Using a Community of Practice (CoP) model to expand allied health Telehealth services in an acute hospital setting

Prof Liisa Laakso1, Ms Rae Parker2, Ms Ann  Edwards2

1Mater Research, South Brisbane, Australia, 2Mater Health, South Brisbane, Australia

Background: Allied health telehealth services are a means of addressing multiple factors including reducing demand on outpatient services, and for improving continuity of care. To date, telehealth uptake and expansion has been problematic due to a range of barriers including access to health technologies by older patients, and acceptance by clinicians. We describe the implementation of a multidisciplinary Community of Practice model for increasing AH clinician capability in telehealth.

Methods: A CoP of interested allied health practitioners (users and non-users) and education and IT experts has been formed for the purpose of acquiring new skills, knowledge and evidence about telehealth, constructively critiquing current services, identifying enablers, implementing evidence and as quality improvement strategies for existing services with the overall aim of expanding use of telehealth. An appreciative inquiry approach has been adopted for the CoP, and the BetterEvaluation Rainbow framework underpins its evaluation strategy.

Discussion: The CoP model permits team members to engage in a process of collective learning to improve a shared undertaking; and we aim for CoP members to become leaders in telehealth implementation. Appreciative inquiry (AI) involves the art and practice of asking questions that strengthen a system’s capacity to anticipate and heighten positive potential. The benefit of AI in a CoP is that cognitive aspects of project design and implementation will be less constrained and more innovative. The Rainbow Framework consists of a series of questions in seven domains for guiding project implementation and evaluation; and the CoP will use the Rainbow Framework to evaluate existing telehealth services through 360⁰. We expect the CoP model will lead to the development of a robust evaluation framework that can be used to analyse the need for, benefits of and potential outcomes for future expansion of allied health telehealth services at the Mater without repeating costly errors of implementation.


Biography:

Dr Liisa Laakso is Senior Research Fellow, Allied Health at the Mater in Brisbane where her primary role is to increase capability and capacity in health service research. Liisa is an Honorary Associate Professor at The University of Queensland, and Professor of Physiotherapy at Griffith University where she worked in full-time academe for more than 15 years before commencing at the Mater in January 2018.

The use of e-learning tools in the management of common pregnancy related musculoskeletal conditions

Ms Sheridan Guyatt1

1Mater Health, South Brisbane, Australia

Lumbopelvic pain (LPP) is the most common musculoskeletal condition in pregnancy with a prevalence of up to 65%. Systematic reviews conclude that timely patient education and guided self-management are effective components of Physiotherapy management of this condition; however, timely intervention in an outpatient (OPD) setting is a challenge.

To facilitate timely intervention in an oversubscribed physiotherapy outpatient clinic at the Mater Mothers Hospital (MMH), electronic health (eHealth) was identified as a viable adjunct. A review of literature revealed that pregnant women access most of their health-related information online and physiotherapy eHealth interventions during pregnancy have been shown to increase adherence to prescribed self-management programs.

In January 2018 a new countermeasure was implemented: patients presenting with mild to moderate LPP symptoms were sent a personalised email, including self-management information and a video (https://youtu.be/E7Yi8rL7ZDU) providing clear guidelines to facilitate techniques for moving, stretching and postures during and after pregnancy. Patients who received the eHealth package were advised that if significant LPP persisted after two weeks of self-management to re-contact the Physiotherapy department for an urgent OPD appointment. Patients presenting with severe LPP were immediately booked an OPD appointment.

The new process reduced face to face antenatal physiotherapy OPD activity by 9.4% compared to the previous year. Patients requiring urgent treatment can now be offered appointments within an appropriate timeframe (< 1 week). Patient acceptability of this tiered eHealth program is high and further evaluation of the effectiveness in managing LPP is currently being assessed.

This quality improvement project demonstrates that eHealth is an effective tool for managing OPD waiting times and is an acceptable method of managing mild to moderate LPP in pregnancy. eHealth, as the first line of treatment, has the potential to extend to other caseloads where education and self-management are integral to care.


Biography:

Sheridan is a Physiotherapist with over 25 years’ experience working with pregnant and postnatal women in both public and private settings here in Queensland and also in Tasmania. She is currently the Team Leader for the Mothers, Women’s and Pelvic Health Physiotherapy Team at the Mater Mothers Hospital, South Brisbane where over 10 000 babies are born each year. Sheridan is completing a PhD through the Faculty of Medicine, University of Queensland. She is passionate about interdisciplinary practise, effective patient communication and how together we can achieve great outcomes for expectant and new parents.

Embedding Telehealth through Allied Health Innovation Grants

Miss Clare Daley1, Mr Ashley Young2

1Hunter New England Local Health District, Newcastle, Australia, 2Hunter New England Local Health District, Newcastle, Australia

BACKGROUND: Hunter New England Local Health District (HNELHD) is a large organisation within NSW Health that covers 25 LGAs, including metropolitan, regional and rural sites, and has over 16,000 employees (approximately 1500 Allied Health). For a decade, a key focus of the District has been increasing the utilisation of clinical telehealth to improve access to services for our community and reducing the impact of our large geographical area on our patients and their families. To support this, in 2015 an Allied Health Telehealth Equipment Grants Initiative was developed to encourage clinicians to establish innovative clinical telehealth services.

METHOD: An application process was developed that outlined eligibility criteria and requirements. All Allied Health staff providing direct patient care were encouraged to submit a project that could benefit through the use of desktop and specialised telehealth equipment. The grant process also allowed clinicians to formalise innovative projects, gaining executive support and empowering the clinician.

RESULTS: From 2015 to 2017, 32 allied health clinical telehealth projects were awarded grants. A reporting mechanism ensured there was ongoing accountability to complete the project, and provided an opportunity to gather feedback and learnings, and troubleshoot any issues.Once the application, review and reporting process was established, it was easy to offer grants in subsequent years.The cost of the program has been $85 000 with all equipment purchased through existing approved IT services.

DISCUSSION: These grants greatly increased uptake of telehealth by allied health clinicians in HNELHD, and is one of the key factors in why HNELHD performs over 50% of NSW’s Clinical Telehealth activity. Many projects have been recognised at the District’s annual High Value Health Care Awards. A guide and resources for Allied Health staff introducing a telehealth model of care was developed based on learnings from the projects.


Biography:

Clare is a Dietitian who has been working in allied health project and management roles for the last 5 years in Hunter New England Local Health District. One of the key initiatives Clare has worked on is increasing the utilisation of clinical telehealth amongst Allied Health staff.

Ashley is a passionate leader in the delivery of equitable and accessible healthcare. He began his career at Royal Prince Alfred Hospital in Sydney as a histology scientist, after 10 years moving into change management at NSW Health. From there he led statewide reforms in Aboriginal Health, Disability Funding, Emergency Department Access, and Immunisation Services. In 2012, he moved to Newcastle and began the implementation of Clinical Telehealth in Hunter New England Local Health District (HNELHD). This work saw him awarded Collaborative Leader of the Year for the District, and as a finalist for the Premier’s Award for ‘Making NSW a Better Place to Live’. The service is now delivering over 10,000 appointments annually to patients in their homes, community health centres, GP practices, Aboriginal Medical Services and Aged Care Facilities. Ashley is currently the Director of the Multicultural and Refugee Health Service for HNELHD.

Managing paediatric feeding disorders via telepractice: What’s being done and what services are needed?

Miss Madeline Raatz1,2, Professor Elizabeth Ward2,3, Dr Jeanne Marshall1,2

1Speech Pathology Department, Queensland Children’s Hospital , Brisbane, Australia, 2School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 3Centre for Functioning and Health Research, Brisbane, Australia

Background:  The delivery of paediatric feeding assessments via telepractice is a new and novel area of practice with limited evidence. Although there are a number of studies that have validated the use of telepractice to deliver swallowing assessments for adult clients, there are key differences between adult and paediatric services, thus limiting the transference of this evidence.

Aims: To gather information from speech pathologists (SPs) and parents of children with feeding difficulties to identify current feeding service delivery methods, the need for telepractice services, and enablers/barriers to the delivery of feeding services via telepractice.

Methods: SPs with paediatric feeding experience across Australia (n=84) completed a survey regarding feeding services, telepractice experience and perceptions of telepractice. A cohort of parents of children accessing feeding services at a state-wide clinical service (n=40) participated in individual interviews exploring issues with current services and exploring perceptions of receiving feeding services via telepractice. Information from both stakeholder groups was analysed separately, then synthesised to examine current practice and perceptions.

Findings: Although the majority of SPs and families were interested in telepractice feeding services, only 20% of SPs reported experience offering telepractice services. A range of benefits to telepractice services were identified by both groups including reduced distance/travel and the natural assessment environment. Families indicated a preference for a hybrid service model, with a combination of face-to-face and telepractice appointments. Both SPs and families raised some potential concerns about the safety and efficacy of conducting paediatric feeding assessments via telepractice. Additionally, SPs reported difficulty accessing regular videoconferencing technology and limited organisational support as a barrier to uptake.

Conclusions: Uptake of telepractice for the delivery of paediatric feeding services is currently low, however clinician and family interest is high. Further research is required to demonstrate the safety and efficacy of this service delivery model to inform clinical uptake.


Biography:

Madeline is a senior speech pathologist at the Queensland Children’s Hospital and is currently undertaking her PhD at the University of Queensland. Her PhD aims to investigate the validity and reliability of using telehealth to provide paediatric feeding services.

Highlighting Allied Health’s value in improving health informatics through a standardised data set for NSW

Mr Min Jiat Teng1

1NSW Health

Background: Allied Health in NSW have been collecting clinical, administrative and activity data since 2001. The lack of a standardised electronic system and an agreed data set has led to localised collections of information.  Data quality is further degraded as stakeholders are poorly invested in the data journey. This means benchmarking and monitoring of services throughout the state was near impossible, making it difficult to ascertain the true value of Allied Health.

Aim: To update and standardise the NSW AH MDS as an extension to the Ministry of Health’s core data set.

Design: A review of the MDS is compared to current publications to investigate its uses and quality. Consultations were conducted with Allied Health disciplines, data coordinators, and various end-users at the Ministry of Health to update the current data set. The final MDS will drive electronic data collection tools, provide data governance and be presented to the Allied Health Professions through multiple platforms.

Results: This project is still progressing. 85% of disciplines provided their expertise during the first stage in updating the MDS. Disciplines with current codesets recognise the requirement to update it to reflect their current needs, which most of them have used to support department operations or patient outcomes. The next phase is to finalise the codeset for disciplines who do not have an existing codeset.

Impact: We anticipate this will improve NSW Allied Health’s data quality, allowing better confidence in using data for care planning as decision support tools. By linking this to the Ministry’s core data set, a patient’s journey through the health system is better understood. We will also realise our value by providing more accurate information for activity-based management, workforce resourcing and benchmarking models of care.


Biography:

Min Jiat has been working as a Physiotherapist in NSW Health for the last 10 years. He has keen interests in how data can assist in service planning and patient care. With the advancement of eHealth, data collection and analysis are becoming more available and transparent. This has led Min Jiat to question whether a standardised state-level Allied Health data set can lead to better understanding of the true value of Allied Health services and it’s impact on the health system.

Saving clinicians time by introducing simplified inpatient data entry systems

Mrs Louise Maye1, Mrs Mary Caine1, Ms Clare Daley1

1Hunter New England Local Health District, Newcastle, Australia

In 2018, Hunter New England Local Health District developed a specialised system to record Allied Health inpatient activity. The development of IDAH (Inpatient Data Allied Health) provides a time efficient, clinician friendly replacement for retiring archaic data source systems to collect reportable Allied Health activity within an inpatient setting.

IDAH, was developed by the district’s own application development team, in consultation with key stakeholders from allied health, existing clinical system teams, costing and activity reporting departments with the aim to enable efficient collection of mandatory data items, and where possible, auto populating from the Patient Administration System (PAS).

IDAH access is based on logging into an internet browser page, using a network log in and bringing up defaults for the logged in user (facility, wards, provider type and role e.g. Clinician or student or AHA) which can be changed if required. The patients display on screen for a chosen ward with the key fields required for data collection adjacent – requiring the clinician to simply choose the correct patient, adjust the fields as required and add the service delivery.

The information collected in IDAH is utilised for mandatory state reporting requirements, as well as localised reporting and quality improvement tasks.

Since the roll out in June 2018, clinicians have reported an average reduction in data entry time of 60%. For the most part, this is attributable to the system’s design features that negate the need for replication of data entry, resulting in increased data entry efficiency and additional time to focus on patient care. In addition, the design of the system reduces data entry error rates through the use of actual PAS admission data and the elimination of free text entry fields.


Biography:

Louise Maye is an Allied Health Project Officer for Hunter New England Local Health District. Over the past 10 years, Louise has coordinated many projects such as telehealth, clinical supervision, clinical redesign and data reporting systems for the district, all with a key focus on providing workforce solutions to enable clinicians to streamline their practice and provide better patient care and outcomes.

Hireup, an online platform revolutionising the Australian disability sector

Mr Jordan O’Reilly

There is no doubt that the world is becoming increasingly technologically dependant, with the disability sector being no exception. In this presentation you will hear about how Hireup is harnessing the power of technology to revolutionise the way Australians with disability find, hire and manage their own support workers. Hireup is proud to have built a platform that is secure and easy to use, transparent and flexible. A system that matches people with disability and support workers not just on qualification but on shared interests. Hireup believes that bringing people with disability and support workers together over their own common ground, whatever it may be, will encourage meaningful connections, enduring relationships and (ultimately) healthy communities.

For people with disability and their families, Hireup allows users to manage their own employment relationships with support workers. Unlike other online care marketplaces, Hireup takes care of administrative back end functions like tax and super payments, insurance, payroll and workplace health and safety. For support workers, Hireup is an easy way to find flexible, meaningful work. Support workers can be anyone in the community, such as allied health students who are looking to gain more experience throughout their studies, supporting the implementation of a therapy plan for someone seeking support on a casual basis that fits in with their studies, their availability and connecting with someone they genuinely enjoy working with.

This presentation will explore how the rapid rate of growth of the Hireup community has seen the emergence of more specialised supports such as using allied health professionals that families with young children are seeking.


Biography:

Jordan O’Reilly is the co-founder and CEO of Hireup, an online platform connecting Australians with disability with support workers who fit their needs and share their interests. For Jordan, the design of Hireup comes from a deep personal experience. As a sibling growing up alongside a brother with a disability, Jordan knew how important it was for people with a disability and their families to have control of their supports and at the same time as an OT student and disability support worker he could see the untapped potential of health students looking for meaningful employment. In just 4 years, Hireup has become a community of 55,000 registered users and a platform that caters to anyone with a disability looking for a range of one-on-one supports. The innovative for-purpose business was named Australia’s fastest growing tech company by Deloitte in 2017 and a Google.org Impact Challenge winner in 2018. Jordan was also recognised as EY’s 2018 Emerging Entrepreneur of the Year.

Prior to Hireup, Jordan co-founded Fighting Chance Australia, a not-for-profit organisation that exists to enrich the lives of young Australians with significant disabilities. Fighting Chance now supports over 200 young adults on a weekly basis towards goals of employment and social inclusion.

My hip journey: Implementing a eHealth program for patients undergoing a total hip replacement

Catherine Ashford1

1Ramsay Health Care, Perth, Australia

Virtual eHealth programs to deliver individualised pre-operative preparation, post-operative and home rehabilitation to patients has the potential to increase program engagement and compliance. This may lead to enhanced recovery outcomes and reduced risk of post-operative complications.

An interprofessional team from a large private hospital in Western Australia created a virtual program for patients undergoing total hip replacement surgery. The objectives include; strengthening the lines of communication between patients and therapists, extending the relationship time between the hospital and patients, improving access to pre and post-operative education for patients in metro and rural locations, and giving patients and their support team tools to prepare both physically and mentally for their hip surgery journey.

One hundred patients undergoing a primary elective total hip replacement were recruited to participate in a six-month parallel, randomized control trial. The control group received the standard education program whilst the intervention group received the tailored virtual program called, “My Hip Journey”. Patients had access to “My Hip Journey” for two weeks pre-operatively and four weeks post-operatively. I will discuss patient feedback, consumer engagement and how this study research is expected to change our practice.


Biography: 

Catherine is the Physiotherapy Specialist Coordinator in rthopaedics at Hollywood Private Hospital where she has worked clinically in acute orthopaedics and inpatient rehabilitation. Catherine is currently leading the My Hip Journey research along with the allied health team, clinical team and researchers from Edith Cowan University. The ‘My Hip Journey’ platform was created as an alternative method of delivering information about the hospital and education to prepare patients for their total hip replacement. Real members of the allied health team, nurses, doctors and members of the executive team feature in the education videos. The goal of My Hip Journey is to connect with patients and further engage them in their preparation and rehabilitation for their surgery.

Identity stalking – the good, the bad and the criminal

Mr Tom Mason1

1Cyberman Consulting, Donvale, Australia

Every time we go online, we leave a virtual trail about who we are, what we are doing and potentially where we are going. In this presentation, I will ask for a volunteer to allow me to perform an identity hack on them and show how easy it is for anyone to uncover potentially sensitive information about them and how this can be used against them. It can be a confronting demonstration and my goal is not to scare the audience but to enlighten them about how they can follow some simple steps to be safer online.


Biography:

Tom Mason is the founder of Cyberman Consulting and Head of Sales for a data analytics software company. Many have described him as a certified geek and his profile pic clearly demonstrates this as he spent 4.5 years building his own movie grade wearable Darth Vader costume. Some say that he was not born but crafted from a computer chip but no one can deny he has a true passion for information technology. Tom is a member of AISA, the Australian Information Security Association and BECCA, the Business Espionage Controls and Countermeasures Association. He has over 20 years experience in many different disciplines of IT. In his spare time, he practices a martial art called aikido and speaks to schools, business and universities about how to stay safe online, the art of social engineering and the advances in data analytics.

Using the technology acceptance model to understand clinician barriers and facilitators in using emerging technologies for rehabilitation of the upper limb: A mixed methods study

Dr Marlena Klaic1, Dr Vincent Crocher2, Dr Justin Fong2

1Royal Melbourne Hospital, Parkville, Australia, 2University of Melbourne, Parkville, Australia

Introduction

It is estimated that up to 85% of stroke survivors have impairment of upper limb function following a stroke. Functional recovery of the paretic upper limb continues to be one of the greatest challenges faced by stroke survivors and their rehabilitation team. Clinical interventions that have the strongest evidence share a common emphasis on task-specific training applied with a higher intensity than usual care. However, there are major barriers associated with the provision of such interventions including limited rehabilitation resources and time constraints. Technological advances in robotics and gaming technology may provide potential solutions to these barriers.

Numerous robotic and gaming devices are now available, and studies have shown that use of these devices can have positive effects. These devices offer a platform for the intensity of practice of upper limb activities that is considered critical for synaptogenesis i.e. neuroplasticity. Despite the growing evidence for using emerging technologies in rehabilitation of the neurologically impaired upper limb, clinical adoption of such devices remains low. Understanding the barriers to implementation of may assist in promoting adoption.

Objectives
To explain rehabilitation clinicians intention to use emerging technologies in rehabilitation of the neurologically impaired upper limb, using the Extended Technology Acceptance Model (TAM2).

Methods
Mixed methods including surveys, focus groups and clinical observations.

Results
18 surveys were completed and 3 focus groups consisting of participants from occupational therapy, physiotherapy and exercise physiology. Clinical observations occurred over a period of 6 weeks in 3 settings, including public and private rehabilitation. Preliminary data analysis suggests that participants believe that emerging technologies can increase work productivity and effectiveness but are too complex to use.

Conclusion
The results from this study can be used to inform implementation strategies aimed at enhancing the uptake of emerging technologies into clinical practice.


Biography:

Dr Marlena Klaic is the DHHS appointed Allied Health Research & Translation Leader at the Royal Melbourne Hospital. She has 20 years’ experience working clinically in neurological rehabilitation, research and project management. Marlena was a core member of the multidisciplinary team that established the Hand Hub – Australia’s first publicly funded upper limb rehabilitation centre using emerging technologies. She was a co-author on a peer-reviewed paper on the clinical outcomes from the Hand Hub. Marlena completed her PhD on “Enhancing the uptake of evidence-based practice with allied health professionals: A quasi-experimental study”. She is currently involved in a number of multi-site studies related to emerging technologies in rehabilitation of the neurologically impaired upper limb.

12

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

Conference Managers

Please contact the team at Conference Design with any questions regarding the conference.

Photo Credits: Tourism & Events Queensland

© 2017 Conference Design Pty Ltd