Telehealth - Residential Aged Care Facilities

What is the telehealth incentive?
Provides financial incentives to eligible aged care services that help patients participate in video consultation, with a specialist, consultant physician or consultant psychiatrist (Medicare, 2012).
Who is eligible for telehealth incentive?
Telehealth is available to all residential aged care services (urban and rural) that provide care and accommodation to residents under the Aged Care Act 1997 and hold a residential aged care service ID (Medicare, 2012).
What are the incentives for RACF?
·         On Board incentive - a one-off, lump sum payment available to eligible aged care facilities on lodgement of both the On Board application and the claim for hosting a telehealth consultation.
2011-2012
2012-2013
2013-2014
2014-2015
$6000.00
$4800.00
$3900.00
$3300.00
 
·         Telehealth Hosting Service Incentive – an ongoing, monthly payment based on the total number of telehealth consultations between a specialist and resident conducted within the aged care service during the month.
2011-2012
2012-2013
2013-2014
2014-2015
$60.00
$48.00
$39.00
$33.00
                                                                                                                          (Medicare, 2012)(RACGP, n.d.)
What are the advantages of telehealth?
·         Provides better access for residents to specialist care;
·         Reduced waiting times to see a specialist / medical practitioner;
·         Reduces the travel costs and time associated with taking a resident to a specialist; and
·         Reduces the number or people and the time the RACF spends on arranging and providing medical care for residents (RACGP,n.d.).
What do RACFs need to do to register for the incentive?
·         Have access to appropriate telehealth equipment;
·         Have a room appropriate for a telehealth consultation; and
·         Have used and can provide a report on telehealth hosted consultations in order to receive the On Board and Hosting service incentive (Medicare, 2012).
Who can provide telehealth services?
·         Medical practitioners;
·         Practice nurses and Aboriginal health workers (on behalf of a medical practitioner);
·         Nurse practitioners; and
·         Midwives (Medicare, 2012).
What are the privacy requirements?
The general privacy requirements are the same as those for standard face-to-face consultations. The video aspect should, however be conducted via a secure infrastructure or encryption and the patient should be told and asked for their consent to proceed with the video consultation.
RACF video conferencing technology considerations
1.       What type of video conferencing will we require?
·         General; and
·         Complex medical or diagnostic.
 
2.       What type of video conferencing accommodation can you provide?
·      Utilise an existing GP/ specialist room at the RACF;
·      Have a Video conferencing specific consulting room; and
·      Enable residents to access Telehealth within their rooms
 
3.       Will we have access to high speed internet?
·         Assessment of whether an internet connection will need to be upgraded – if that is possibleWill you have a dedicated nternet connection for video conferencing?
 
4.       What is the expected volume of consultations?
·         Will the GPs/ specialists currently managing your patients care be willing / able to use telehealth?
 
5.       How many specialists /GPs that the RACF regularly see are already Telehealth enabled?


Video conferencing technology (NTSC, 2011; RACGP, 2011)
Type
 
Description
Advantages
Disadvantages
Examples
Web based conferencing
 
Video conferencing is accessed through a web browser
·Easy and reliable to get started
·Accessible from anywhere there is a web browser
·Inexpensive
·Uses online directory for contacts
· 
· Video quality is dependent on the bandwidth
· Reduces functionality in some products
· May have a limited interoperability
· Low quality video
· May have privacy issues.
·Skype
·WebEx
·Google Chat
·Oovoo
·Vivu
Computer based video conferencing
 
Video conferencing software installed on a computer.
Commercial grade software works with a central server.
Some solutions connect directly from one computer to another.
·Commercial grade software offer high definition video quality and are easy to install and start using.
·Can be available on multiple computers
·Compatible with a hardware and software video conferencing.
·Integrates with e-health systems
· Interoperable between other video conferencing systems may be an issue
· Requires software downloads / firewall permission. Software may require high PC specifications
· In general may require more technical support when updating the system
·Polycom
·Tandberg/Cisco.
·Lifesize
Tablet video conferencing
 
Video conferencing software or app installed on a device
·Mobile
·Easy and reliable to get started
·Accessible from anywhere there is a web browser
·Inexpensive
·Uses online directory for contacts
 
· Small screen size
· Poor quality image
· Lower processing power
· Battery dependant
· WiFi / 3G co nnectivity only
· 3G may result in poor quality communication due to signal strength and dependence on location
· May have privacy issues
·Polycom
Desktop video conferencing appliance
 
Self contained video conference solution that sits on the table or desk.
·Can use separate data connection from the RACF for quality and reliability
·Can act as a monitor for a PC
·Robust dedicated unit part of a quality controlled managed network
·Easily moved from room to room
·User-friendly
·Ready for use at all times.
· Lack of flexibility
· Can present integration challenges
· Not suitable for use by groups or families as inbuilt camera not usually wide angle
· Camera has no pan/tilt/zoom function
 
·Polycom.
·Tandberg/Cisco.
·Lifesize.
Video conferencing room appliance
Self-contained video conference solutions fixed or on trolleys.
May be in dedicated room or multimedia room.
·Moveable from room – to –room
·Pan-tilt-zoom (PTZ) cameras can be controlled by remote site
·Self contained solution
·Can be purpose built for specific clinical scenarios.
 
 
· High cost
· Fixed to one video conference technology
· Can be inconvenient, bulky and inflexible
· Prone to video and audio corruption over unmanaged internet services
· Manual connection operation required
· Requires manual maintenance of a local directory of numbers.
· Polycom
·Tandberg/Cisco.
·Lifesize.
·Vidyo.
 
Immersive video conferencing
Immersive telepresence suite, multi codes or single solely dedicated to conferencing.
·Purpose built rooms
·High definition
· Life-size images
· Correct camera gaze angle for eye contact, position and proximity perspective.
· High cost
·Telepresence
·HPs Halo
·Polycom
·Tandberg/Cisco
 


Useful resources

Australian College of Rural and Remote Medicine
Telehealth program guidelines, tips
 
Telehealth Technology Directory (requires logging in / signing up is free and available to any health professional) provides a comprehensive list of available software and hardware telehealth products.
 
Telehealth Provider Directory (requires logging in) provides a list of specialists, GPs and RACFs that offer Telehealth services.
AHPRA
Guidelines for technology based patient consultations
DoHA – MBS Online
Information on security and privacy considerations, interoperability and technical requirements to assist in choosing telehealth equipment.
 
Factsheets for service providers, patients, RACFs and practitioners.
 
Questions and answers for patient-end practitioners
 
MBS item numbers (specialist services & Patent-end services
Medicare
 
Factsheet, frequently asked question, application and payment forms, MBS item numbers.
National TeleHealth Service Centre
Provides information and guidance for specialist, GPs and Residential Aged Care Facilities on the issues around being ‘Telehealth enabled’.
Royal Australian College of General Practitioners (RACGP)
Telehealth factsheets, implementation guidelines for video consultations in general practice, practice checklists, video consultation etiquette factsheet, evaluation tool and Telehealth standards

 
 
Reference List:
Medicare Australia. (2012). Telehealth. Cited, March 22nd, 2012, from http://www.medicareaustralia.gov.au/provider/incentives/telehealth.jsp
National TeleHealth Service Centre (NTSC). (2011). Getting Telehealth Enabled. Cited, March, 26th, 2012, from http://www.telehealthenabled.com.au
The Royal Australian College of General Practitioners (RACGP). (n.d.). Telehealth. Cited, March, 22nd, 2012, from http://www.racgp.org.au/telehealth
The Royal Australian College of General Practitioners (RACGP). (2011). Implementation guidelines for video consultations in general practice: A telehealth initiative. Version 2.0. Cited March, 26th, 2012, from http://www.racgp.org.au/Content/NavigationMenu/PracticeSupport/Telehealth/TelehealthImplementationGuide.pdfn