Consulting Services

The Australian, 2 April , 1996

The tyranny of distance is being conquered - at least for some South Australian kidney patients - by the innovative use of telemedicine. Trudi McIntosh reports.

A pioneering project in renal telemedicine in South Australia is attracting world wide attention.

The renal dialysis telemedicine network uses live, real-time audio and video links between The Queen Elizabeth Hospital (TQEH) in Adelaide and dialysis centres at Wayville, North Adelaide and Port Augusta, 300km away.

Recent innovations in telemedicine networks and training initiatives in several States have earned praise from overseas hospitals and health authorities.

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

South Australia has an impressive record in building telemedicine networks, adapting software applications and introducing nursing education and staff training and management schemes, particularly in renal dialysis and treatment.

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

Dr Alex Disney, project director of the hospital's renal telemedicine network, told The Australian last week the unit wanted to expand its course delivery in the graduate diploma in nursing (nephrology) to nurses at Alice Springs and other interstate sites.

The renal unit's network already enables staff at Port Augusta to undertake the graduate diploma in nursing in their home towns.

"We are also speaking to a big hospital in Indonesia - an area where we believe we can make significant inroads with our telemedicine and training initiatives," Dr. Disney said.

He would like to see more health services in the Asia-Pacific region establish telemedicine networks.

"This is an area in which Australia can play a significant role."

Mr John Mitchell, the renal telemedicine project manager said the potential of telemedicine was still to be tapped.

"The Queen Elizabeth Hospital and the South Australian Health Commission, sponsors of the telemedicine project, have reached world class in a shot time, and we now have constant requests for planning advice throughout Australasia," Mr Mitchell said.

Research in the United States had shown that the telemedicine system - which was used the most in the US in 1994 - involved 271 consultations in three months.

"In our recent evaluation of the TQEH renal telemedicine network, we found the network was used more than 1150 times in the middle three months of 1995 for clinical consultations, educational and administrative purposes," Mr Mitchell said

TQEH's telemedicine network expertise will be shown live to the LETA (Learning Environment Technology Australia) 96 international conference in Adelaide from September 29 to October 4.

Mr Trevor Temple, LETA's project manager, said the global conference would explore on0line education, technology in health education, and planning and architectural blueprints for building 21st-century communities.

More than 2000 delegates were expected to attend.

Mr. Bob Bishop, chairman of Silicon Graphics' global marketing strategies division and a member of the SGI international board, will present the keynote speech.

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 marketing manager for health, said the hospitals 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 car".

Dr Disney, who is also senior staff nephrologist at TQEH, said the network relied on strong teamwork.

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

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

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 outpatients' clinic every two months.

The renal unit also cares for 29 patients who receive dialysis at home.

Dr Disney and Mr Mitchell said one of the biggest advantages of the renal telemedicine network was that it reduced the stress of many patients who formerly had to be driven to Adelaide for special treatment.

The South Australian Health Commission provided much of the funding.

Dr Disney said the next challenge for the unit was to attract industry funding over the next five years.

Mr Mitchell recently recommended in a report that TQEH's renal dialysis telemedicine project be expanded to provide more training and technical support for wider base of users.

The report recommended that collaborative business arrangements be made with video-conferencing technology providers and suppliers, to provide support for R&D activities.

The report recommended that 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 their network but Australia's high ISDN charges limit that considerably, as they do for most other hospitals.

Dr Disney would also like to explore the role of electronic stethoscopes capable of operating with codecs 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," Dr Disney says.

Acknowledgment. The above content is copyright The Australian, 1996.