Scenario: Remote consultation

From DoHA Medicare Rebates for Telehealth Brochure.

Mary lives on a dairy farm in NSW, twenty minutes drive from Bega. Mary’s local GP is Dr Sharma, who detected Mary’s respiratory disorder in 2010. Dr Sharma referred her to Dr Brown, a specialist based in Sydney, and she has recently finished her treatment. She should now see Dr Brown every second month for a follow up consultation. However, Mary finds it difficult to find the time and money to travel to Sydney. At Dr Sharma’s suggestion, and with Dr Brown’s agreement, Mary begins attending consultations via telehealth. A practice nurse attends each consultation, on Dr Sharma’s behalf, to provide clinical assistance. Mary is bulk billed by Dr Sharma and Dr Brown. In this case, each practitioner receives MBS rebates and financial incentives from Medicare Australia.

From GP and Specialists Telehealth Enablement  Perspective

Dr Sharma and Dr Brown agree that Mary would benefit greatly by not having to travel to Sydney for her follow up visits. They decide to take steps to become Telehealth Enabled.

Dr Sharma

Dr Sharma has decided that a practice nurse will be the best person assist Mary with her attendance to Specialist Consultation via Video. The practice would benefit from a facility independent of Dr Sharma’s usual room so that these appointments do not conflict with local appointments. The consultations are general in nature and so do not demand a custom room and hardware video conferencing unit.

After speaking with an expert on Video Consultations, Dr Sharma decides that enabling another room in the practice with Video Conferencing Software and Services is appropriate as it will provide adequate quality for most of the expected uses.  On advice from the VC expert the practise contacts their existing ISP and asks for an upgrade to ADSL2+. This is confirmed as available and they are given a 3 week lead time for commissioning.

The specification of an existing PC is confirmed as suitable, so the only other equipment necessary is a $130 HD Webcam and an Echo Cancelling Speaker Microphone. The room is small so they opt for a basic model costing around $300. They order these online from a popular supplier and receive them in a week. The hosted Video Conferencing service they have decided on has an online sign up process which they complete and follow on to do basic tests with their new equipment. A training session is organized for the practise nurse. This session is started on the phone and then continues through the appointment process to use the Video solution to complete her orientation.

Dr Brown

Dr Brown speaks with Dr Sharma about their experiences in getting enabled and decides to follow a similar path. He decides though, that he would like to stay at his normal desk in his rooms where he already sees most patients. After checking his internet speeds against those recommended for his solution choice, he finds he requires no upgrade to proceed. He gets the model numbers and supplier details of the peripherals from Dr Sharma and orders them online. When these arrive he installs them to his PC following the quick instructions.

As Dr Sharma is the initiator of the Telehealth service, Dr Brown only has to respond to requests from Dr Sharma’s practise to join a virtual appointment. He does not need to sign up for any particular video service.

They organize a test run of the appointment process. This is led by the practice nurse who has already received the orientation. The nurse assigns a new access key to a virtual video meeting place where the appointment will take place. She provides a unique link including credentials to Dr Brown. He enters this link into his browser and follows a few simple steps to install the required software and enters the video appointment.   Dr Brown comments on the simplicity of the process but notes that the video quality could be better. Dr Sharma’s nurse informs him that they are still waiting on their ISP to complete the ADLS2+ upgrade and they expect better quality in time for Mary’s first scheduled follow up.

The ISP upgrade is completed a week later, so the nurse organizes another quick test to confirm video quality. Dr Brown confirms he is now happy that the quality would support his needs for the consultation. The nurse notes that Dr Brown's video image is high definition but quite dark and suggests that he organize some additional lighting from in front of his desk so that he looks more natural and Mary will be able to communicate more easily.

The time of the first scheduled follow up consultation has arrived and Mary is accompanied into the Telehealth Enabled room by the practice nurse. She enters the virtual video appointment room assigned for this consultation and they wait for Dr Brown to arrive. He is running just a little late.   Dr Brown finishes with his current patient and looks to his online calendar to find his next appointment. This is noted as a Telehealth appointment and has a link which he clicks on.  As the previous desktop tests have installed all the software and established the correct configuration of lighting and peripherals, he enters the video appoint in several seconds. He greets Mary and the nurse and then commences with the consultation.