1. 1 Digital Regions Initiative Chronic Disease Management for Regional and Rural Communities Dr David Doolan Director, Clinical IT Support and Development Information Technology and Telecommunications March 2010

2. Digital Regions Initiative  The four year $60 million Australian Government initiative will co-fund innovative digital enablement projects with state, territory and local governments to improve the delivery of education, health and/or emergency services in regional, rural and remote communities.four year $60 million Australian Government initiative  State, territory and local governments seeking funding will be required to provide matching funding.  The Digital Regions Initiative commenced in 2009 and concludes in 2013.  HNEH application announced in December 2009 by Prime Minister as one of seven successful Round One projects http:// www.dbcde.gov.au/all_funding_programs_and_support/digital_regions_initiative

3. ABS Definition of ‘Regional’ does not include Newcastle, Lake Macquarie, Maitland and Raymond Terrace.

4. DRI Funding and Governance  $11.8M Capital Funding July 2010 – June 2013 –Commonwealth $4.9M –NSW Health $3M –HNEH $3.9M  HNEH $1.8M recurrent  Strict financial and milestone reporting  Must be complete by December 2012

5. What is included in DRI  Chronic Disease Management System ($5M)  Telehealth equipment to 10 sites and 200 homes with central Telehealth management system ($3.3M)  Digital Imaging Reporting and Delivery improvements ($1.9M)  Network upgrade to 9 sites ($1M)  Program Management ($0.6M)  NO SERVICE DELIVERY!

6. Chronic Disease Management System  CDM to run within CAP similar to that used in New Zealand, Canada and US (HNEH LICENCE)  Workflow –Establish program and parameters –Enrol Patients –Manage patients –Notify clinicians –Report outcomes and variances  GP secure clinical messaging

7. How to ‘operationalise’ this model

8. CDM Task List

9. Data entry form: CDM Home Care

10. Activity Summary

11. Summary view of Diabetes Data

12. Notifications

13. Example of a trend view

14. Population Reporting

15. CDM Issues  Program development and maintenance  Patient enrolment (how many?)  Overlap with existing systems especially CHIME  Interaction with GPs and other external providers  Level of integration with other systems and telehealth

16. Facility Based Telehealth  The following sites will get videoconference equipment –Ashford –Boggabilla –Bundarra –Gwabegar –Moree AMS –Mungindi –Pilliga –Tambar Springs –Toomelah –Warialda  The following Hospitals will get desktop telehealth equipment (20) –John Hunter –Calvary Mater –Tamworth –Armidale

17. Bluetooth RS232 port InfraRed port The Telehealth Monitor supports a number of external biomedical devices for collecting clinical data such as Weight Blood pressure monitor Blood glucose meter Peak flow meter Oxygen saturation monitor Home Based Telehealth

18. Patient Data Flow in the home Host Server Questionnaire is started Data and patient answers are sent to the Orion Server Your weight is: 83 kg (person stepson scale)‏ Are your legs swollen? Do you feel short of breath? Below target weight Have you been exercising? Your data and responses will be sent Above target weight Do you use an extra pillow at night? YesNo Your weight is: 83 kg (person stepson scale)‏ Are your legs swollen? Do you feel short of breath? Below target weight Have you been exercising? Your data and responses will be sent Above target weight Do you use an extra pillow at night? YesNo teps Are your legs swollen? Do you feel short of breath? Question Tree activated Below target weight Have you been exercising? Your data and responses will be sent Above target weight Do you use an extra pillow at night? YesNo Question Trees are configured for each distinct program Separate database for central data store and administration? In home device or PC?

19. Telehealth Issues  Clinical staffing and responsibilities  Patient identification, enrolment and management  Patient, clinician and equipment scheduling  Potentially separate data store and system  Not intended for real time monitoring but as a partial substitute for physical visit  Risk of increasing patient reliance and driving up service demand

20. Digital Imaging  Direct network extension to 4 private imaging providers in Sydney and Melbourne to improve turnaround times of reporting  Delivery of imaging reports via Medical Objects secure messaging  External web based PACS for outside providers with secure link embedded in report

21. Network Upgrades (4 MBS)  Ashford  Bundarra  Gwabegar  Moree AMS  Nundle  Premer  Pilliga  Tambar Springs  Toomelah

22. Next Steps  Finalise funding agreements with Commonwealth and State and begin recruitment and vendor contracts  Commence implementation in July 2010 with all infrastructure projects completed by Jun 2011  CDMS –Program 1 live Mar - Jun 2011 (Diabetes?) –Program 2 live May – Jul 2011 (Aboriginal Health?)  Home based telehealth – 200 homes by December 2012

23. Questions and Discussion