Scottish paediatric video-conferencing network 

Information and Communications Technology (ICT) applications that come under the headings of “telehealth”, “e-Health” or “telemedicine” have now been tested and piloted in a number of health specialties. In recent years, there has been a shift away from viewing these applications as purely something for the “techie enthusiast” or short-term research projects, towards seeing them as tools that are part of the modernisation and health improvement agenda.

A number of health service priorities are driving the use of e-Health. These include:

  • improving access to clinical expertise for patients and to diagnostic support for health professionals
  • providing greater equity of access for patients in remote and rural areas
  • reducing unnecessary transfers to tertiary care services and supporting local management and diagnosis. Where transfer is required, the use of video-conferencing gives the staff that will be receiving the patient the opportunity to have an enhanced (words and images) consultation with colleagues and the patient/parents.
  • facilitating managed clinical networks (MDTs) to allow multi-disciplinary groups to share information in case conferences.

Background

In Scotland, the e-Health strategy is to support improvements in the ICT infrastructure nationally as part of overall service modernisation and improvement. Along with these large-scale developments – for instance, PACs – there have been a number of innovative smaller-scale e-Health/telehealth demonstration projects. The underlying principle is to facilitate a diverse group of clinically driven technological solutions to achieve health priorities in Scotland.

Through one such initiative, the Scottish Executive Health Department (SEHD) funded a number of e-Health demonstrator projects. One of these was a paediatric video-conferencing network. (Although advice from the local ethics committee was sought at the outset, this demonstrator was viewed as a service development rather than research.)

Clinical objective

The paediatric network was designed to support rapid surgical and cardiology referrals using innovative, highly mobile video-conferencing technology. It allowed experts based in Glasgow’s Royal Hospital for Sick Children (Yorkhill) to “view” a baby at a remote site and provide diagnostic support and information on managing the patient locally and advice on whether to transfer the baby to the receiving site if more acute problems are identified. 

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The mobile unit’s small footprint makes cotside video links both possible and practical. The equipment also allows consultants to view not only the patient, but also echocardiograms and radiological images. 

The network was developed in two phases, with continuous feedback and clinical engagement via a dedicated project manager, Hazel Archer. Phase 1 initially linked four sites to Glasgow, but following a successful pilot, now completed, participating sites across Scotland eventually numbered 10. The range of uses gradually increased beyond the original aims and objectives of the project, and included: 

  • cardiology: emergency and routine follow-up
  • surgical: emergency and routine follow-up
  • psychiatry: consultations and case conferences
  • education: weekly sessions
  • microbiology: infection control sessions
  • child protection: case conferences
  • tumour board: case conferences
  • genetics: consultations
  • endocrine: network meetings
  • gastrointestinal: network meetings.

Conclusions

  • This system has provided an additional method of obtaining advice for emergency cases, as well as for more routine management of patients across Scotland.
  • The most sustainable e-Health systems have proved to be multi-functional, multi-professional and often mobile in practice.
  • The health professionals and parents involved have responded positively to the use of the network, and this support has made a long-term network much more sustainable.
  • The success of the network has highlighted the importance of clinical engagement, not just at the outset but throughout development. 
  • It has been vital to have both dedicated support in the form of project management and the involvement of all IT staff at participating sites.
  • Embedding the network into routine use was helped by having clear aims at the outset, providing all users with appropriate and frequent training and encouraging incremental increases in use throughout the development.
  • A multi-disciplinary steering group provided guidance and practical support.

Future developments

As the funding for the paediatric network ended, the Scottish Executive Health Department published key policy documents recommending a “centre for telehealth” to support innovation and service modernisation in the priority areas of:

  • unscheduled care
  • remote and rural care 
  • professional education
  • chronic disease management.

Its commitment to e-Health/telehealth was confirmed in the ehealth strategy and in the setting up of the Scottish Centre for Telehealth (SCT) in 2006. The SCT will act as an umbrella organisation, supporting new and existing developments.  

The paediatric network provides an innovative model for supporting emergency paediatric care, plus support for a wide range of other health-care and educational activities.  It is now moving beyond the demonstrator phase into becoming a routine part of the modernisation of paediatric services nationally in Scotland.

For further information, read the final report (5.8 MB pdf).

Nessa Barry