Videoconferencing in the
Welsh Health Service
Experience of the
South West Wales Cancer Network
and Hywel Dda Health Board
Delyth Lewis
Telemedicine 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
Challenges
South West Wales Cancer Network covers a large geographical area –
combination of inner city, urban and small
dispersed rural populations.
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 service
No rail links
Aims
Telemedicine in routine use in Ceredigion and South West
Wales 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
31
48
38
Number of trees required to
absorb total kg CO2
*14 excluded from survey – details of car engine/fuel and/or mileage
omitted from questionnaire
Palliative Care Telemedicine
•
•
•
Improved community staff support – access to
ad hoc advice – weekly videoconference
Dedicated
videoconference
meetings
suite
Reduced the need for staff to travel for
Palliative Care
Resource Centre
advice/support
Extended to palliative care units at:
110 miles
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
Marie Curie
Hospice,
South Wales
40 miles
Paediatric Cardiac Telemedicine
Transmission of echocardiography images
42 miles
Singleton Hospital, Swansea
1 day
University Hospital Wales, Cardiff
• 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.
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
Clinical Pathology Conferences
Clinicians use videoconferencing to link into educational,
professional and multidisciplinary meetings, eg Interstitial Lung
Disease Network, Regional Stroke Meetings, Welsh Paediatric
Network, 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 details
Delyth.lewis2@wales.nhs.uk