Digital Health (and technology)

A New Era of Opportunity: Informatics for Allied Health

Digital Health (and technology), Oral Presentation

Ms Danielle Hornsby¹

¹Townsville Hospital And Health Service, Townsville, Australia

As electronic medical records (EMR) become common place in our hospitals nationally, allied health leaders have a window of opportunity to mine the rich data source, to rapidly change the way we measure the value of our services and our care. To harness this, we must think differently about the way our clinicians identify, collect, capture and consume data.

This presentation will challenge allied health leaders to consider the value proposition of old dated methods of data collection, and introduce an alternative prospect for mining structured data from EMRs. The presentation will provide a real case study from a tertiary hospital (Townsville Hospital), to demonstrate the organisational, operational, workforce and service impacts of switching out self-reported data, to a platform providing real-time data for clinicians, by clinicians.

This implementation, over a 12 month period, released the equivalent of eight full-time equivalent allied health professionals back to frontline care, produced a net saving of over $1million per annum, and dramatically changed the way that clinicians interacted with information dashboards to improve their day to day work. The presentation will outline the methods, toolsets and organisational change strategies used, so that other leaders can effectively advocate for new solutions within their own settings.

Biography:

Danielle, as well as her role as an Executive Director Allied Health, has been an executive sponsor for EMR implementations for the past decade in Queensland, and has first hand experience in the transformation of practice and process in hospitals related to digitisation. She has lead several state and national award winning initiatives, including pioneering the development of real-time tools for allied health clinicians to visualise service data, and the integration of biomedical equipment to transform the way that deteriorating patients are managed. She has a passion for challenging our ways of thinking about measuring allied health value, particularly the types of data that reflect contemporary health issues.

Randomised controlled trial of technology enhanced vs. face to face cardiac compression training

Digital Health (and technology), Oral Presentation

Associate Professor Alison Pighills^1,2, Ms Rachel Waye¹, Ms Stephanie Taylor¹, Ms Vicki Braithwaite¹

¹Mackay Hospital And Health Service, Mackay, Australia, ²James Cook University, Townsville, Australia

Background: Effective training in external cardiac compression (ECC) skills improves survival rates. Technology enhanced ECC training is more effective than traditional, face to face training. [1] Current annual ECC retraining cycles do not maintain competence,[1] with high frequency, low dose training required to prevent skill degradation.[2] Few studies have examined the trajectory of skills degradation.

Methods: This randomised controlled trial (RCT) examined the effectiveness of technology enhanced ECC training compared to face to face training, timeframes for skills decline and the impact of frequent skills practise. Participants included; hospital based doctors, nurses, health practitioners and operational staff whose roles might involve ECC.

The intervention group received technology enhanced skills training and objective feedback via the Resuscitation Quality Improvement (RQI) training system. The control group underwent traditional ECC training.

The RQI system provided objective measures of rate, depth of compression, release and hand position to give an overall score (%). A score of 75% or over indicated competence. The system recorded the number of times staff practised ECC skills.

Results: 502 participants were recruited to the trial. Baseline results showed that 21% of staff were competent at ECC which increased to 38% on re-assessment. Only 16% of the 75 Health Practitioners, were competent at baseline increasing to 47% on reassessment. Health practitioners showed the greatest increase in skill level following training. There were no statistically significant differences between groups in ECC skill level on reassessment (p=0.941). Only 73% of participants attended ECC training and those who received training achieved higher competency scores (p=0.001). The mean time to decline in skill score was 32 weeks. The participants who practised ECC between assessments had a statistically significantly higher mean score than those who didn’t (p=0.02).

Discussion: ECC training increased healthcare staff skill levels, but neither training modality was more effective than the other.

References

Cheng, A., et al., Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial. JAMA Pediatrics, 2015. 169(2): p.137-144.
Mundell, W.C., et al., Simulation technology for resuscitation training: a systematic review and meta-analysis. Resuscitation, 2013. 84(9): p.1174-1183.

Biography:

Alison completed her PhD in 2008 at the University of York, UK, which involved a RCT (n=238), to evaluate the clinical effectiveness of environmental assessment and modification to prevent falls in older people. She was awarded the University of York K M Stott prize for the best PhD thesis. She is currently a co-investigator on a multi-centre RCT in the UK (n=1333) which replicates her PhD research on a larger scale. Her research interests include: falls prevention, rural and remote models of care, professional skill sharing and delegation; and, research capacity development.

Introducing eHealth into Physiotherapy care for enhanced recovery caesarean patients

Digital Health (and technology), Lightning Talk

Mrs Joanne Crowley¹, Mrs Sheridan Guyatt^1,2

¹Mater Health Services, South Brisbane , Australia, ²Universtiy of Queensland , St Lucia, Australia

Across Australia and worldwide, maternity hospitals have successfully introduced enhanced recovery caesarean birth models of care, aiming for new mothers to discharge home approximately 24 hours after Caesarean birth.

In 2018 Mater Mothers Hospital introduced their own Enhanced Recovery Caesarean Section (ERCS) model of care, implemented by a multidisciplinary team. Key to the success of this program is early mobilisation (usually within 4-6 hours). In addition to standard post-operative care, preoperative physiotherapy intervention was identified as an opportunity to optimally prepare patients for early mobilisation and successful facilitation of a 24-hour discharge.

Initial attempts to provide preoperative physiotherapy care face-to-face proved inefficient and resulted in inconsistent patient care. The A3 Thinking Tool for problem solving was used to investigate alternatives that were effective, timely and efficient. Electronic health (eHealth) was identified as an option for providing preoperative physiotherapy. Women participating in the ERCS program were sent an email with written, pictorial and video attachments in the week prior to their delivery that they were able to access in their own time. Patient outcome data was collected from care pathways and within physiotherapy treatments.

Preliminary results:

High patient acceptability of pre-operative physiotherapy delivered via eHealth methods
Cost effective with reduced physiotherapy occasions of service and decreased length of stay
Effective care outcomes with 61% of women mobilised within 6 hours and reduced use of schedule 8 medication (oxycodone)
Successful implementation of Physiotherapy eHealth and subsequent expansion of material sent to patients to include a multidisciplinary inpatient care guide.

This quality improvement project demonstrates that implementing an eHealth model of pre-operative physiotherapy care is an acceptable, effective and efficient treatment option for this group of patients and has the potential to extend into additional clinical caseloads in the future

Biography:

Jo Crowley is an experienced physiotherapist having worked for many years in both the private and public sectors in Queensland. For the last 10 years she has worked primarily in women’s health in clinical and team leader roles within Mater Mothers and Mater Mothers Private Hospitals. She has a passion for providing quality obstetric care to women in both the inpatient and outpatient setting. She also enjoys working with multidisciplinary teams in providing antenatal education in community based outreach clinics to vulnerable obstetric populations.

Paediatric Speech Pathology via Telehealth

Digital Health (and technology), Oral Presentation

Jessica Hajdu¹

¹Queensland Health, Redcliffe, Australia

The Speech Pathology team at Redcliffe Hospital was awarded project funding to establish and provide a telehealth service to paediatric outpatients. Prior to this, there were no telehealth services within Metro North for Paediatric Allied Health.

Our aim was to:

Support communication and feeding development for children in their homes.
Enable easier access to therapy for our consumers
Decrease FTA rates
Increase parent/carer satisfaction due to improved access to services
Provide more frequent appointments to high risk patients
Empower parents/carers to meet the communication and feeding needs of their child within their own environment

Telehealth services were offered to appropriate patients. Parents/carers were sent an online survey after every telehealth occasion of service to collect satisfaction data. Information was also recorded about connection, quality, technical issues, and the distance and time saved in travelling.

Results to date include:

90% of survey respondents reported they agreed or strongly agreed they were satisfied with the health care they received via telehealth
We have saved patients from 3102kms and 67hours of travel
From the consumers point of view, any dissatisfaction with the telehealth service was in relation to technical difficulties/internet connection
Getting buy-in from families and encouraging them to try telehealth was a challenge

Establishing a paediatric outpatient Speech Pathology service at Redcliffe Hospital has been a positive and rewarding experience. Families are empowered by receiving support for their children in their home, without the challenges sometimes associated with attending appointments. We faced challenges around technology and internet connection, and with encouraging consumers to try this mode of service delivery. This project has enabled the speech pathology department to become Allied Health leaders in telehealth at Redcliffe Hospital, and establish resources and networks that will enable us to continue to provide this service.

Biography:

Jessica Hajdu is a Paediatric Speech Pathology based at Redcliffe Hospital. She graduated from The University of Queensland in 2009 and has worked in various paediatric positions since then in Australia and the United Kingdom. As the sole paediatric speech pathologist for Redcliffe Hospital she provides both an inpatient and an outpatient service for children from birth to 16 years of age. She enjoys working with children and supporting families to help their children reach their potential especially with feeding difficulties and early language acquisition.

Development and implementation of a multi-disciplinary training package to improve the confidence and competence of clinicians in the use of Telepractice for outpatient services

Digital Health (and technology), Lightning Talk

Mr Michael Harris¹, Ms Naomi Scolari², Mr Denis Morton², Ms Sarah Fulton¹, Ms Rachel Domalewski¹, Dr Laurelie Wishart³, Ms Kelly Hale¹, Professor Elizabeth Ward⁴

¹Metro South Health – Bayside Health Network, Cleveland, Brisbane, Australia, ²Metro South Health – Chronic Disease Service, Brisbane, Australia, ³Metro South Health – Allied Health, Brisbane, Australia, ⁴Centre for Functioning & Health Research, Brisbane, Australia

The integration of telepractice into aspects of routine clinical care remains limited despite technological advances and policy changes, substantial investment, and a growing literature base. Appropriate education and training has shown to be integral to the success and uptake of telepractice, especially for patient related interventions. Staff confidence and perceptions are also integral to the successful implementation of telepractice, as clinicians are responsible for promoting the use of telehealth by selecting and referring suitable patients.

The ultimate objective of this work is to support and promote the uptake of telepractice service delivery models to provide services to outpatients, and to develop a sustainable and skilled health workforce with a positive culture towards telepractice models of care in the future.

The aim of the current project is to develop, implement and evaluate a telepractice training package for clinicians at Redland Hospital.

Telepractice training has been delivered to staff across 3 teams: Chronic Disease, Physiotherapy and Speech Pathology. The training has consisted of:

An introductory PowerPoint presentation
Self-paced online training
Access to a training manual and printed resources
Practical demonstrations
Clinical simulations

Pre- and post-training surveys were used to measure change in clinicians’ perceived skill, confidence and perceptions using telepractice for outpatient related activities. The pre- and post-comparisons collected from the clinician surveys were analysed using non-parametric Wilcoxon signed-rank tests.

Statistically significant (p<0.001) increases in perceived knowledge were seen post-training as well as significant increases in confidence for both clinical and non-clinical use of videoconferencing post-training.

Results to date suggest that a telepractice training package is an effective method of developing and sustaining staff skill, knowledge and confidence in the use of telepractice. This research will further evaluate whether this translates into increased uptake of videoconferencing-based telepractice service delivery.

The preliminary results suggest that a comprehensive and varied training package is effective in increasing perceived skills and knowledge and increasing confidence for both clinical and non-clinical uses of videoconferencing. We are yet to determine whether this translates to increased use of videoconferencing 6 months post-training, which will be measured in the final phase of this project.

Biography:

Michael is the Director of Physiotherapy & Podiatry, Bayside Health Services. The Bayside Health Service is part of the Metro South Hospital and Health Service and includes Redland Hospital, Wynnum-Manly Community Health Centre, Gundu-Pa and the Marie Rose Centre on North Stradbroke Island.

Michael has an interest in the utilisation of telehealth to improve access to services for clients of the Bayside Health Service with a particular focus on those that live on the Moreton Bay Islands.

Michael is presenting today on behalf of a multidisciplinary research team led by Principal Investigator, Denis Morton (Chronic Disease Team Leader, Redland Hospital). Other co-investigators include Ms Sarah Fulton (Speech Pathologist), Ms Kelly Hale (Speech Pathologist), Ms Rachel Domalewski (Physiotherapist), Ms Naomi Scolari (Dietitian), Dr Laurelie Wall (Research Workforce Development Officer) and Professor Elizabeth Ward (Professor, Centre for Functioning & Health Research).

Realising the benefits and avoiding the pitfalls of automation: A state-wide clinical service delivery initiative

Digital Health (and technology), ePoster

Dr Rachel Brough¹, Ms Kristen Morris¹

¹Medical Aids Subsidy Scheme – Queensland Health, Cannon Hill, Australia

This presentation gives an overview of the allied health team’s role in developing eApply, an online application system now in use at Medical Aids Subsidy Scheme (MASS).

eApply was developed to improve the efficiency of the assistive technology (AT) application process at MASS for:

Prescribing therapists, by eliminating the ability to accidentally omit key information and providing a user-friendly interface that reduces completion time of applications
MASS, by replacing manual checking of form data with automated algorithms and reducing the number of applications requiring clinical review
Clients, by tracking their own application progress and reducing delays.

A critical success factor for the project was the involvement of the allied health team in all stages of development, from specifying requirements to the vendor, through to supervision of testing and acceptance of the system. Clinical judgement was essential in determining where automation is effective, and where it is not realistic.

The allied health team conducted a systematic review of clinical work flow processes and developed written specifications for these. The review and specifications document were incorporated into the design of eApply by the program vendor through a process of collaborative development and testing.

The allied health team also played an important role in organisation change management, helping staff at MASS navigate the perceived threat that automation poses to job security.

Implementation of the eApply online application resulted in improvement in both internal and external processing times of applications. The project also resulted in identifying other areas of work practices that could be improved as well as increased opportunities to focus on other areas of work for all staff.

The process of involving the allied health team in the lifecycle of the project to translate clinical decision making can be applied by other organisations interested in converting aspects of clinical practice into a digital system.

Biography: To be confirmed

Barriers to uptake of low intensity digital mental health apps and online programs in Allied Health. Defining the Policy Landscape

Digital Health (and technology), ePoster

Dr Ruth Crowther¹, Mrs Heidi Sturk¹

¹Queensland University Of Technology (QUT), South Brisbane, Australia

Globally, a considerable amount of funding has been invested in the development and delivery of low intensity, digital interventions for mild to moderate mental health issues. Despite such investment however, countries have achieved varying levels of success in increasing the uptake of these interventions, despite the ever increasing and compelling evidence base for their effectiveness.

In the Australian context the National Mental Health Commission’s Review of Mental Health Programmes and Services reported that digital services had been poorly integrated and difficult for people to access and navigate. In response, the Department of Health invested $4.7 million for 2018/2019 towards ongoing development and refinement of the digital gateway Head to Health, with a key aim being to increase awareness and uptake of digital mental health apps and programs.

Despite this increase in funding and the work of eMHPrac partners in providing training in selection and utilisation of digital mental health resources in clinical practice for all health professions, uptake appears to be slow with ongoing barriers being reported. A challenge remains that much of the evidence showing effectiveness of digital interventions does not necessarily provide information on how such interventions can be embedded effectively within the existing health system. Yet, mental health experts and advocates remain optimistic that digital mental health programs have huge potential to enhance accessibility and increase cost-efficiency of services, whilst overcoming geographic obstacles to service utilisation and promoting consumer empowerment.

This presentation will therefore consider the current policy landscape and the systemic challenges associated with removing existing barriers and increasing uptake of low intensity digital interventions in Australia. It will draw upon the policy drivers and organisational factors that have been shown to be effective in other parts of the world, specifically the UK, Sweden and the US, and consider their application in our unique Australian context.

Biography:

Dr Ruth Crowther is a Senior Research Fellow on the eMHPrac (e-Mental Health in Practice) project. Ruth’s role is to develop, deliver and evaluate national training on digital mental health resources to allied health practitioners and service providers. Her research interests include the integration of digital mental health resources into healthcare, and effective implementation of evidence based mental health policy. Ruth has over twenty years experience in applied mental health research, public health and teaching in both the UK and Australia and is a member of the APS E-Psychology and Buddhism and Psychology Interest Groups.

Establishing Telehealth within Redland Hospital’s Physiotherapy Musculoskeletal Management Clinic’s model of care to improve patient access to services

Digital Health (and technology), ePoster

Vicki Parravicini¹, Andrea Jeffrey¹, Karen Lucas¹, Mr Michael Harris¹

¹Queensland Health – Metro South, Brisbane, Australia

Background: The Physiotherapy Musculoskeletal Management Clinic and Conservative Management Service (PMMC and CMS) is an allied health-led multi-professional conservative management alternative pathway for clients referred to the Redland Hospital Orthopaedic Specialist Outpatient Service. The aim of the service is to reduce the Orthopaedic wait list and support timely access to appropriate care. The service provides patients with earlier access to an expert assessment by an Advanced Musculoskeletal Physiotherapist, whose role is to assess, diagnose and provide multi-professional allied health case management. This management includes physiotherapy, nutrition and dietetics and psychology.

Objectives: The purpose of this project is to improve access to the service by enhancing Telehealth capability and utilisation within the Redland Hospital PMMC and CMS. This project will deliver services by the allied health team at the Redlands facility directly to the client’s home. It will provide an alternate option to benefit clients who live on the Bay islands, mainland clients whose work commitments limit access to Redlands Hospital during business hours, and those who have difficulties accessing the service.

Project Implementation: December 2018 – June 2019.

Project Evaluation: Project Evaluation will be completed in July 2019 with data to be presented at the Allied Health Conference in August.

The project evaluation will include: Demographic information, Clinical outcome measures, Episode details, Discharge outcomes, patient satisfaction and Clinic productivity data (Occasions of Service, FTA/Cancellations rates). Barriers, enablers and key lessons learned will also be discussed.

Discussion: Currently 80% of face to face clients who attend the PMMC and CMS at Redland Hospital remain off the Orthopaedic Wait List. The aim of this project is to examine whether Telehealth can provide improved access for clients and deliver similar clinical outcomes compared to face to face. It will also aim to establish Telehealth within the existing PMMC and CMS model of care and increase the application of Telehealth by other allied health professions and teams.

Biography:

Vicki is an Advanced Musculoskeletal Physiotherapist working in the Physiotherapy Musculoskeletal Management Clinic and Conservative Management Service at Redland Hospital. She is the team leader of a multidisciplinary allied health team that aims to reduce the Orthopaedic Wait List by providing earlier assessment, diagnosis and multi-professional allied health case management. She has a Masters Degree in Musculoskeletal and Sports Physiotherapy and was a physiotherapist at the Commonwealth Games at the Gold Coast for Track and Field. She has also worked as a physiotherapist with the Queensland Academy of Sport Track and Field Jumps Squad and has in interest in Telehealth.

Supporting Allied Health professionals to find and use reliable mental health apps and online programs with their patients

Digital Health (and technology), ePoster

Ms Heidi Sturk¹, Dr Ruth Crowther¹, Professor David Kavanagh¹

¹Queensland University Of Technology, South Brisbane, Australia

There is fast-growing interest in the use of apps and online programs for mental health and wellbeing. Many allied health professionals are keen to recommend these to their patients but are unsure where to start and how to integrate into their practice. We can feel overwhelmed by the large amount of online resources available so it is important to know how to find those which are evidence-based and reliable.

Many people do not receive face-to-face help for their mental health for a variety of reasons. Digital mental health resources can provide an easily accessible method of help and can be effective for people who have mild to moderate mental health issues or are going through difficult times. These resources also cover a range of health topics that impact wellbeing such as managing chronic pain or parenting support.

The Australian Government has funded the E-Mental Health in Practice (eMHPrac) project to raise awareness of digital mental health resources. The project provides free nationwide training and support to health practitioners about digital mental health and how to use these resources with clients. This training includes face-to-face workshops, awareness presentations and online webinars and modules. The project is led by Queensland University of Technology in collaboration with Black Dog Institute, Menzies School of Health Research and University Centre for Rural Health, University of Sydney.

This presentation will outline how to find and assess apps and online programs and resources to support the mental health and wellbeing of patients. It will also present features of the new Head to Health website which links people to trusted online and phone mental health services. There are some excellent resources available and the presentation will give some examples and also discuss how to integrate them into practice.

Biography:

Heidi Sturk is the Deputy Director of eMHPrac (e-Mental Health in Practice) at Queensland University of Technology. Heidi delivers national training and support on digital mental health resources to GPs, allied health practitioners and service providers working with Aboriginal and Torres Strait Islander people. She has a Masters in Organisational Psychology and 25 years’ experience in applied mental health research. Her areas of interest include how to integrate appropriate digital technologies into health care, rural and remote mental health, and wellbeing of health practitioners.

CALD Assist: Developing technology to assist communication between clinicians and patients from CALD backgrounds

Digital Health (and technology), Oral Presentation

Miss Courtney Pocock¹, Dr David Silvera- Tawil², Ms Sally Brinkmann¹, Dr Jill Freyne², Dr Dana Kai Bradford², Ms Andrea Donnell¹, Ms Karen Harrap²

¹Western Health, St Albans, Australia, ²CSIRO, ,

Interpreters are required to aid communication between clinicians and patients from Culturally and Linguistically Diverse (CALD) backgrounds to ensure appropriate and timely care. It is often not practical for interpreters to be present for daily basic care interactions. Western Health and CSIRO have built upon the CALD Assist- Allied Health app to design, deploy and evaluate a solution to support communication between nursing staff and patients from CALD backgrounds during daily basic care interactions.

CALD Assist utilises key phrases translated into ten common languages using pictorial, written and voice-over prompts.

A user needs analysis incorporating staff focus groups and patient interviews was completed to identify technology and content requirements of CALD Assist. A four month impact analysis was conducted incorporating staff satisfaction focus groups and surveys, structured patient interviews, app usage log analysis and observation data collected before and after the introduction of CALD Assist to determine the impact on the patient experience and safety.

Results from focus groups and interviews demonstrated participants were enthusiastic about the development of CALD Assist. Results suggest that staff confidence of the patient’s level of understanding of interactions (p<0.001) and their perception of the success of interactions (p<0.001) were significantly higher with use of CALD Assist compared to without CALD Assist.

CALD Assist harnesses the use of new technologies to directly improve patient care in partnership with them. This app has significant potential to deliver safer, higher quality care to a potentially vulnerable population and may reduce inequity in healthcare delivery although this warrants further evaluation.

Biography:

Courtney Pocock was the original creator of the CALD Assist concept and methodology. Courtney is a senior Speech Pathologist at Western Health. She has experience across the continuum of care, and is currently working within subacute inpatient care services. Courtney has led a number of projects within Speech Pathology and Allied Health and has most recently been the project manager for the development of the CALD Assist iPad app.