Waikato DHB learns lessons about delivering virtual health care

Digital Health Story - Customer experience

Waikato DHB is the biggest rural DHB in New Zealand. With 60% of its population living in rural areas, the time patients had to spend travelling to clinics and the resulting ‘Did Not Attends’ has been a significant and ongoing issue for the health board.

While some telehealth options were available prior to 2016, patients were still having to travel more than 10 million km per year to attend appointments.

Waikato also has a large Māori population, concentrated in the three most remote parts of the district, who die on average 10 years earlier than European population.

Confronted with these issues, Waikato DHB embarked on a Virtual Health Strategy to provide care to people closer to their home, work, communities and whānau.

“We all realised we needed to do something different,” explains the DHB’s Clinical Director Information Services and Virtual Health Care Dr Ruth Large.

“The whole background of this strategy was to alter the way clinicians were practising by being able to access patients better.”

The DHB surveyed patients and found 47% were interested in receiving healthcare virtually and 70% of Māori surveyed said they would be happy to have an appointment via video.

“Our patients really wanted some form of virtual care delivery and we needed to work more with consumers on how we do that,” says Dr Large.

 

Dr Ruth Large

 

SmartHealth

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

One aspect of the virtual health project that is continuing to grow is the use of virtual ward rounds completed by specialists based at Waikato Hospital for services run in Thames, Taranaki and Rotorua.

Consultants do planned ‘rounds’ with patients, where a nurse takes a telehealth cart (similar to a computer on wheels) to the patient’s bedside, and are available for urgent consultations when needed, such as when a patient has suffered a stroke.

The board is also trialling the use of telepresence robots in Thames and Waikato hospitals.

Telepresence robots on Waikato wards

Telepresence robots

A consultant can log in to a hospital computer or a mobile app and have their face instantly visible on the iPad robot screen and then navigate to where they are needed.

 

Dr Large says there is a real difference in patient experience of telehealth and telepresence and the trial is being done to determine what the advantages of each are in different scenarios.

“The important part of these things is evidence gathering. It can be difficult as you want to believe these things will work, but we need to be as unbiased as possible to prove the benefits of these developments,” she explains.

 

Published on 9 July 2018