Telehealth on the other side of the world

[dwwakefield]

Hi all,

I'm one of three Telehealth Development and Support Officers in the Telehealth Tasmania Network (TTN) - part of the Dept of Health and Human Services in Tasmania.
We currently have an IP network of 35 locations all around the state but are in the process of applying for funding for an exciting and very large increase in our capacity.
The network is almost totally Polycom - EX, MP512, VSX6000 and VSX7000 with an Accord MGC50. We also use Polycom GMS and Path Navigator.

Examples of the kinds of medical events we host are:

Oncology specialist clinics accessed from remote areas of the state
Dermatology clinics between King Island and Launceston General Hospital
Parkinson’s clinics with Elsternwick Private Hospital, Victoria
Cardiology – weekly case-conferencing
Oncology/Haematology – weekly case reviews between Acute hospitals (soon to include rural hospitals)
Bone Marrow Transplant Team (client co-ordination statewide)
Mental Health Case Reviews (daily)
Mental Health Grand Rounds (weekly Launceston, Burnie, Hobart)
Mental Health Review Tribunal Hearings
Paediatrics Clinic Appointments
Complex and Exceptional Clinical Needs Case Reviews
Plastic Surgery follow-up consultations/reviews
Palliative Care – GP care planning conferences
Disability Services, Child Protection, Child Health
Continence Education, Nutrition network
Rural Hospital Staff – Pharmacy Education Program
Cancer Council Review Meetings
Clinical Accreditation Meetings
Intensive Care Case Reviews – patient transfer follow-ups

Medical education events include:

Palliative Care – training delivery to rural sites to various topics
Continence nursing education – training conferences run from all major areas of the state to nursing staff in rural centres
University Department Rural Health – Medical Student rural Placements
monthly seminar series involving up to 15 sites
Physiotherapists –professional development
Royal Australian College of Physicians Lectures
Royal Adelaide Hospital Anaesthetics CME
Renal Unit Professional Development
QEII Renal Education Sessions
Post Graduate Nurse Education
Paediatrics Various Training
Obstetrics and Gynaecology Training Sessions
Australian Nursing Federation Training Sessions
Austin Hospital Doctor Education Sessions
Occupational Therapy Training
Continuing Medical Education – content provided by Global Telehealth in Victoria to our teaching hospitals – six sites four nights per week accessing Specialist College courses
Alzheimer’s Australia – Aged Care Training
Elsternwick Parkinson’s Education

The network as it stands saves costs of around $4million pa at the moment and these are only the quantifiable costs.

In the next couple of months we will be commissioning new tele-echocardio endpoints that have been developed in Australia by a leading scientific agency. These units interface with hospital echocardio machines and will send echo traces and patient audio/video over 100mbps links between 3 major sites.

A major frustration for us is our network provider's inability to get external IP calling working satisfactorily for us. At the moment we have to use the gateway to reliably access the outside world and that just introduces extra administrative overhead for us as well as deterring some users on the basis of cost.
I'd be interested in hearing how people have external IP working from behind firewalled networks. Is anybody using border controller devices?

[barita_lola]

Well friend, Now days everywhere the health sector is in the midst of a crisis. The need to halt the current cost explosion has found wide acceptance – but can this be done without sacrificing quality of care? Against this background many have placed their hopes in telemedicine, which seems to offer a solution to a lot of the problems facing the health services.

[TelehealthMan]

Hi Dwwakefield;

Interesting list of activities, we are on the opposite end of the Earth and there is much in common. I run a telehealth network in Northwestern Alberta, Canada. We are running many of the same clinical and educational services that you are.
We have a Province wide Fibre Optic backbone MPLS network here in Alberta (www.albertasupernet.ca). It is a private government network with QoS and at first we had lots of technical issues. Firewall traversal was one of the biggest issues. You will need to implement some firewall traversal technology to overcome this issue.
Tandberg and Polycom have traversal technology, talk to your sales rep and get them to put you in touch with one of their engineers to detail a potential solution for you.
Regards
Telehealthman

[dwwakefield]

Telehealth Man - we're about to undergo a major expansion to our network, from 40 sites to 120. We will be upgrading all network components and have included a border control solution in our tender.
We did get around the lack of external IP connectivity eventually. It's hard to ascertain from the key players what the reasons were but I suspect both a problem with the configuration of our old Accord MGC50 and problems with our network connections to the outside world.

We have been conducting a small number of external IP calls both within Australia and overseas. The limiting factor seems to be the lack of available IP sites without firewall issues or similar.

The way we work at the moment is ugly but effective and I'm looking forward to the new network.