Hazel Archer, Allan Houston, Robert Carachi
SMJ 2005 50(4): 143-144
The Scottish Paediatric Telemedicine Project aims to provide a national telemedicine network to support clinical services in paediatric care. The Project commenced as a pilot involving five linked hospitals in Spring 2004 and has been rolling out since the start of 2005 to a further five sites. Funding was provided by the Scottish Executive Health Department’s Telemedicine Initiative, with the goal of demonstrating whether the technology could provide robust support to address a clear clinical priority area in paediatric services across Scotland.
A review conference in June 2005 had a twofold purpose. Firstly, to bring together the most up to date results on the implementation of the paediatric telemedicine network and, secondly, to present to the wider user group (clinical and managerial) the possible uses of the system and to collate their proposals for the future of the network.
The day itself provided examples of a telemedicine network which is supporting a very positive and diverse range of uses across paediatric services. In effect, this ‘mini’ telemedicine conference of innovative paediatric applications put the uses not the technology to the forefront and highlighted how Scotland-wide telemedicine - although not yet a fully integrated part of clinical services - is providing the essential communications infrastructure to support clinical staff in delivering paediatric care.
The original scope of the project (surgical and cardiac consultations) was always expected to be a vital but partial picture of how uses could develop. This has proven to be the case with cardiac and surgical consultations accounting for less than half the total number of telemedicine sessions. Some of the emerging uses of the system are:
Child Psychiatry
Dr Michael Morton from the Department of Child and Family Psychiatry in-patient unit at Yorkhill reported that the use of telemedicine in child and adolescent psychiatry has steadily grown over the last year. From a total of 52 meetings held, 15 were for case conferences and 25 for direct clinical work. Feedback from the users of the service indicate that the system saves travel time and cost. Improvement in participation has also been noted, in particular it has been possible to engage with patients by controlling the remote camera. The system has also provided a mechanism for skill sharing and improvements to handover at admission and discharge.
Tumour Board
Dr Milind Ronghe, Consultant Paediatric Oncologist at Yorkhill reported on the success of holding multi-site tumour board meetings. These are multidisciplinary meetings, attended by oncologists, surgeons, pathologists, radiologists and other relevant specialists. Clinical cases are discussed, along with examination, radiology and pathology results, and management decisions are made. Three successful meetings have been held involving Glasgow, Edinburgh, Dundee and Aberdeen. An international link to Jordan has also been held. Advantages realised have included: improved networking and collaboration; no travelling involved; shared care centres allowing more involvement in the decision making for difficult cases; improved education and training for SpRs; and increased motivation.
Babycam
Dr Chris Lilley, Consultant Neonatologist at the Princess Royal Maternity has been using the telemedicine system since it was installed in April 2005. At this time it was recognised that it would be possible to use the device to broadcast pictures of the baby to a mother who was unable to visit due to her own medical condition. To assess this novel use of the equipment a trial was set up involving a patient staying in the plastic surgery ward for 6 weeks, 1/ 4 mile away. Following the success of the trial a small device was purchased and connected to the hospital IT network. This allows the device to be positioned at the mother’s bedside. Although nursing staff were initially a little self conscious and wary of the technology, they quickly learned how to use the system and are supportive in its use. Feedback from mothers has been very positive.
Tele-Education
Dr Sheena Kinmond, Consultant Paediatrician from Ayrshire Central Hospital reminded the conference that education is needed for: junior doctors for college requirements and modernising medical careers; senior doctors for continuing professional development; medical students; and other staff. Telemedicine can help informally as every telemedicine consultation is a learning experience and formally through lectures, case presentations and other discussions. Currently the Yorkhill Tuesday CME meetings are broadcast on a weekly basis to up to 4 sites, thus avoiding duplication of effort and crucially allowing maximal attendance. It also has the added benefit of keeping trainees in touch with the tertiary centre and raises awareness of DGHs in the tertiary centre.
Infection Control
Dr Craig Williams, Consultant Microbiologist from Yorkhill told the meeting about another example of an emerging use of telemedicine during a recent influenza outbreak in the Western Isles and the subsequent management of the outbreak by the Infection Control team. Following the set-up of an outbreak committee a number of difficult decisions had to be made regarding how and when to use Tamiflu, how to identify and treat the vulnerable population and how to increase vaccination rates. By using the telemedicine link over a series of meetings it was possible to provide high levels of support from the infection control doctor and Health Protection Scotland and improve working relationships between those based on the Mainland and member of the Island infection control team. It was also possible to optimise the usage of expensive medication. The final outcome was that the flu epidemic was contained and never became an issue on the mainland.
The conference acknowledged the difficulties still encountered in implementing telemedicine, and the fact that many in the wider NHS community do not see telemedicine as a priority. However, the key message from this conference is that the main aim is to improve provision in paediatric care. While the technology involved is innovative, it is not the focus of the network.