Delivering Health Services remotely using broadband technologies

David Hansen| CEO, AEHRC

23 May 2012

THE AUSTRALIAN E-HEALTH RESEARCH CENTRE | CSIRO ICT CENTRE

The Australian E-Health Research CentreHealth Data Management

and Semantics Biomedical Imaging

Mobile and Tele-health

Agent

Representing

Bookings

Supervisor

Agent

Representing

Theatre

Manager

Agent

Representing

Director of

Anaesthesia

Agent

Representing

Charge

Nurse

Agent

Representing

ORMIS

Supervisor

Agent

Representing

Director of

Surgery

Agent

Representing

Anaesthetic

Charge Nurse

Regular

Communication

And

Negotiation

Agent

Representing

Bookings

Supervisor

Agent

Representing

Theatre

Manager

Agent

Representing

Director of

Anaesthesia

Agent

Representing

Charge

Nurse

Agent

Representing

ORMIS

Supervisor

Agent

Representing

Director of

Surgery

Agent

Representing

Anaesthetic

Charge Nurse

Regular

Communication

And

Negotiation

Forecasting and Scheduling

Care Assessment Platform

Partners: Prince Charles Hospital, Metro North Community Services

Traditional Cardiac Rehabilitation

Lack of Referrals

(< 11%) in Australia

Uptake and Completion:

(of eligible patients)

QLD: 16%; NSW: 19%

USA: 18.7%

Mobile Phone based Cardiac Rehabilitation

Health

Reports

Service Provider

Community Care Team

Wellness Diary Connected

Diary dataMeasurement

data

Discussion,

messaging

Educational

material

Patient in the Community

Educational multimedia material

© Multi-ed Medical Inc.

Mobile phone software tools

Wellness Diary – health entries

Step Counter – walking activity

Nokia N96 handset

with a built-in

motion sensor

WellnessDiary Connected web service Mentoring and self- management tool

End User View

• Dashboard: a single view to all user data

• Four central concepts in the feedback and motivation:

– traffic light indicators

– a simple measure of physical activity

– goal setting

– verbal feed back

Professional View, interface for Mentors, Functionalities:

• managing groups

• patient monitoring and analysis

• news postings, system wide messaging with attachments.

• create questionnaires

• access the users’ data

Administrator View

• creation and managing user groups

• providing admin rights

Outcome measuresMain outcome measure:

• % Uptake and completion of CR program

Other measures:

• Adherence to physical activity guidelines (30 mins moderate level activity each day)

• Patient satisfaction: is this technology and home-based process the preferred means by patients?

• Quality of life.

• Risk factors: BMI, blood pressure, lipids, smoking, alcohol, diabetes

• Diet/ nutrition status

• Costs

• Return to work rate

• Readmission rate, deaths

• Psychosocial status

• Pharmacological management

Clinical Trial Protocol

Patients post STEMI or NSTEMIReferred for phase 2 rehabilitation

Traditional (n=60)

Costeffectiveness

analy

sis

CAP (n=60),

Post - assessment of outcome measuresafter 6 weeks

Outcomes evaluation , analysis , reporting

6 month follow -up

Patient Consent

Baseline assessment of outcome measures

Randomization

, ,

Outcomes evaluation , analysis , reporting

Walters, et al A mobile phone-based care model for outpatient cardiac rehabilitation: the care assessment platform (CAP), BMC

Cardiovascular Disorders 2010, 10:5

Clinical Trial Outcomes: Uptake and Adherence

CR Group Withdrew Completed Uptake

+

Completion

Traditional

(n=60, 56±10yrs)

34 26 47%

CAP

(n=60, 57±11yrs)

14 46 80%

Ease of Use

Manual entry of at least one WD entry per day for

each week

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6

CR program week number%

Patients

Usability and Adherence

Varnfield et al. Uptake of Technology Assisted Home-Care Cardiac Rehabilitation Program, Medical Journal of Australia Supplement, 2011: 194 (4), S15-S19.

n=15

Pilbara Tele-ophthalmology Trial

Partners: Pilbara Development Corporation, OPSM, WA Health

Remote Eye Care to Pilbara Region

Acknowledgement: Images taken from FCA website.

Disease Targets

Screening, Monitoring and Follow up

1. DIABETIC RETINOPATHY

2. GLAUCOMA

3. CATARACT

Screen and Plan Intervention

1. TRACHOMA

2. CORNEAL LEASIONS

3. PTERYGIUM

4. TRICHIASIS

Glaucoma management at a distance (~1000 Km)

Optometrist collected all data from glaucoma patients

Ophthalmologist from capital city read the images and give disease management advice – Remote-I

Fee for service for online consultation – Video conference only

Video Conferencing & Store and Forward –Control Polycom systems from iPAD

Cloud Computing

Local Clinics Mobile Assessment

Remote LocationsMetropolitan Hospitals

Universities

Schools

Primary Open Angle Glaucoma

Assessment Plan

Next

Review Next Review with

Consent for VC follow-up

obtained

Review in 2 months for repeat VC and

IOP check .Trial of Lumigan RE only as

using Xalatan did not work.

3

MonthsOptometrist - VC

Better control on Xalatan

and Alphagan, Continue treatment and another VC in

Feb 2012

4

MonthsOptometrist - VC

Started Xalatan 3 months

ago and has a good

response.

Fields show very small

Superior changes

Patient moving to Bunbury and will

therefore transfer management and

care down there.

Bunbury

Ophthalmologist

Smarter Safer Homes

Partners: Australian Centre for Broadband Innovation

Aims

Smarts Assisted Independent Living (SAIL) platform

Enhance the psychological and physiological well-being of aged persons

Evidence-based Decision Support Platform via ICT and Broadband for QoL and FQoL and individualised care planning for timely intervention.

Enable SAIL platform to support varied levels of older people’s support needs- model for designs of future homes for independent living of older people.

Example Scenario of Sensor data fusion –ADL

Bedroom

Accelerometer

Motion Sensor

Power meter

Temperature

Humidity

Acoustic

Reid SwitchBathroom

Kitchen

Living

Room

Toilet

Doctor/Clinical

Wellbeing/Clinical Support Platform

Self-Mgmt

Family/Relatives

Aged care

Social Care

Data and Information

Thank youThe Australian E-Health Research CenterDavid HansenCEO

t +61 7 3253 3610e david.hansen@csiro.auw www.aehrc.com

THE AUSTRALIAN E-HEALTH RESEARCH CENTRE | ICD CENTRE