up patient equipment; double documentation and remote device
reliability (network access, technical glitches and variances of automated equipment). The main limitations
of implementing the HTM service were workforce capacity and procedures. The main themes on benefits of
the service model identified by clinicians were empowerment of the patient, collaboration between
healthcare teams and as a tool for better patient education and management.
The trials indicated that for patients with one or more chronic conditions, the use of HTM provided an
opportunity to undertake patient education and allow patients to be more involved in their clinical
management. The trials have also assisted to identify the barriers, enablers and a better understanding for
how this digital technology might be applied as part of current and future health service delivery in WNSW.
The Bila Muuji Trial will continue until December 2017 and a further evaluation report released early in
2018. As of July 2017, options for WNSWLHD include;
1. Cessation of Tele-Home Monitoring as a service option and return to status quo
2. Continued use of current 37 sets of TeleMedCare equipment for further 2 years, at a cost of $9,000
per annum with targeted projects to increase workforce skills and governance using HTM, with
review in line with directions of Patient Flow Unit patient monitoring.
Barriers
The speed of technological advances is challenging health workforce ability to adapt quickly
Implementation would require significant flexibility, frequent review and adaptation.
Workforce capacity site dependent - number of staff , skills and confidence with technology,
Workforce variable skills to manage and escalate biometrics in the community
Staff comfort/skills with self-management & patient access to additional biometric data
Limited strong evidence to determine HTM cost/benefit contributes to confidence to
implement.
Current vendor’s web-based data not yet compatible with Cerner & Practice software
Enablers
Additional external funding to purchase and trial the technology in a partnership model
Adequately resourced support team with capacity to respond quickly, maintain ongoing training,
coaching support and supervision and develop guidelines and procedures
Local leadership of early adapters, comfort with technology and culture to accommodate change.
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Three critical factors for WNSWLHD excecutive and partners when considering options and directions after
the trials are;
If WNSWLHD executive and partners wish to progress to an integrated HTM service model, then as a result
of the trials, a suggested Model is included in Appendix 1 and the following recommendations are provided
for consideration.
Recommendation 1
That WNSWLHD conservatively support remote HTM with current level of HTM equipment for 2017-19 and;
Continue scoping with community partners (Bila Muuji ACCHS and WNSWPHN), Patient Flow & Transport Unit
(PFTU), WNSWLHD Telehealth Strategy and Primary and Community Health Nurses (PaCH) 2020 Framework for
their roles in supporting an integrated, telehealth model of care (Appendix 1).
Further development of how PFTU may in the future provide support and increase access to specialist care for
remote in-home monitored clients
Recommendation 2
That WNSWLHD and community partners establish a HTM Leadership Group to provide ongoing guidance and
advice for remote HTM as part of the broader WNSWLHD Telehealth Strategy including;
Recommending which WNSW patients to most likely lead to improved patient outcomes with HTM.
Review trial draft documents for Guideline and other supporting documents for endorsement, including action
plan, compliance, auditing and evaluation measures and report on same.
Review training to increase accessibility via WNSW My Health Learning
Develop Quick Reference Guide for Community Health Outpatient & Outpatient Care (CHOC) data entry to
improve performance reporting of clinical activity associated with HTM
Review literature with support of affiliated research partners to determine scope and capacity for further ethics
approved research study in HTM for evidence of specific clinical outcomes and/or cost analysis
Make recommendations on features that will meet future needs including electronic medical record (eMR)
compatibility, live stream data, real-time notifications to staff, patient prompts, Dashboard indicators for
improved care team patient management and in-home videoconferencing
Recommendation 3
That WNSWLHD strengthen capacity within its Aboriginal Health workforce and Aboriginal Health Service partners
• Work with WNSWLHD Aboriginal Health Directorate for supported inclusion of Aboriginal Health workforce in
HTM service provision and incorporate as advanced practice into Professional Portfolio of Practice
• Develop a community Clinical Deterioration training module and competency better suited to community and
Aboriginal Health Service workforce and advocate for inclusion on NSW Health state-wide Learning Management
System
1. As the proportion of the population within the region suffering one or more chronic conditions is attributable to
remoteness and Aboriginality, the comparative ease in which clients of the Bila Muuji ACCHSs have been
enrolled in HTM is an early success and should be explored further as a means of better managing chronic
conditions in WNSW
2. Implementing HTM may expose gaps in WNSW workforce skills, capacity and systems and how we detect and
respond to patients in the community who are at risk of deterioration.
3. Implementing HTM will challenge WNSW health professional workforce beliefs and culture about supporting,
enabling and empowering patients to self-manage with additional biometric data
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INTRODUCTION
Western New South Wales Local Health District (WNSWLHD) is a large rural/remote District with 38
health facilities covering 250,000 square kilometres. In 2016 WNSWLHD has a population of 279,200
people, of which 11.8% identify as Aboriginal or Torres Strait Islander. Bila Muuji Aboriginal Health
Services Co-operative has eleven member Aboriginal Community Controlled Health Services (ACCHS)
within the District.
WNSWLHD is one of three demonstrator districts for the NSW Integrated Care Strategy. The WNSWLHD
Integrated Care Strategy formed a partnership between the LHD, Western NSW Primary Health Network
(WNSWPHN) and the Bila Muuji Aboriginal Health Services Co-operative with the aim to:
Transform existing services into an integrated Western NSW system of care that is tailored to the
needs of rural and remote communities, and improves access to care and health outcomes, with
particular focus on closing the gap in Aboriginal health. (21)
Under the Integrated Care Strategy, innovative models of care are being developed to improve health
outcomes, patient experience and enhance system inefficiencies. NSW eHealth Strategy is enabling new
technologies like the electronic Medical Record (eMR), telehealth and remote patient monitoring to
support consumers and healthcare providers to better communicate with each other and increase
access to healthcare services. WNSWLHD’s Strategic 2016-2020 plan’s vision is to become Australia’s
first digital health region by implementing eHealth technology and systems with our key community
partner (18)
Remote patient monitoring allows patient biometric information to be gathered remotely or in the home
so that it can be reviewed in conjunction with information held in the patient record or a shared care
tool. Remote patient monitoring regimes may be part of a recommended pathway for managing a
condition, set up as an alternative to hospitalisation, used to track the health of remote patients who
cannot make it to a facility or used as part of a formal care plan (1). Remote monitoring is not an end in
itself; rather it is an enabler in supporting new and innovative models of care. Successful implementation
and realisation of benefits requires remote Home Tele-Monitoring (HTM) to be integrated with other key
factors such as clinical governance and change management.
In WNSWLHD, long-term (HTM) has been available since 2013/14 from non-government organisations
(Integrated Living and Carewest) for people over 65 years with chronic disease. HTM can be delivered as
a single service or under the Commonwealth Home Support Program (CHSP). Clients are trained to self-
measure at home and provided with biometric devices linked via a web portal to the service provider.
Time from referral to connection of patient can take a minimum of 1-2 weeks or under CHSP could be
several months. Services can include monitoring daily vital signs by service nurse provider, video-
conferencing, messaging and providing reports for other members of the patient’s health care team.
Literature Review
Systematic reviews and meta-analyses of HTM programs have differed in scope, analysis and
methodological quality which make it difficult to interpret available evidence (12). Telehealth evaluation
can be complex with a great variety of potential inputs, outputs, outcomes and stakeholders which may
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explain the lack of an established telehealth evaluation protocol and hindering decision-making to
implement wide scale initiatives (2). A 2015 Cochrane Systematic review (3) demonstrates that
supporting people with heart failure using information technology can reduce rates of death and heart
failure-related hospitalisations, improve people’s quality of life, knowledge about their condition and
self-care. Most patients, even those who are elderly, are adaptable and can learn how to use the
technology easily and are satisfied with these interventions. Quality of evidence for primary outcomes in
the review was rated as very low for all cause hospitalisation to moderate for all-cause mortality and
heart failure related hospitalisations.
The Australian National Heart Foundation (ANHF) Guidelines (7) makes a Grade A recommendation that
remote management assisted by structured telephone support and tele-monitoring should be
considered for patients who do not have ready access to a Cardiac Heart Failure program. Australian
Guidelines and current expert consensus (20, 8) recommend that home blood pressure (BP) monitoring
offers advantages beyond clinic BP measurements in terms of better evaluation of BP control, better
prognostic indication, greater engagement of patients and improved compliance with drug therapy.
Commencing in 2012, the Australian government funded a number of telehealth pilot projects under the
NBN-enabled Telehealth Pilots Program. One of the larger studies with Commonwealth Scientific &
Industrial Research Organisation (CSIRO) (11) found after one year of home tele-monitoring across
diverse sites there was a 46% reduction in rate of MBS expenditure; 25% reduction in rate of PBS
reduction; 53% reduction in rate of admissions to hospital; 75% reduction in rate of length of stay;
40% reduction in mortality; 83% user acceptance of technology and 89% of clinicians would recommend
HTM to other patients. An economic analysis was undertaken based on these results and applied to an
operational model of one clinical care coordinator managing 100 patients and suggests that;
For chronically ill patients, annual expenditure of $2,760 could generate a saving of between
$16,383 and $19,263 per annum;
LHD’s and PHNs are well positioned to implement and manage tele-monitoring services and clinical
triage call centres and;
People aged over 65 with complex chronic conditions and multiple co-morbidities who are admitted
to hospital at least once each year would benefit from home tele-monitoring.
The report found that success metrics for the deployment of telehealth services relate more to on-site
clinical leadership, capacity to accommodate change and the flexibility of existing processes and
systems (11). This finding is reinforced by experiences of the trials contained in this report.
A systematic review on outcomes with telehealth with Aboriginal and Torres Strait Islander people (4 )
found a predominance of descriptive studies and small sample sizes but recommended that telehealth
models of care facilitated through partnerships between Aboriginal Community Controlled Health
Services (ACCHSs) and public hospitals have potential to improve both patient outcomes and access to
specialist services for Indigenous people.
BACKGROUND
March 2015, the NSW Health Rural e-Health strategy allocated four rural Health Districts $120,000 to
undertake proof-of-concept trials of remote HTM with Home in the Hospital (HitH) patients.
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In March 2016, NSW Health HitH directed $230,000 to “develop pathways of care around chronic
disease pathways with Aboriginal people to prevent Emergency Department presentation and
hospitalisation”. With the WNSWLHD HTM trial already underway, the value and opportunity to share
recently developed resources and knowledge with Bila Muuji, one of our key community partners, was
recognised and a second adjunct trial was commenced.
Two options were presented to the Bila Muuji executive – to use the one-off funding to commission a
third party provider to conduct a HTM service on behalf of the ACCHS’s for 1-2 years or build on existing
WNSWLHD/ACCHS relationships to share knowledge, strengthen local capacity and integration over the
long term. The latter was the preferred approach by both partners. Eight of the eleven ACCHS’s of Bila
Muuji are participating in the trial.
PURPOSE AND OBJECTIVES
The initial purpose of the proof-of-concept trials from NSW Health were to test remote HTM in the HitH
setting as an enabler to delivering more in-home care and reducing hospitalisations. However, several
factors limited trial implementation and objectives for WNSWLHD:
Short timeframe for the submission, implementation and evaluation back to NSW Health which
prohibited full exploration of suitable cohorts and models of care;
Limited knowledge with the application of remote HTM with rural health clinicians and patients;
Initial consultations with HITH services revealed considerable apprehension from the workforce.
Therefore, WNSWLHD objectives include testing and evaluation of the following;
Objective Measure
1. Acceptance and relevance of tele-home monitoring with a variety of clinicians and patients.
Demographics of staff and patient uptake,
2.Useability of tele-home monitoring within a range of existing service delivery models
Pre and post-trial staff confidence and usability with the technology, perceived patient benefits and workload impact
3.Improvements in patient knowledge of symptoms and capacity to self-manage
Patient reported experience
METHOD
Planning: Choice of vendor and purchase of equipment was driven by the short-time frame for
expenditure. TeleMedcare was the vendor of choice due to range of equipment available to purchase;
ease of device set up and their partnership with the CSIRO trial in 2013/14.
As HTM is an emerging technology within NSW Health – there was a lack of robust protocol or guidelines
to support trial implementation. Local community providers had not yet developed the policy or
governance documents rigorous enough for guidance of public health facilities and staff. The ACT Health
Home Tele-Monitoring Standard Operating Procedures (9) were adapted for use in WNSWLHD.
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Initial consultation with HitH Nurse Managers, Medical staff, Clinicians, PaCH Nurse Consultant,
Integrated Care and Information, and Health Information & Communication Technology (HICT) staff was
conducted via teleconferences and a workshop in October 2015.
Training: WNSWLHD Trial – between March and October 2016, information and initial training sessions
were provided. Target clinicians to conduct HTM were PaCH Nurses across nine sites of Bathurst,
Orange, Dubbo, Parkes, Cowra, Mudgee, Cobar, Molong and Wellington.
Bila Muuji Trial –initial training was held at Wellington and Walgett in October 2016 and mop-up
training or information sessions provided afterwards to those who couldn’t attend initial training or new
staff. Target clinicians to conduct HTM were ACCHS Practice Nurses and Aboriginal Health Practitioners
and Workers.
Trial Design Type: The design was broadly an adaptive proof-of-concept trials. Whilst objectives, project
plans and evaluations were scoped, limited time meant that ethics approval was not sought and the
trials had to take a more quality improvement approach. The main intent of the trials was to test the
process of implementing HTM technology into the rural workplace to inform NSW Health, WNSWLHD
and Bila Muuji Executive, Integrated Care Strategy and others doing similar work.
Evaluation – was obtained via demographics of the patient enrolments; pre and post-trial staff surveys;
post-trial patient surveys and project team observations on the implementation process and interactions
with clinicians and patients.
Site and patient selection: Due to the short-time frame to report trial findings back to NSW Health, the
project team decided to offer supported testing in a range of different sized sites.
WNSWLHD Trial (May 2016-June 2017) Target patients:
1. HitH inpatients (Bathurst, Dubbo, Orange, Parkes)
2. Community outpatients with one or more chronic conditions (all sites).
3. Integrated Care outpatients - outpatients risk stratified and enrolled in local Integrated Care
Program at wave one demonstrator sites (Cowra, Cobar, Molong, Wellington)
Bila Muuji ACCHS Trial (October 2016-December 2017) Target patients: ACCHS outpatients with one or
more chronic conditions at Bourke, Brewarrina, Coonamble, Dubbo, Forbes, Orange, Walgett and
Wellington.
Guidelines and Training: Guidelines, professional tools, patient resources, training and support
strategies were drafted with review points to incorporate iterative changes provided by feedback from
staff and patients during the trial.
Daily Monitoring – local clinicians designated for enrolled patients were responsible for checking their
client’s data once daily Monday to Friday. Both clinical leads for each trial also reviewed the web portal
once daily Monday to Friday and followed up with site staff if patient or technical anomalies were
noticed. Weekend readings were checked on Mondays. An additional safety net during the initial twelve
months of trial included the purchase of remote daily checking by TeleMedcare, who would contact the
LHD or write in the patient’s portal notes if an anomaly was observed but did not contact patients.
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Equipment: (37) sets of equipment were purchased for WNSWLHD Trial and (20) for Bila Muuji Trial
from TeleMedCare. Patient Home sets (see Picture 1) included a HUB communications device and an
automated PC-303 Spot-Check Monitor (Shenzhen) with peripherals for blood pressure, temperature,
blood glucose, oxygen saturation, weight and ECG. A hand-held spirometer was included in the set but
withheld during initial trials as many PaCH nurses did not have current competency in spirometry.
Medical equipment adhered to Australian Regulatory Guidelines for Medical Devices Class IIa. All patient
devices, including scales, were also checked by WNSWLHD Biomedical department prior to use to ensure
reliability and precision. Data was transmitted to a secure website via 3G mobile network provider
(Telstra).
Picture 1: TeleMedCare Patient Home Hub (transmitter) and Spot Check Monitor with attachments for
Blood pressure, pulse oximetry, blood glucose and 3 lead electrocardiogram.
Timeline: Figure 1 illustrates the time line of both trials (see below).
Figure 1: Diagram of WNSWLHD and Bila Muuji HTM Trials Timelines
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RESULTS
Results will be presented and discussed under the three objectives of the trials; 1. Acceptance and
relevance of HTM; 2. Usability of HTM within existing service models and 3. Patient Knowledge of
Symptoms and Self-Management
4.1 WNSWLHD Trial - Acceptance and relevance of tele-home monitoring.
A total of (54) WNSWLHD staff were involved with the program of which (43) staff attended the
information session with (36) staff completing the training from across 8 sites in WNSWLHD. Note that
some staff attended either the information session and/or the training. Of the WNSWLHD staff that
participated in the program (77.8%) identified as working in the nursing profession, followed by medical
(11.1%) and allied health (7.4%), with both ambulance and Aboriginal Health workers (1.9%) each.
During the WNSWLHD trial period to 30/6/2017 a total of (20) patients were involved in the HTM trial, of
which (17) had been discharged and (3) were still being actively monitored. Patients were more likely to
be located in a regional area (16) and the remaining residing in a remote area (4). Table 1 lists health
facility site enrolments and the number enrolled in each of the three cohorts of HITH (7), Community
outpatients (11) and Integrated Care enrolled outpatients (2). The most common diagnosis on admission
to the HTM was cardiovascular disease followed by respiratory disease, (6) and (5) cases respectively.
Multiple conditions were noted for (5) of the participants and included a minimum of two chronic
conditions (Table 2). The average age of a HTM patient was (68) years old (range 27-89 years); with
females being slightly more represented (12:8). The average number of days per patient spent enrolled
in HTM was (31.9) days (range 5-149 days).
Table 1: WNSWLHD Health Service trial enrolments June16-June 17
Facility Outpatients
HITH Inpatients
Integrated Care enrolled outpatients
Total enrolments Trial to date
Active D/C Active D/C Active D/C
Orange 2 1 0 0 4
Dubbo 0 3 0 0 3
Bathurst 0 0 0 3 0 3
Parkes 0 0 0 4 0 4
Cowra 0 1 0 0 0 0 1
Mudgee 0 0 0 0 0 0 0
Wellington 0 1 0 0 0 1
Cobar 0 2 0 0 0 2 4
Shared Pks/Orage
1
Total 4 8 0 7 0 2 20
Source: Patient data WNSWLHD HTM Trial 2016/17 June Report
Table 2. Primary diagnosis of WNSWLHD patients on entry to HTM.
Primary Diagnosis (n)
Cardiovascular disease 6
Respiratory condition 5
Hypertension 4
Multiple chronic conditions 5 Source: Patient data WNSWLHD HTM Trial 2016/17
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Table 3 lists the reasons for patient discharge from the program and as of 30/06/2017, there were 3 patients
actively participating in the program. Hardware issues with the equipment were identified in early stages of
the WNSWLHD trial and (2) participants had to be discharged for this reason. Of the two patients that were
admitted to discharge, one for the continuing management of hypertension and the second due to
deteriorating health status requiring more intensive management. Of the (20) trial patients, (3/17)
discharged patients were referred to community providers to continue long term monitoring and (2/3) of
the active patients will be referred – representing (5/20) 20% referral on discharge to third party providers.
Table 3. Reasons for WNSWLHD HTM patient discharge as of 30/06/2017
Reason for discharge (n)
Completed program 13
Hospital admission 2
Hardware fault 2
Active, ongoing 3 Source: Patient data WNSWLHD HTM Trial 2016/17
4.2 Bila Muuji ACCHS Trial – Acceptance and relevance of tele-home monitoring.
The Bila Muuji ACCHS trial is still in progress and a more comprehensive report will be completed in
December 2017. A total of (38) ACCHS staff have completing a training session from across (8) ACCHS’s. Of
the ACCHS staff that participated in the training (47%) identified as working in the nursing profession,
followed by Aboriginal Health Workers (32%) and Aboriginal Health Trainees (15%) and Medical (5%) and
each. Other information only sessions have been provided at most ACCHS to general staff.
During the period October 2016-June 2017, a total of (24) patients enrolled through an ACCHS as part of the
HTM, of which (2) patients enrolled twice bring the total occasions of service to (25). Of those admitted into
HTM a total of (14) have been discharged by 30/06/2017 with (11) actively being monitored in June. The
most common diagnosis on admission to HTM was for multiple chronic conditions (18), indicating that
Aboriginal clients enrolled in HTM had higher and more challenging co-morbidities (Table 5) than those
enrolled through WNSWLHD (Table 3). The average age was (66) (range 32-87 years) which is slightly
younger than the WSNSWLHD average, with slightly more females (14:10) than males represented in the
cohort. For patients where there was data completeness so far (12/26) the average number of days per
patient spent enrolled in HTM was (30.5) days (range 4-79 days). Patients enrolled through ACCHSs were
more likely to be remotely located (16) with only (8) residing in a regional town. Table 4 below shows site
activity so far. As the trial is incomplete at time of this report - discharge reasons have not been provided
from ACCHSs.
Table 4: Bila Muuji ACCHS HTM Trial Activity in June 2017 Source: Patient data Bila Muuji HTM Trial
Facility Outpatient with chronic disease
Total enrolments Trial to date Active D/C
Bourke 1 3 4
Brewarrina 1 6 7
Coonamble 0 2 2
Dubbo 2 1 3
Forbes 2 0 2
Orange 1 0 1
Walgett 3 0 3
Wellington 1 1 2
Total 11 14 25
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Table 5. Primary diagnosis of ACCHS patients on entry to HTM.
Primary Diagnosis (n)
Cardiovascular disease 1
Respiratory condition 0
Hypertension 3
Multiple chronic conditions 18
Diabetes 2 Source: Patient data Bila Muuji HTM Trial Data
4.3 Useability of tele-home monitoring within existing service delivery models
Pre-trial Staff Survey – WNSWLHD and ACCHS clinicians (36) returned surveys at completion of initial
training. Key findings were:
Confidence with HTM after training - (97%) identified as being confident or somewhat confident and (79%-90%) would recommend to other clinicians and eligible patients.
Managing trial in current workload – (52%) believed it would be easy/very easy, with the remaining participants feeling neutral.
Usability – (90%) believed HTM looks easy to use though (69%) indicated that they believed they would need technical support.
Perceived Benefits to Patients – (97-100%) agreed/strongly agreed HTM would improve patient’s knowledge of their condition and allow them to better manage their condition.
Common perceived benefits of HTM included increased patient ability to self-manage their conditions,
reducing presentations to hospital and/or early discharge. Currency of measurements and ability to see
trends over time with graphs supported clinicians being able to monitor chronic conditions. Time saved
by either patient or staff by not having to travel to clinic or as frequent home visits was seen as a key
benefit given the rurality of the region.
Common Limitations or barriers identified included patient /Nurse/GP and/or GP compliance; and the
time required for home visits and the initial setup.; Lack of monitoring after-hours; an adverse impact on
patient anxiety; poor Telstra 3G network coverage in remote areas and changes to workforce could
disrupt continuity of service.
The staff survey conducted after 12 months was not linked to the pre-trial survey as a proportion of the
staff attending training sessions did not actively enrol and manage patients in their workplace.
Post-trial staff survey – WNSWLHD and Bila Muuji ACCHS clinicians who used the equipment with
patients were surveyed in June 2017 with (20) responses from staff received. Of these responses (11)
were from WNSWLHD staff and (9) from ACCHS staff. Key findings were:
Communication amongst the team and with clients – (78-56%) identified communication between staff being very easy or easy, the only staffing groups where staff did not feel it was easy or very easy to communicate with was specialists and GPs (33%) and (47%) respectively.
Use of equipment and website – (31%) of respondents felt that the equipment was difficult/very difficult to use with (71%) indicating that the website was easy/very easy to use.
Patient outcomes – (74%) of respondents believed HTM would provide improved health benefits to clients with (89%) indicating that patients were able to better identify symptoms as a result of HTM.
15 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
Health system benefits – (89%) agreed/strongly agreed HTM would provide early detection of a client’s condition, though (39%) agreed/strongly agreed that HTM would result in preventable ED/Inpatient presentations and (44%) agreed/strong agreed that patients admitted would have a reduced length of stay. Yet respondents reported (67%) overall satisfaction with HTM with respondents willing to recommend HTM to clients and other clinicians (94%) and (76%) respectively.
The main challenges of the service model identified by clinicians was attaining and maintaining skills to set
up the equipment with the patient; documenting in two separate places and remote device reliability
(network access, technical glitches and biometric variances of automated equipment).
The main themes identified for limitations of implementing the HTM service were workforce capacity and
procedures. The main themes on benefits of the service model were empowerment of the patient,
collaboration between internal and external team members and as a tool for better patient education and
management.
4.4 Improvements in patient knowledge of symptoms and capacity to self-manage
Client of both trials are asked to complete a survey after discharge from the HTM service. Only WNSWLHD
trial client responses are included in this report. (15) Client responses were received (79% response rate).
Loss to follow up occurred when nurses forgot to provide the survey to the patient in the immediate
discharge period and patients could not be re-contacted at a later date.
Satisfaction with technology – 93% of clients felt very confident with using the HTM technology
Satisfaction with the Service - 100% of clients were satisfied with the HTM service provided by
staff involved in the trial
Improvement in patient knowledge of symptoms and capacity to self-manage - 100% of
patients strongly agreed/agreed that HTM improved their knowledge of symptoms and
80% strongly agreed/agreed that they were better able to manage their health condition.
Anxiety – (11/15) or 73% strongly disagreed or disagreed that seeing their vital signs increased
their anxiety, and (2/15) or 13% agreed that their anxiety was increased. (2/15) were neutral or
unanswered.
During post-trial patient experience interviews patients often stated how they felt the HTM gave them
additional information to make decisions about their own health care. One patient, during the post-trial
interview discussed how she has been monitoring her blood pressure at home for labile blood pressure and
hypotensive episodes and had provided two weeks’ worth of data to her GP. He changed her medication but
reassured her that she didn’t need to monitor her blood pressure so often, as’ doing it too often, would
make her anxious’. When asked by the interviewer if it did make her anxious, she replied “No, if I felt unwell
and my blood pressure was too low then I would just go and lie down. But now, after the GP changed my
medications at my last visit, it’s not happening so often so I won’t need to check as often as I did.”
Overall, 93% of respondents indicated that if required for their health, they would like to continue with the
HTM – the 1/15 patient who did not want to continue HTM stated that she had found it very useful to have
in the immediate period following discharge from hospital whilst still recovering from an acute illness but did
not see the necessity to have HTM all the time.
16 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
4.
5.
DISCUSSION ACCEPTANCE AND RELEVANCE
Generally, uptake or enrolments of patients by WNSWLHD PaCH nurses with HTM over the twelve month
period were small. Enrolments with outpatients with cardiovascular disease were the highest cohort in the
WNSWLHD trial (6) and those with multiple chronic conditions in ACCHSs (18). Enrolments in smaller HItH
facility were more sustained and continue to enrol where one HItH nurse gained confidence and was the
lead (Parkes) compared to a large site (Bathurst) where momentum and skills with many nurses was difficult
to maintain. Orange and Dubbo HitH services did not engage in the trial. Enrolments in integrated care sites
were low (n=2) but these small sites had implemented significant changes in the two year period and
possibly were change fatigued. Project team initial training and support capacity to increase momentum was
also limited.
It is important to frame the enrolment results within context. From the four NSW LHD’s who trialled HTM,
WNSLHD had the highest number of enrolments and the most comprehensive evaluation. As a comparison,
another LHD, who commissioned a third party NGO to do HTM on their behalf, with more narrow patient
criteria, enrolled only one patient during the twelve month trial period. NGO’s in WNSWLHD reported small
numbers of enrolments referred from GP’s and PaCH Nurse in the period prior to the trials. Enrolment
uptake may be related to the newness of the technology, Australian health practitioner’s knowledge and
familiarity of the concept, research ambiguity and current marketing, access and integration.
Positive perception with the concept of HTM during training sessions was high and this was reinforced by the
post-training/pre-trial survey. Post-trial staff surveys still showed a highly positive perception with the
concept of remote HTM, both in perceived patient benefits and recommending to other patients – however,
clinicians in both WNSWLHD and ACHHS found the implementation process a challenge. The Bila Muuji
ACCHS staff did progress to enrolling more patients more quickly. This was most likely influenced by;
Initial technical issues with tablets in WNSWLHD trial delayed enrolments and affected staff and
patient confidence;
Resources, knowledge and experience with HTM by WNSWLHD staff in the consultation and
planning stage - WNSWLHD staff were initially more apprehensive with HTM doing more harm or
Case Study 1
An 80 year old gentleman in Orange with
emphysema, heart disease and lung cancer had
multiple admissions to hospital. At the last
admission in January 2017, the Nurse Practitioner
assisted to set him up with home tele-monitoring.
His hospital admissions and ED presentations
reduced as by May, he had still not presented to
Emergency or been admitted to hospital.
“I felt safer – I could check myself if I felt unwell. I
was looking after myself better as I knew what
was going on”
Case Study 2
A 74 year old lady with heart and lung disease and cancer
was admitted to Parkes Hospital for low blood pressure,
shortness of breath and dizziness. The Hospital in the
Home Nurse set her up with home tele-monitoring
equipment on the ward for 24 hours which enabled her
leave the ward and transferred to Hospital in the Home
for 4 days.
“When you are in hospital, you become so reliant on
medical and nursing staff and worry about whether you
are going to cope going home. It was really
comforting…I didn’t want to leave hospital but I didn’t
want to BE in hospital – this was an in-between.”
17 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
the unintended outcome of increased anxiety in patients becoming more involved in their clinical
measurements. WNSWLHD staff expressed more concern for liability for missed deteriorations,
adverse patient outcomes and how they were going to manage the data “If we have this additional
biometric data then we have to do something with it”. This was possibly exacerbated by the
WNSWLHD staff being involved in the initial consultation stage, when guidelines and governance
processes were still being sourced and general knowledge was low. By comparison, when the Bila
Muuji ACCHS trial commenced, there was a complete set of draft resources and more positive
patient experiences and knowledge of how to use the HTM with local patients.
ACCHS staff generally did not convey during training that their clients would be more anxious or
unable to participate in HTM whereas this was a concern raised by WNSWLHD staff. ACCHS staff
were more vocal in wanting to support anything which would increase access to services which
might improve the empowerment and health of their communities. (See critical factor 1)
USERBILITY OF HTM WITHIN A RANGE OF SERVICE DELIVERY MODELS
Resources
Tablets initially purchased for the WNSWLHD trial were returned to vendor in July and replaced with hubs
due to ongoing technical issues affecting staff and client faith in trial. As a result, videoconferencing capacity
and patient clinical surveys were not available for trial, however, neither features on the tablets were being
used at that point. Overall, the Hub sets were simple and fast to use, and the web portal was easy to
navigate.
Most selected rural/remote patients could access HTM using the local 3G mobile network service provider;
however, some remote sites required a booster antenna and did experience fluctuations in connection.
Logistics management was significantly underestimated due to the number of devices, limited initial skills
with technical issues and assisting multiple staff over multiple sites. This improved over time as project team
and clinicians became more skilled.
The following table 6 outlines the costs of the equipment and portal.
Table 6: HTM Trial Costs
Equipment Cost per unit (Au $ 2017) Frequency of cost Provider
HTM Hub Set $1,100 Once only NSW Health eHealth Strategy Grant Web portal $240 Annual per device Grant 16/17, Integrated Care 17/18 HTM consumables
$60 Annual WNSWLHD eHealth Strategy Grant
Patients had negligible costs in the trial – they only had to provide an electricity outlet in their home.
Electricity costs for running the HTM equipment was estimated by the vendor at five cents per week. As the
trial funding was external to WNSWLHD and Bila Muuji ACCHS’s, participating facilities did bear any direct
costs in 2016-17.
Critical Factor 1
As the proportion of the population within the region suffering one or more chronic conditions is
attributable to remoteness and Aboriginality, the increased ease in which clients of ACCHSs were
enrolled in HTM is a success and should be explored further as a means of better managing chronic
conditions in WNSW
18 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
At time of report, both WNSLHD and Bila Muuji ACCHS have sufficient number of devices and do not require
any additional purchases. The Integrated Care Strategy has met the web portal costs ($8,800) for the 37
current WNSWLHD devices to enable continued use in 2017/18. The initial grant allows Bila Muuji ACCHS to
continue HTM until December 2018 with their (20) devices. Existing project or clinical staff time was
provided in kind and as an indirect cost was not a variable being collected in the trials.
Governance
Interactions with staff in both trials revealed variation with both clinician technique and quality of client
education provided on self-measurement. Subsequent training will require more emphasis on ensuring a
standardised approach to client education.
NSW Health policy PD 2014_004 for Recognition & Management of the Patient who is Clinically
Deteriorating (15) were adapted for the trial for people living at home - both HiTH inpatients with an acute
illness and community outpatients with a chronic condition. Community nurses and ACCHS staff found it
challenging to manage or escalate (according to set criteria) outpatients with chronic disease, who
frequently had measurements in the amber or red zones but otherwise felt well. There are more variances
in the community setting which influences biometric measures and management action. With the exception
of patient activity, variances including patient technique and compliance, patient conditions, limitations of
automated devices, access to a GP, access and compliance to treatment in the community and clinician skill
and confidence with escalation. Variances may be more immediately controlled in the acute setting as
clinicians can do manual measurements more easily, check patient compliance and equipment calibration
and can more quickly consult/escalate to senior staff. This is more challenging to mimic remotely in the
community setting. More work is required in training staff to interpret and action trending of biometric data
rather than one-off measurements. (See critical factor 2)
Initially, both trials experienced gaps in clinician adherence with documentation their daily checks and/or
management actions on the portal in addition to the medical record, when patient measures were not
between the flags; however, this improved as greater understanding of the new procedures were gained by
both project team and clinicians.
Managing HTM did increase workloads initially – both in supporting the patient to use the equipment and
following up if vital signs varied from the set parameters but nurse time was not a measured in this trial.
While not a contraindication, automated monitoring may be limited in some patients including (but not
limited to) those with irregular heart rate and arrhythmias (3) due to equipment using algorithms to
calculate estimated heart rate per minute. Staff need to be knowledgeable of limitations, complete full
manual measurement and assess patient suitability on enrolment. Staff familiar with the clinical history of
the patient would easily be able to factor this in when interpreting vital signs.
Provision of long term HTM is a growing industry and clients who would benefit from this may be referred to
third party providers. To date, NGO provision of HTM is an unregulated industry. At present there are no
community providers in the WNSWLHD who can provide immediate, short-medium term HTM with the
Critical Factor 2
Implementing HTM may expose gaps in our workforce skills, capacity and systems and how we detect and
respond to patients in the community who are at risk of deterioration.
19 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
integration that the WNSWLHD and partners would expect. Government telehealth documents have been
dominated by eMedical Records (eMR) and videoconferencing between health professionals and patients.
Remote HTM has been a smaller component and remains an area to be further developed. Therefore, report
Recommendations (1) and (2) for WNSWLHD executive approval include;
Workforce and change management
The project team significantly underestimated the time required for planning, drafting of documents,
logistical management of equipment and consumables, managing technical issues and overall culture change
required to support the WNSWLHD trial. It was assumed that staff would be fully engaged and embrace the
role of HTM as a tool to support both client and health service in the management of chronic conditions in a
community setting. WNSWLHD staff in particular were concerned about the anxiety of patients reviewing
their vital signs which may have impacted on uptake of the trial. This was not observed amongst the staff of
the ACCHSs which were able to enrol more patients and was keen to involve the patient in the management
of chronic conditions.
No additional staffing was provided for WNSWLHD and existing Integrated Care roles were used to
implement the trials. HTM is new and it was a challenge for WNSWLHD to source the right mix of local
people with the skills, capacity or interest within existing roles to sustain a broader implementation group
for the length of the trial. Teleconferences and site visits were used with better effect in the Bila Muuji
ACCHS trial by recruiting 0.6FTE AMS Project Nurse Lead to sustain engagement, momentum and support.
Only PaCH Nurses were targeted initially in WNSWLHD; however, the Bila Muuji ACCHS trial targeted
Registered and Enrolled Practice Nurses and Aboriginal Health Practitioners, Workers and Trainees. The trials
Recommendation 2
That WNSWLHD and community partners establish a HTM Leadership Group to provide ongoing guidance and
advice for remote HTM as part of the broader WNSWLHD Telehealth Strategy including;
Recommending which patients and clinical situations should use HTM that would most likely lead to improved
patient outcomes. Whilst there is scope to test HTM with other patient cohorts – current research indicates that
there may be more potential in the management of patient s with cardiac heart disease.
Review current trial draft documents and make recommendations for final Guideline and other supporting
documents for executive approval, including action plan, compliance, auditing and evaluation measures and
report on same monthly
Review the literature with support of affiliated research partners to determine scope and capacity for further
ethics approved research study in HTM for evidence of clinical outcomes and cost analysis specific to WNSWLHD
Make recommendations on features that will meet future needs including electronic medical record (eMR)
compatibility, live stream data, real-time notifications to staff, patient prompts, Dashboard indicators for
improved care team patient management and videoconferencing
Recommendation 1
That WNSWLHD conservatively support remote HTM by maintaining current level of HTM equipment for 2017-
2019 and;
Continue current scoping with community partners (Bila Muuji ACCHS and WNSWPHN), Patient Flow & Transport
Unit (PFTU), WNSWLHD Telehealth strategy and Primary and Community Health Nurses (PaCH) 2020 Framework
for their roles in supporting an integrated, telehealth model of care (Appendix 1).
Model to develop how PFTU is able to provide future access to specialist support for monitored clients of both
WNSWLHD and Aboriginal Health Services.
20 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
identified that the Aboriginal Health Workforce has more potential to participate in HTM, particularly in the
management of chronic disease for Aboriginal people.
HTM is a tool in a suite of health service delivery and like all tools, the potential for clinical benefits will be
influenced by the skills of the people (clients and staff) who are using it – to apply correctly, recognise and
respond to anomalies and escalate care. HTM requires an integrated system of well trained staff wrapped
around the patient. Therefore, a system with role delineation and clinical governance specific to a HTM
service model would require effective clinical training, support and supervision of both patients and
monitoring staff. If WNSWLHD executive and partner facilities wish to progress to an integrated service
model using HTM, then a suggested model and roles are provided for consideration in Appendix 1.
Improvements in patient knowledge of symptoms and capacity to self-manage
After resolution of initial hardware issues, similar to the CSIRO trial, WNSWLHD patients indicated high
confidence and satisfaction with the technology.
A common behaviour observed during the trial was medical and nursing staff unfamiliar with HTM, were
more apprehensive or made a decision on behalf of a client, assuming that because of their age or other
factors, they would not ‘cope’ or would become ‘anxious’ with HTM. Despite 29% of patient respondents
reporting that seeing their vital signs did increase their anxiety, 93% said they would still like to continue. As
one patient stated during their survey interview – her anxiety was more related to her general state of
health at that time rather than the effect of seeing her vital signs. Rather than an assumption that an
unintended outcome of HTM in itself maybe increased anxiety, further research or effort might be required
into the other factors which may influence patient anxiety in HTM. These might include objective
assessment of patient/carer capacity, data/equipment reliability or variance and most importantly the
capacity of the HTM staff to effectively train and support the patient. (See critical factor 3)
Limitations of the trial included short timeframe for implementation which prohibited full exploration of
suitable cohorts and models of care, rapid development of processes and seeking of ethics approval.
Strength of evidence in terms of clinical outcomes as an alternative to usual care is not as rigorous as we
would have preferred. Limited knowledge of application of remote HTM with generalist rural clinicians and
patients; small patient numbers and broad range of patients/staff and sites increases the heterogeneity of
Recommendation 3
That WNSWLHD strengthen capacity within its Aboriginal Health workforce and Aboriginal Health Service
partners in regard to increasing access to HTM training, support and supervision via WNSWLHD and PTFU
specialist staff;
Develop and evaluate a community Clinical Deterioration training module and competency better suited to
community and Aboriginal Health Service workforce and advocate for inclusion on NSW Health state-wide
Learning Management System
Advocate for key community partners (AHS & PHN) access to NSW Health’s Learning Management System
Work with WNSWLHD Aboriginal Health Directorate for supported inclusion of Aboriginal Health workforce in
HTM service provision and incorporate as advanced practice into Aboriginal Health Practitioner Professional
Portfolio of Practice
Critical Factor 3
Implementing HTM may actually challenge our health professional workforce beliefs and culture in
supporting, enabling and empowering patients to self-manage
21 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
results. WNSWLHD staff compliance with patient surveys contributed to 20% loss to follow-up. Limited
return of pre and post staff evaluations introduces selection bias.
Conclusion
The trial goal was to test implementation of THM technology into rural health workplaces and provide
information for NSW Health and this is still ongoing with the Bila Muuji trial. Due to the previously stated
limitations, the process measures (number of staff trained, number of patient enrolments and staff reported
experiences) and outcome measures (impact of HTM on the health status of the patient) are able to provide
some useful information in terms of service delivery and potential future models. Whilst clinical trials
provide highest strength of efficacy (does HTM work in a specific patient cohort compared to usual care),
they provide limited information about the effectiveness in WNSW (implementation of HTM in real life) and
efficiency (is HTM a suitable strategy for WNSWLHD to invest in as part of patient management).
Whilst clinical trials continue to evaluate efficacy of HTM in Australia and overseas, the time and numbers of
clients required to achieve power and statistical significance may make it difficult for WNSWLHD to conduct
its own clinical trial. Further discussion on research relevant to HTM in WNSWLHD practice is required and
specifically regarding the qualitative aspect of HTM for patient, staff and the health services.
The success of incorporating telehealth into our existing service model s or service may relate more existing
staff constraints, on-site clinical leadership, capacity to accommodate change and the flexibility of existing
processes and systems (11). Having the evidence and access to digital healthcare technology is not sufficient
– the quality of the data and the workforce practice of using the data as part of holistic assessment to
support, monitor, respond and intervene with community clients is crucial.
The value of the trials in allowing WNSWLHD and Bila Muuji to test current HTM technology in rural NSW
practice has been positive. The trials indicated that for patients with one or more chronic condition, the use
of HTM provided an opportunity to undertake patient education and allow patients to be more involved in
their clinical management. The trials have assisted to identify the barriers, limitations, enablers,
opportunities and better determine ‘our space’ with HTM and move cautiously forward to skill our patients
and workforce with digital technology as part of current and future health service delivery in WNSWLHD.
22 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
Appendix 1: Potential Integrated Model for Remote Home Tele-Monitoring
HTM Role Responsibilities:
Role Delivered where
Home Tele-Monitoring Responsibility
1 Client (+ - carer) Home Minimum - Capacity and skills to use HTM equipment correctly, knows how to escalate if concerns Medium - minimum + has a self-management plan, knows how to manage symptoms within plan and escalate if concerned Advanced – medium + may access web portal if desired to see/print own data for self or health professional appts
2 Local Health Team I Aboriginal Health Practitioner/Worker, PaCH EEN/RN, Practice EEN/RN
Home Minimum - Manage equipment, engage, Conduct full manual set of observations and assess patient suitability, quickly initiate HTM, Medium – minimum + participate in daily checking and be competent to detect anomalies or deterioration trends, Advanced – medium + train & support clients, assist in rectifying technical issues and maintain patient engagement for the period of HTM, organise patient for further assessment and escalate to senior health professional, provide data reports
3 Local Health Team II PaCH RN, Practice RN, Nurse Practitioner, GP, THM clinical lead/s
Home, Health Facility or remotely
Provides clinical oversight of patient care, ability to detect and interpret HTM data trends in relation to other available information to assess patient’s overall clinical condition, enable action, change in treatment and/or escalation if required to a more senior/specialist health professional
4 Specialist Team PFTU, Nurse Practitioner, Medical Specialist
Health Facility or remotely
Specialist consultation and intervention
NGO
23 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
Appendix 2: Angus’s Story
24 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
Appendix 3: Kay’s Story
25 WNSWLHD Home Tele-Monitoring Trial Report_V3 November 2017
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