The DHB trialled a project called SmartHealth for two years starting in May 2016 as part of its virtual health care project.
The platform, provided by US company HealthTap, was free for all of the DHB’s patients to use and gave people access to online platform and mobile app they could use on a computer or mobile device. Patients could text or do a video consult with the specialist they were linked with and these could be planned or unscheduled.
The app had an ‘ask Dr’ section, where patients could ask questions and get help out-of-hours via a text or video consult with a primary care physician, and patients could also search for healthcare information which was vetted by healthcare staff.
The telehealth project had two aspects: one connected clinicians directly with patients wherever they may be and the other involved patients going to rural health clinics where telehealth nurses were involved in the consultations with specialists.
In April 2018, the DHB announced that a lower than expected uptake and lack of expected results meant the high cost of the platform could not be justified and the two-year trial of SmartHealth came to an end in May 2018.
A fresh start
Dr Large says the virtual health strategy is being refreshed and interim solutions being considered after the decision was made to discontinue the SmartHealth trial.
She advises anyone embarking on a similar journey to ensure they clearly define the problem they are trying to solve before investing in a solution. Also, ensuring that clinical leads like herself are on board as early as possible.
“There weren’t any clinicians involved in the choosing of the tool or the development of the strategy and these are really good lessons to take away,” she explains.
“We had a solution for a problem we hadn’t defined. That’s probably one of the biggest issues we had.”
Also, the patient-centred nature of the app meant that patients need to make their own appointments. This does not always work well as there can be a variety of reasons why patients do not attend clinics or initiate treatment.
Dr Large believes it is important to be transparent and talk about the mistakes that were made with SmartHealth so that others can learn from them.
“We tried to do something very big very fast and we underestimated the amount of change management and the need for underlying cultural buy-in.”
Dr Large says the DHB also underestimated the issues around integration with the older software and hardware already in place.
“But a huge amount of work went into that and now we’ve got this really great wealth of knowledge in the DHB as to how we do this sort of stuff.”
Staff have learned about how to book virtual appointments and prepare patients for virtual consultations, as well as registering patients with an online service using identity verification.
There were also unexpected learnings such as patients’ enthusiasm for being able to text and send images to clinical staff, rather than always having a video consultation.
Staff are getting much better at accepting an agile development methodology and are generally more enthusiastic about the difference that virtual health services can make for their patients, Dr Large says.
Telehealth and telepresence