Telehealth in Residential Aged Care

Telehealth provides opportunities to better support residents living in aged care homes. This initiative is funded by the Commonwealth Department of Health and Aged Care, which includes the provision of telehealth equipment and training for staff, as part of their response to the Royal Commission into Aged Care Quality and Safety.

Supporting access to primary care clinicians, specialist services and other service providers in aged care homes through telehealth will improve health outcomes for residents, avoiding unnecessary hospital transfers and ED presentations.

The choice of telehealth equipment was informed by our Healthy Ageing Strategy (HAS), our Digital discovery questionnaire and further consultation workshops with a range of stakeholders, including interviews with residents on attitudes toward telehealth.

 

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Our local offering

Our findings from the digital discovery questionnaire clearly showed that a ‘one size fits all’ approach would not be effective. Residential Aged Care Homes (RACHs) in our region have varying levels of digital maturity and connectivity capabilities. However, participants in the consultation workshops widely recognised virtual care models as crucial for healthy ageing and access to services, with strong support for remote patient monitoring.

Considering these insights, Healthy North Coast proposed a tiered approach to support all RACHs, regardless of their capabilities or capacity. Through an Expression of Interest (EOI) process, RACHs selected the option they felt best suited their needs and capacity to implement.

As a result, 78% of Residential Aged Care Homes opted to participate and have now received telehealth equipment. Most participating RACHs have received laptops and/or iPads, while 11 RACHs have chosen to implement the more advanced remote diagnostic system, Visionflex Telehealth Cart.

Building confidence and skills to use telehealth

Healthy North Coast (HNC) has invested significantly in supporting RACH nurses, GPs, and other service providers to enhance their comfort and capabilities in telehealth. While technology acts as an enabler, education is crucial for helping healthcare professionals develop the skills to assess the clinical appropriateness and effectiveness of telehealth. This ensures that residents receive the best possible care in a timely and appropriate manner.

Education initiatives as part of the Telehealth in Aged Care project

Along with 15 other PHNs, Healthy North Coast (HNC) has invested in a National Telehealth Training Program to provide standardised training for RACH staff and service providers. This initiative supports aged care homes by ensuring that nurses and service providers approach telehealth delivery with a consistent level of understanding, comfort, and clinical standards.

These modules will be available for nurses on the Aged Care Quality and Safety learning management system (LMS) – ALIS.

(COMING SOON) Healthy North Coast will also provide local access to these modules for RACH staff and service providers, including General Practitioners, Allied Health professionals, Specialists, and other service providers.

Visit the Telehealth Training Program – PHN Telehealth Training website to learn more. 

Healthy North Coast (HNC) has commissioned the nurse education specialist, Primary Care Innovation (PCI), to support Residential Aged Care Homes (RACHs) across the region. PCI is developing customised education plans for each RACH to help staff build confidence and capacity in using telehealth. These education plans will also enhance nursing skills in using HealthPathways and MyHealth Record, as well as advance care planning, palliative care, and triaging residents’ deteriorating health.

Glaser (2022) states that most digital transformations take years and require several iterations, which typically arise from learnings and experience. A Community of Practice offers members a platform to share their experiences and learn from each other, potentially accelerating the digital transformation process.

According to Glaser (2022), there are three factors that contribute to successful digital transformation: (1) defining the transformation before selecting the technology, (2) innovating the business model to leverage new technologies, and (3) managing the process of organisational change.

Healthy North Coast (HNC) plays a crucial role in supporting shared discussions, discovery, and learning. It provides best practices, guidelines, and change management strategies for members to utilise. HNC ensures that clinical and business changes are at the forefront of discussions, with technology acting as the enabler of digital transformation.

Source: Glaser J, PhD, Shaw S, MD, PhD (2022). “Digital Transformation Success: What Can Health Care Providers Learn from Other Industries?” NEJM Catalyst.

Case study 1

An 89-year-old female resident experienced a fall at their RACH, resulting in a fractured neck of femur. Following her treatment, her follow-up appointments were conducted via telehealth with the Local Health District (LHD) fracture clinic.

This innovative approach has yielded significant benefits:

  • Enhanced Comfort and Convenience: By leveraging telehealth services, the resident avoided the need for a strenuous trip in an ambulance and the discomfort associated with a day-long visit to the clinic.
  • Cost Savings: Utilising telehealth eliminated the expenses associated with ambulance transportation and the need for a staff member to accompany the resident to the clinic, thereby reducing overall healthcare costs.

This case exemplifies how telehealth not only improves patient experience and convenience but also offers cost-effective solutions while ensuring continuity of care.

Case study 2

Vincent Court Aged Care Community in Kempsey has had great success adopting the Visionflex telehealth carts to provide timely access to GP assessments.

With the availability of general practitioner face-to-face appointments declining in Kempsey, Vincent Court needed to explore a different model to ensure residents received the best care to maintain routine and urgent medical appointments.

Vincent Court embraced the opportunity to plug fill this gap by establishing a hybrid model of care with a GP based in Grafton. Once a week, this GP conducts telehealth appointments using the Visionflex technology, and supplements this with on-site visits once a month.

Visionflex is a telehealth service provided by Healthy North Coast, as part of a program to help aged care residents across the region access timely quality care through telehealth technology and practitioner training.

“Visionflex goes much further than an iPad telehealth service. It actually simulates a real GP surgery, with a large, high-definition screen that enables clearer communication between the resident and their GP. Importantly, the technology enhances diagnostic capabilities so the GP can make more informed clinical decisions.” 

“We are finding that we can better manage health outcomes for residents in their home, with the aim of preventing escalations to hospital. As part of the Apollo Care Alliance, Vincent Court is committed to embracing technology to provide the best care to residents.”

−Vincent Court Manager, Alan Pretty.

Case study 3

The Royal Freemasons Benevolent Foundation (RFBI) embraces telehealth as a means to offer equitable and accessible healthcare to its residents. By leveraging this technology, RFBI not only reduces wait times and hospital visits but also facilitates early intervention and ensures a seamless continuum of care.

According to Nurse Practitioner Amanda Woodlands, the Visionflex cart is more than just a telehealth tool;

“It is not just a telehealth cart that is able to perform visual and audio consultations. It has improved diagnostic tools that take the consultation to that next level.“

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Click here to learn more about the Healthy Ageing Strategy and related activities

Project details

To ensure that we are meeting the unique needs of local RACHs, we conducted a comprehensive survey in 2022 to assess digital capabilities and attitudes towards technology.

Through this survey, as well as additional consultations with RACH managers, residents, local health district partners, and ageing workshops, we were able to gain valuable insights that informed the development of a multi-tiered project model designed to meet the different digital journey stages of RACHs.

Some of the key findings from our survey include:

  • Internet coverage varies significantly across all RACHs, indicating that there is no one-size-fits-all model. 
  • Only half of the RACHs indicated that they have sufficient video consultation equipment.
  • RACHs were highly supportive of virtual care models, with over 80% indicating that they are very or quite confident in using technology.

Throughout the consultation process, RACH managers showed strong support for a proposed 3-option offering, with anecdotal feedback indicating that many are interested in the advanced remote diagnostic option. 

This virtual care project is part of an integrated model of support for RACHs, inclusive of after-hours, palliative care initiatives and access to other specialist services. This will provide ongoing assistance to create culture change, engage with other health practitioners, and collaboratively improve health outcomes. 

Healthy North Coast’s RACH Virtual Care project offers three different telehealth options, enabling RACHs to choose the most suited option to their technology journey.

This option will provide the RACH with digital equipment to undertake videoconferencing with clinicians or other services required by the residents.

RACH responsibilities:

  • Have a designated clinic consult room – site will need to provide internet connection
  • We promote appointing a telehealth champion, to support other staff
  • Engage internal or regular IT teams (where possible) to support the setup and installation of the equipment

Healthy North Coast responsibilities:

  • Provide support to internal IT teams regarding the installation of the equipment
  • Provide a digital consultant to support installation for RACHs that do not have an internal or regular IT team to assist
  • Purchase and dispatch equipment to RACHs with relevant purchase and warranty documentation
  • Coordinate initial and ongoing telehealth training
  • Provide the RACH integrated model of support

Equipment

  • Dell 27” Full HD Monitor
  • Portable camera + speaker +microphone —Logitech Connect
  • Wireless keyboard and mouse, spill-resistant design — Logitech MK235

Optional add-ons – choose one or both

  • Noise-cancelling wireless headphones – Dell Pro WL5022
  • Laptop – Dell Inspiron 3511 15.6” FHD laptop, 1 HDMI, 3 USB-A, Windows 11, i5, 512G storage, 8MB memory

This option will provide the RACH with digital equipment to undertake mobile videoconferencing. RACHs with existing mobile solutions may select this package to increase their fleet of mobile equipment.

RACH responsibilities:

  • Have Wi-Fi coverage for areas where mobile solution will be used
  • We promote appointing a telehealth champion, to support other staff
  • Engage internal or regular IT teams (where possible) to support the setup of the equipment

Healthy North Coast responsibilities:

  • Provide support to internal IT teams regarding the installation of the equipment
  • Provide a digital consultant to support installation for RACHs that do not have an internal or regular IT team to assist
  • Purchase and dispatch equipment to RACHs with relevant purchase and warranty documentation
  • Coordinate initial and ongoing telehealth training
  • Provide the RACH integrated model of support

Equipment:

  • iPad Pro 12.9” 512GB (6th Gen)
  • Noise-cancelling wireless headphones – Dell Pro WL5022

Optional add-ons – choose any

  • Apple magic keyboard
  • Apple pencil
  • Case/stand – Cygnett TekView Shell for iPad Pro 12.9”

This option will provide the RACH with remote diagnosis equipment to undertake clinical examination of residents, inclusive of heart and pulmonary sounds, ear, eye, skin and oral camera examination, and monitoring of vital signs. Subject to pending evaluation, this would be via the Visionflex Telehealth cart solution, inclusive of hardware, peripherals and software. 

RACH responsibilities:

  • Have good Wi-Fi coverage across the RACH, with minimum internet upload speed of 1 Mb/second
  • Appoint a change champion to coordinate adoption of this technology and support staff as they adjust to a new way of working
  • Participation in ongoing community of practice during pilot
  • Recruit one or all of the general practice team to participate in pilot i.e. prepared to undertake training, work remotely with telehealth diagnostics ECG, stethoscope, camera; wounds, oral and ear
  • Engage internal or regular IT teams (where possible) to support the setup of the equipment

Healthy North Coast responsibilities:

  • Supply equipment and 1-year software subscription*
  • Coordinate initial and ongoing training on use of system and equipment to change champions
  • Facilitation of community of practice to set up clinical systems and ongoing meetings to support pilot
  • Support general practices participating in the pilot
  • Provide the RACH integrated model of support

*RACHs will need to review their ability to take on ongoing investment post 12 month pilot. $820.00 yearly software fee (max 500mins/month) + Platinum support for telehealth cart including accessories, calculated at 15% per year ~$2,200.00 yearly. Total ~$3k per year.

Equipment

  • Visionflex equipment:
    • Ergotron cart with Intel i5 512GB 16GB RAM PC with Windows 10-Pro, 24” patient-facing monitor on swing arm, patient-facing camera on telescopic pole, wireless keyboard and mouse. Camera suited to eye, skin, ear, etc examination)
    • Accessories – HD examination camera suited to oral, skin, eye, ear; blood pressure cuff with integrated pump and Bluetooth, pulse oximeter Bluetooth; ECG single wire and three wire Bluetooth; digital stethoscope
    • Visionflex subscription
    • Visionflex support, implementation, training

Submit your Expression of Interest today

If you have any questions, please get in touch through our contact form