So this is delayedon from this morning with talking aboutaccess for patients.
I'm actually not fromJohn Hunter Hospital.
I'm actually from TareeHospital Manning Hospital.
And my coworkers that aresitting in the row here, they're not goingto get away lightly.
I'm going to get them tostand up so that they can also introduce themselves.
[? Karen ?] [? Dada ?] is ourreal cancer care coordinator who's actually away, soI can't introduce her.
[? Annette ?] [? Davis ?] isour breast and gyny coordinator.
So I'm gonna get [? Annette ?]to stand up and turn around and introduce herself.
[INAUDIBLE] [LAUGHTER] I do the hematology andcancer care coordination, and I'm also a CNC.
[? Rachel ?] [? Pitt ?] is ourbrilliant nurse practitioner [INAUDIBLE].
And [? Jenny ?][? Rutherford, ?] who used to work in gyny oncology is nowworks in clinical telehealth.
So she's the personif anyone wants to know about telehealth to ask.
So just so you know, Manning Hospital, Taree Hospital ison the North Coast, for anyone that doesn't know.
We've also– we service Taree, Forster, and the Great Lakes area.
We have a small oncology unit.
We have six treating chairs.
But we also have access to fourchairs in the private hospital, as well.
So we have apublic-private agreement, which is a bit of anunusual circumstance.
So we have 10 chairs.
We only have onetreating oncologist, which means that we have alot of patients that can't get their treatment ina timely manner, so have to travel out of area.
So hence, that's why we'reusing telehealth now.
So we're hoping to decreasesome of our patients' emotional, physical, andfinancial burdens, which the patients are lovingit, I have to say.
Part of the 2018strategic plan is to improve the quality, equityand access to service delivery for our patients.
And this is one way thatwe can really do this.
So I've got a coupleof patient stories just to sort of show you howwe actually utilize telehealth.
And the first one is a70-year-old patient from Taree that was havingtreatment for a brain tumor with the [INAUDIBLE]Newcastle Oncology Group.
He had had histreatment in Newcastle and had came home, butbecame very unwell, ended up in the privatehospital at Mayo.
And had– scans had showed thathis disease had progressed.
It was decided thathe would really benefit from afurther discussion with his medicaloncologist as far as what the nextstage should be, which was going to be[INAUDIBLE] with supportive care.
But his family was reallykeen to have that discussion with the oncologist.
So our very [? innovative ?]cancer care coordinator, [? Karen ?] [? Dada, ?]got the laptop, took it out to the bedside, and organized a review with the Mater medical oncologist, which the family really appreciated.
And obviously thepatient did as well, because he hadthat final consult with his medical oncologist, whereas previously it would have been the physiciangiving him that final news, and he wouldn't havehad that final exit from his medical oncologistto have that final review.
The next one is a verycomplicated young man who lives at Forster.
He's actually havingsecond-line treatment for a Hodgkin's lymphoma.
He has a very complicatedsocial and lifestyle choices, which really impact greatly onhis compliance and continuation of his treatment.
So the only way that wefelt that we could really treat this man effectivelyand continually was to really include hisGP in the actual consults.
So what we've done is actuallygo out to Forster to the GP surgery, and the GPdoes the tele-consult with his hematologistin Newcastle.
This has been very effective.
And so far, we've been able tokeep this young boy on track, and he's up to his seventhcycle of treatment.
GP also found it really–a really excellent way of doing a consult.
He'd actually dealt with this particularhematologist for many years.
Not just withhematology patients, but also with practicing newrecruit GP's, traineeships.
So he'd never actually metthe GP, the hematologist, face to face.
So he sort of went oh, wow, that's what [? Philip ?] [? Rawlings ?] looks like.
There you go.
So it was really beneficialfor him, as well.
The next one is a60-year-old man.
And this is where the nursepractitioner comes in.
I utilize a nurse practitionerin all the consults, tele-consults for thephysical examination, and anything that needsto be followed up on.
So this was a 60-year-old manwho had a diffuse large B cell lymphoma.
On diagnosis, he was veryunwell, transferred to Mater.
And he had his first cycle ofchemotherapy urgently at Mater.
Came home, and he wasstill quite unwell.
And when he came infor his second cycle, we decided to do ittelehealth, because he didn't want to go back to Newcastle.
He found the travelquite exhausting.
So the nurse practitionersat in and was able to do thephysical examination and actually discuss itwith the hematologist as far as that he didshow that he had quite a good response to treatment.
So then he could make thedecision whether to go on.
He was quite reluctant tocontinue on with treatment.
He was really wanting togo more natural therapy rather than– because he'dhad such a great response.
We did get one morecycle into him, but then he decided todo natural treatment, unfortunately.
So far, we haven'tseen him back.
The next one is one ofthe breast care patients.
She actually livesat Gloucester, which is about an hour from Taree.
And for travel to Newcastle, it's about an hour and a half.
43-year-old single ladywith three children who one has a medicalcondition which requires a lot of hospitaland medical intervention.
So she does a lot of traveland was really feeling that she had enoughof the travel having to go see a specialist.
Our breast care nurse also worksin Gloucester one day a week, so we organized a telehealthconsult with the breast care nurse there with her atone end, nurse practitioner on the other, and theydiscussed the CT results, which happened to be–she didn't actually have any disease progression, which is why she had the CT.
So it was a verygood consult, and she was very happy to be able todiscuss that with the nurse practitioner.
This is actually one ofour telehealth consults.
This gentleman, when I askedpermission to take this photo, asked would I pleasepass on to everybody in the audience it'snot just the travel to and from theconsults, but it's also parking is alwaysvery difficult– same as in Sydney, I'm sure–getting to and from the consults into the actual clinic.
Often accommodationneeds to be sought, because if it's a late consult.
And also, it's usually a three- to seven-minute consult.
So it's a long way to go for a seven-minute consult whenwe can do it at home in Taree, which takes him 15 minutesto get to his actual consult.
So he's very happy, andvery reluctant to go back to [? Morter.
?] But hewill have to at some stage, as [? with ?] mostof the patients.
When Jenny extracted data fromour electronic medical system area, it was very difficultbecause, unfortunately, what had happened, it's a new system, as far as clinical telehealth, and people were still putting it into theirdiaries, not into the system as far as the consult.
So thisis very understated as far as how many we've got.
These are mostly hematologyand gyny telehealth consults.
But there are a lotof medical oncology that haven't beencorrectly put in.
But it just gives you anidea of the estimated cost that it saves the patients, andalso the kilometers it saves.
But once again, as I said, that is quite understated.
Hopefully we'llget better at it.
So, the benefits.
Efficient use of valuableresource, obviously.
Many of our patients arereally happy with it.
I did another one this week withthe patient on his third cycle.
Hadn't had one before.
Had been goingbackwards and forwards.
And he said, I'm notgoing back to number six.
You can do them all in Taree.
We're able to tailorwhat support's needed for the patient.
So we can have the nursepractitioner there, we can do specialist tospecialist if need be.
So it's very efficient.
Reduce travel, obviously.
Better than a phone consult.
Sothey've got that face to face.
And even for consultants such as[? us ?] [? or ?] the [? GP, ?] he was able to see whatthe actual physician– or specialist that he'd beendealing with for years looked like.
Flexibility of the telehealth.
You can take it to the bedside.
You can go to the GP, goto other institutions, HQ, wherever you need to go.
Difficult of scheduling.
Sometimes, if there'stwo specialists, obviously the time canbe difficult as far as getting the twoto agree to a time.
But so far, we haven't hadmajor difficulties with that.
Obviously, we'redealing with technology.
So sometimes there areintermittent difficulties.
However, if you've gota great support system, then that's reallyessential to your success, which we do have in[? Hunter, ?] [? New ?] [? England.
?] Patient experience.
So these are just some ofthe satisfaction surveys that we did.
Obviously, they'reall very happy with the actual experience thatthe telehealth is giving them, instead of having to travel.
That's some of the comments.
[? Jen, ?] you might like toexplain the actual complexity of how this works.
[INAUDIBLE] There are two ways that weactually can access patients.
If they're withinour health service, we can link via[? Polycom ?] system.
But we also have another programcalled [? Scopia, ?] which is very much like Skype, butit's safe, secure, encrypted for patient consultations.
So that's thedevice that we use, or the program we use whenpatients are in their home.
So they can be on theiriPad, their iPhone, laptop, whatever device they have.
And the same withthe GP practices.
So I've had patients taketheir laptop to the GP practice if the GP practice isn't set up.
Having said that, many[? rural ?] practices are set up.
And also, within the healthservices, there are rooms, community health [? rooms, ?][? all the ?] [? MPS's ?] are set up with telehealthfacilities where patients can go.
This scenario withthe oncology setting, it works so wellwhen they've got the support of their localoncology team linking directly through.
So it's just a directlink through the hospital connection.
Connections aregenerally very good.
Obviously, if thepatient's at home or in their localcommunity, it depends on internet connectivity.
But I've got to say, I've beenin this role now 18 months, and even in that time, weall know that connectivity is getting a lot better.
And of course, that'ssomething in my role.
I check to ensure thatthat connection is good for that patient or thatconsultation before that link, if they're somewhereoutside the health service.
Thanks, [? Jen.
Telehealth an obvious exampleof excellence.
[INAUDIBLE] Every patient, every time.
So for anyone in Sydney, ifyou do have rural patients, really consider telehealth.
If it's [? out ?] [? of ?][? New ?] [? England, ?] then as [? Jen ?] said, they'rethere to help connect you to the area.
And if they're withinour area, we're more than happy tofacilitate that.
So thank you.