Videoconferencing in the

Welsh Health Service

Experience of the

South West Wales Cancer Network

and Hywel Dda Health Board

Delyth LewisTelemedicine Service Manager South West Wales Cancer Network

and Hywel Dda Health Board

Introduction

• Requirement to achieve compliance with National Cancer Standards in Wales

• Meet challenges of delivering healthcare in rural Wales

• Response to clinical needs

National Cancer Standards

Calman Hine Report 1995 Cameron Report 1996 (recommendations)

Cancer Centres Cancer Units Multidisciplinary Teams Cancer Networks Minimum Standards

Keeping Care Local (KCL) Feasibility Study, 1998 Reducing unnecessary travelling for patients and staff Forming electronic links with specialist centres and centres of

excellence Creating educational links with others to overcome clinical

isolation

Cancer Unit and Cancer Centre 75 miles apart

Road infrastructure is poor - 4 hours travelling time by car

Long distances for patients/staff to travel

Poor public transport –Limited bus serviceNo rail links

South West Wales Cancer Network covers a large geographical area – combination of inner city, urban and small dispersed rural populations.

Challenges

Aims

Telemedicine in routine use in Ceredigion and South WestWales over last ten years.

Main aims:

• keep care local as much as possible

• reduce travelling for patients and health professionals

• improve the quality of care.

Examples of uses of videoconferencing

• Clinical use - ‘virtual’ meetings between cancer multidisciplinary teams in local hospitals and specialist teams in specialist centre.

• Patient videoconsultations – ‘virtual’ clinics

• Transmission of live images for specialist advice, radiology/ histopathology images and echocardiography ultrasound.

• Educational seminars, lectures and professional sessions.

• Management and staff meetings.

• Interviews (national/international).

• Cross video-network links eg Universities, County Council, English Health Authorities and International sites.

• Multi-site and point to point sessions.

(No dedicated videoconferencing suites at NHS sites)

Virtual Cancer Multidisciplinary Team Meetings

• Improved access to specialist opinion• Improved communication• Improved patient care• Achievement of national cancer standards• Efficient Multidisciplinary Teams • Strengthening of clinical networks

Environmental impact of using videoconferencing(one month - one site)

October 2006

October 2007

October 2008*

People using vc 60 90 72

Meetings held 21 30 25

Hours travelling saved 247 330 215

Miles travelling saved 11,176 12,9930 8,737

Travelling expenses saved £4,470 £5,172 £3,249

Total kg CO2 saved 1696kg 2590kg 2039kg

Number of trees required to absorb total kg CO2

31 48 38

*14 excluded from survey – details of car engine/fuel and/or mileage omitted from questionnaire

Palliative Care Telemedicine

Palliative Care

Resource Centre

Dedicated videoconference

suite

Marie Curie Hospice,

South Wales

• Improved community staff support – access to ad hoc advice – weekly videoconference meetings• Reduced the need for staff to travel for advice/support• Extended to palliative care units at:

Ty Bryngwyn - Llanelli, Ty Olwen -Morriston and Y

Bwthyn - Bridgend

Marie Curie Hospice link enabled: • Joint educational meetings and best practice seminars to Consultant Palliative Care Physician and team in South Wales

40 miles

110 miles

Paediatric Cardiac Telemedicine

Transmission of echocardiography images

Singleton Hospital, Swansea

42 miles

1 day

Welsh Health Video Network

(minutes)

• Quicker diagnosis and implementation of treatment plan agreed by a group of experts.

• More efficient use of specialist staff.• Reduced the need for Consultant Cardiologist’s travel to Singleton

Hospital (especially on call).• Lower cost of service delivery due to reduced travel expenses.• Guidance/supervision of newly qualified staff in echocardiography

ultrasound.

University Hospital Wales, Cardiff

Neurology Telemedicine Clinic

• Improved patient access to neurology services - frequency of clinics increased from once every three months to six weekly.• Waiting list eliminated.• Neurologist travel eliminated• Better use of scare resources, eg clinical time.• Improved educational opportunities for staff at remote site.• Opportunity for local physician to discuss neurological

diagnosis/management of patients requiring local assistance from time to time (eg epilepsy).

• Instigated regional neuroscience videoconference meetings with remote site for consultant and trainee education.

Head and Neck Cancer Speech and Language Therapy

Patient videoconsultations to Speech and Language Therapist in tertiary centre for pre and post laryngectomy management (Aberystwyth – Singleton and Withybush – Singleton)

Patient benefits include:• immediate positive verbal feedback• not having to travel for consultations• specialist services closer to home• more relaxed, no anxieties about travelling, weather, parking etc

Welsh Health Video Network

Clinical Pathology ConferencesClinicians use videoconferencing to link into educational,professional and multidisciplinary meetings, eg Interstitial LungDisease Network, Regional Stroke Meetings, Welsh PaediatricNetwork, Nutritional multidisciplinary meetings)

Benefits:• Enables clinicians’ participation in clinical discussion on complex or

interesting cases

• Opportunity to present own patients, share radiology and discuss management with colleagues across Wales (eg Regional Stroke Meetings, Interstitial Lung Disease Network)

• Reduced travelling expenses and clinicians’ time travelling

Need for sites hosting conferences/educational sessions to make videoconferencing available

Management/Educational Use• Multi-site management meetings between health board managers and

locality staff, clinical team leaders and staff working across different sites.

• Cancer Network board meetings.

• Consultants and trainees linking into Paediatric Academic Programme – weekly sessions.

• Tele-lecture between Physician at Bronglais and Swansea medical students.

• Tele-lectures to students on BSc Medical Sciences and Humanities,- Module PM102 Delivering Healthcare at Swansea University and MSc Health Informatics Module at Swansea.

• Nursing staff linking into PGCE lectures at Newport University.

• Nursing students linking into lectures with Carmarthen Trinity College and Swansea University.

Lessons for Universities

• Training for users (including etiquette) to be confident and competent in use.

• Promote potential of videoconferencing. • Introduce videoconferencing techniques into curriculum

of future workforce.• Reliability - network and equipment.• Robust helpdesk support.• Establish easier inter-organisational/network connectivity• Encourage use of videoconferencing for lectures.

Contact detailsDelyth.lewis2@wales.nhs.uk