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Pioneers network technological frontier

The Australian, April 30

Pioneers network technological frontier

By Trudi McIntosh

During the past five years Australia has continually forged a world-class reputation for exploring the potential of telemedicine networks.

The tyranny of distance has provided a powerful catalyst to push the technology frontiers further.

A range of staff training projects and diagnosis programs are running successfully on a number of telemedicine links in various States.

During the past 18 months a pioneering project in renal telemedicine in South Australia has also been attracting international attention.

The renal dialysis telemedicine network used live audio and video links between The Queen Elizabeth Hospital in Adelaide and dialysis centres at Wayville, North Adelaide and Port Augusta, 300km away.

Telemedicine and 3-D imaging experts from the Silicon Graphics Biomedical Systems research laboratories in Israel recently visited TQEH and the South Australian Health Commission to see the telemedicine network.

TQEH's renal unit has long been recognised internationally for its management of kidney failure.

The guiding force behind the hospital's renal telemedicine project, Dr Alex Disney, said he could not keep the project running without his local team and the input from staff and patients at the network's remote sites at other hospitals in South Australia.

Dr Disney and his team have completed a number of successful phases in the telemedicine project.

Their latest quest involved expanding the unit's course delivery in the graduate diploma in nursing (nephrology) to nurses at Alice Springs and other interstate training sites.

The renal unit network now enabled staff at Port Augusta to undertake the graduate diploma in nursing in their home towns.

Last month The Australian visited TQEH's renal telemedicine site and spoke to patients and staff at Port Augusta via the videoconferencing links.

TQEH's telemedicine network expertise will be shown live to a global educational technology conference at Adelaide in September.

More than 2000 national and local delegates are expected to attend LETA (the Learning Environment Technology Australia '96), from September 29 to October 4.

LETA project manager Mr Trevor Temple said the global conference would explore on-line education, technology in health education, particularly telemedicine, and planning and architecture concepts for 21st-century communities.

Both Telstra and PictureTel, which supply most of the hardware for the TQEH network, have praised the hospital's pioneering efforts.

Ms Rhonda Whitfield, Telstra's national manager for health, said the hospital's telemedicine network was 'an outstanding display of using modern telecommunications to deliver quality health services at an economic cost and to provide greater accessibility for patients to quality care".

Dr Disney, who is also the senior staff nephrologist at TQEH, said one of the most interesting aspects of the network was its simple and effective use of technology.

"Although we had to adhere to a budget, we were still able to build and adapt this network," Dr Disney said.

"Our project has proved that you don't need state-of-the-art technology and wizardry to put these important and very practical networks in place".

The renal dialysis telemedicine project began in June 1994, based on a plan developed by Dr Disney and Dr Timothy Mathew.

The TQEH renal unit provides dialysis to a total of 145 patients at its four centres.

Each patient normally requires dialysis three times a week and attends an outpatient clinic every two months.

The renal unit also cares for 29 patients who received dialysis at home. Dr Disney and Mr John Mitchell, the renal telemedicine project manager, said one of the biggest advantages of the renal telemedicine network was that it reduced the stress of many patients who previously had to be driven up to several hundred kilometres to Adelaide for special treatment. So far the South Australian Health Commission has provided much of the funding. But Dr Disney said the next challenge for the unit was to attract industry funding to help it expand the telemedicine network and upgrade technology in the next five years.

Mr Mitchell has written two reports about the successes of the project.

He recommends in his reports that TQEH's renal dialysis telemedicine project be expanded to provide more training and technical support for a wider base of users.

Mr Mitchell also recommends that collaborative business arrangements be made with videoconferencing technology providers and suppliers to provide support for further research and development.

The report also recommends Dr Disney and his team develop a package of telemedicine services for Darwin and the Asia-pacific region, as well as collaborative telemedicine agreements with Asian health organisations. Given a larger budget, Dr Disney and his telemedicine team would like to provide ISDN connections to improve the quality of its network , but Australia's high ISDN charges limited that considerably, as they did for most other hospitals.

Dr Disney also wants to explore the role of electronic stethoscopes capable of operating with codec in the telemedicine network.

He wants to introduce multipoint operations trialed and evaluated, particularly for educational courses.

"We would also like to develop pilot activities with other hospitals and interstate bodies - there is so much scope for this network, across the nation and overseas, particularly in the Asia-Pacific region," Dr Disney said.

The TQEH has already spoken to an Indonesian hospital about its telemedicine and training initiatives. Mr Mitchell told The Australian the TQEH and the South Australian Health Commission - sponsors of the project - had reached world-class in a short time and they had constant requests for planning advice throughout Australasia.

Mr Mitchell also recently completed an evaluation of the non-clinical aspects of the South Australian Mental Health Services Telemedicine Pilot Project (June-October 1994).

The report, The Challenge To Embed Telepsychiatry, identifies a crucial challenge for the South Australian Mental Health Services and the South Australian Health Commission to take the significant successes of the 1994 Telemedicine Pilot Project further to the embedding of telepsychiatry in the SAMHS and the SAHC.

Videoconferencing networks linked clinicians and other health workers at Glenside Hospital in Adelaide, the Riverland Regional Hospital (225km from Adelaide) and Mt Gambier Hospital (450km away).

Although Whyalla Hospital (400km away) was not formally part of this project, some evaluation of its use of the facilities was recorded in the report.

An evaluation of clinical aspects of the pilot is being undertaken separately by Dr Michael Baigent, who is comparing interviews of patients by psychiatrists in face-to-face settings with those interviews involving telecommunication.

Despite the successes of the pilot, Mr Mitchell said some problems and issues would need addressing. These included legal and ethical problems regarding telepsychiatry that needed further investigation and technical problems with codec equipment at Berri and Mt Gambier.

Mr Mitchell found that, overall, the 1994 pilot uses of the telepsychiatry network were generally very successful and encouraging and that telepsychiatry could be an "effective medium".