November 26, 2024
This article published by HiNZ last week provides a welcome insight to Te Whatu Ora’s telehealth goals.
“Health New Zealand – Te Whatu Ora has set a goal to have at least 10 percent of care delivered via digital channels by June 2025.
Current levels of outpatient attendances completed via telephone or video are seven percent, slightly up from 6.7 percent in quarter three.”
There is a lot of work to be done by Te Whatu Ora (and its partners) if staff and patients are to achieve this goal. Maintaining the current quarterly growth rate won’t do. If we want to succeed, we need to identify outpatient appointments where we can quickly and materially increase the proportion of appointments conducted via digital channels in the next 6 months.
Keep in mind, telehealth isn’t appropriate for many types of outpatient appointments. So, if you want to lift the overall average to 10%, we need to achieve a much higher rate than that for appointments where telehealth is possible.
You can do this by taking a “remote first” approach; something Spritely has been advocating for in order to save time, money and space for the health system. It simply states that:
“If care can be delivered remotely without detrimentally effecting the patient, then deliver the care remotely”.
To shift the dial, we also need to target areas/specialties that account for a high volume of outpatient appointments. If at least 50% of these appointments can be conducted using telehealth it will be easier to achieve the specified target and there will be significant benefits for many patients, clinicians and the wider health system.
I’d love to see some data on the different types of outpatient appointments and where they would be plotted on this matrix.
It would make a logical starting point for a strategy to increase the percentage of outpatient attendances completed via telephone or video.
With advances in telehealth technology, we now consider a growing range of outpatient appointments suitable for telehealth. This includes HF clinics for medication titration.
For a long time, these appointments weren’t considered suitable for telehealth because patients had to be physically present for vital observations to be made. This is no longer the case. HF monitoring programs around the world have matured, and there is a growing number of examples that are working very effectively.
Here in New Zealand, we’re just starting to use remote patient monitoring (RPM) for HF patients. There are around 12,000 discharges from NZ public hospitals each year with a primary diagnosis of HF (data from year ended June 2021). This makes it one of those areas where we can shift the dial on telehealth.
Many HF patients need guideline directed medical therapy (GDMT) supervised by a nurse specialist. This requires the patient to physically attend multiple outpatient clinics for 3-6 months following discharge from hospital. Unless they live in Hawkes Bay, where a new tech-enabled model of care, that is equitable and efficient has become popular.
In Hawkes Bay on the East Coast of the North Island telemonitoring is being used to quickly and safely up-titrate heart failure patients with reduced ejection fraction (HFrEF) in just 6 weeks. The new model of care is achieving considerable success as evidenced by this poster, which was presented at the annual conference for Cardiology Society New Zealand and Australia (CSANZ).
The trial, which was started in 2023 and expanded in 2024, uses Spritely’s telemonitoring platform to manage and support heart failure patients remotely. This aligns closely with objective 1.2 of the Government Position Statement on Health, to “develop models of care to better meet people’s needs closer to home”.
Spritely Telemonitoring combines aspects of telehealth and remote patient monitoring (hence the name, “tele-monitoring”) in a single, easy to use device kit that connects through to a nurse specialist with one tap of the supplied touchscreen.
Hawkes Bay hospital has pioneered a superior model of care by taking an innovative, tech-enabled approach to managing HF patients in the community. This was necessary as there aren’t enough clinical nurse specialists to provide optimal therapy to all the patients who need it. Especially those who live a long way from the hospital.
It is recommended there be at least 2 FTE heart failure nurses per 100,000 of population to optimise clinical outcomes for patients with heart failure . There are nearly 180,000 people in Hawkes Bay but instead of the recommended 3.6 nurse specialist FTE they have just 2.4 nurse specialist FTE to cover a very large geographic area. That’s why they are using Spritely, to help make up the shortfall. It saves a considerable amount of time and enables the same FTE to manage a lot more patients per annum.
One of the Hawkes Bay nurse specialists (Daman Kaur) is delivering a presentation at Digital Health Week on the new, tech-enabled model of care for heart failure patients in Hawkes Bay.
Those who can attend will hear first-hand that remote patient monitoring is highly engaging, efficient, cost effective and can be easily transferred to other regions allowing for local variations where necessary.
Heart failure outpatient appointments are an excellent candidate for taking a remote first approach. The model of care is mature in other countries and has been well tested here in NZ. There are clear criteria for inclusion and exclusion and a documented RPM model of care has been developed by New Zealand cardiologists.
By June 2025 we can conduct at least 10% of NZ’s heart failure outpatient appointments remotely (based on the Hawkes Bay model) and this could grow to >25% the following year.
Expanding telemonitoring programmes to include other cardiac phenotypes would further increase the percentage of outpatient appointments that can be delivered via telehealth and help Health NZ to exceed its target.
1 DoughtyRN, Devlin G, Wong S, McGrinder H, Chirnside J, Sinclair L, Copley M, HarrisonW, Lund M, Grey C, Kaur D, Fisher R, Chan D. 2023 position statement onimproving management for patients with heart failure in Aotearoa New Zealand. NZ Med J. 2024 Feb 23;137(1590):93-99. doi: 10.26635/6965.6461. PMID: 38386858.
