Interview with Gary Doherty, Director, Business Development, CSIRO ICT Centre, Laurie Wilson, Post-Retirement Fellow, CSIRO ICT Centre and Steve Smith, General Manager, Oxyoptia November 2008 and June 2009²⁰⁸

Technology can help deliver cost-effective access to specialist services for those Australians who live far from our major hospitals. Pilot demonstrations of the Virtual Critical Care Unit (ViCCU)²⁰⁹ and Echocardiographic Healthcare Online Networking Expertise in Tasmania (ECHONET)²¹⁰ have shown how point-of-care telemedicine systems, running over high speed broadband networks (100 megabits per second full duplex), can provide support for specialist services in regional hospitals.

The CSIRO funded the Centre for Networking Technologies and Information Economy (CeNTIE²¹¹) project to develop specialised health conferencing technologies assuming high bandwidth broadband infrastructure. ViCCU and ECHONET were developed as a result of this project.

Three ViCCU units were piloted from 2004 with the Sydney Western Area Health Service (SWAHS) at their Blue Mountains and Nepean facilities. Three ECHONET units were piloted from 2005 (and formally launched in 2007) with Tasmanian Health at Burnie Regional Hospital, the Royal Hobart Hospital and the Department of Cardiology at the Royal Hobart Hospital.

The pilots, because of their success, continue to be deployed and are now commercially supported.

Brief description of the units

The ViCCU unit enables remote consulting sessions between a specialist doctor at the Nepean site, and medical professional(s) and their patient(s) at either Lithgow or Katoomba. Relevant components of the units are located at the patient and specialist ends.

The ECHONET unit enables real-time remote echocardiography²¹² consultations and diagnosis between doctors at multiple hospitals. The network supports near-broadcast quality images of the patient, including ultrasound images, and the cardiology specialist can guide the examination if necessary.

Conferencing between more than one ECHONET unit is also possible, allowing multiple specialists to consult at the same time.

In both cases, the units were designed to be used by one person with minimal training. For example, they are powered for an 'always on' work status and require only one to two mouse clicks by a doctor to connect to any other end. The units are also designed to be used in a restrictive space environment and be non-intrusive in an ICU or other hospital ward.

Impact

The effectiveness and impact of the ViCCU and ECHONET telemedicine systems during their pilots has been evaluated. The evaluations found that the systems had been used for a wider variety of applications than initially envisaged. For example, during the nine month clinical trial of the ECHONET system, there were 84 recorded activations.

The main uses of the ECHONET system included:

• Bedside consultations with ICU patients in Burnie, which also reduced the number of times patients needed to be transferred out of Burnie. This resulted in a reducing transport costs and minimising disruptions to patients and their families lives.
• Echocardiography examinations of ICU patients in Burnie, with a cardiologist in Hobart interacting with the local specialist to optimise the views of the patient's heart and their interpretation.
• Case and teaching presentations from the bedside of patients in Hobart, which have proved to be a valuable teaching resource for junior ICU staff in Burnie (the local patient load is relatively small and reduces opportunities for case-based learning).
• Cardiology outpatient consultations for patients in Burnie. These patients experience a considerable cost saving since each patient would otherwise need to make an eight-hour return journey to Hobart.

In addition, there was a high level of satisfaction with usability and media quality associated with the system. The high media quality is a direct consequence of using an advanced network.

There was also growing evidence of a closer collegiate relationship between the two hospitals, especially the two ICUs. Sharing interesting cases provides opportunities for training and skills benchmarking. Specialists located at Burnie have expressed appreciation of the reassurance from their Hobart colleagues when they are faced with difficult patient management decisions.

Similar results were experienced in the ViCCU project.

Awards and recognition

The impact made by ECHONET was recognised through a special mention under the Health category of the 2008 Australian Telecommunications Users Group Awards.

Similarly, ViCCU won the 2007 Don Walker Award for improving access to healthcare in rural and remote communities.

Commercialisation

In July 2007, CSIRO commercialised the ECHONET technology. Oxyoptia now provides support for the existing units. The piloted technologies form the basis for two new products—Oxy2 and Oxy4—which have high definition imaging capability, standards-based integration with other conferencing systems and significantly reduced deployment and operational cost. They also include a range of health-specific features.

The ViCCU system was commercialised by Telstra, which in turn transferred these rights to an Australian manufacturer and service provider to support and evolve the deployed units.

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[208] Reuse or distribution of this case study must include the following attribution: Australia's Digital Economy: Future Directions © CSIRO, Oxoptia and Commonwealth of Australia, 2009, www.dbcde.gov.au/digital_economy/final_report

[209] see www.csiro.au/science/ViCCU.html

[210] see www.csiro.au/science/ECHONET.html

[211] CeNTIE provided a high capacity (up to 10 Gbps) experimental optic network linking Perth, Melbourne, Canberra and Sydney. This network enabled research into and commercialisation of network technologies, virtual environments, trusted systems and the developing and testing of leading edge broadband applications. CeNTIE demonstrated that providing networking research engineers and scientists access to leading edge infrastructure and some support can lead to the development, trialling, demonstrating and commercialisation of innovative and leading edge technologies and broadband applications and services in health, media and finance. These technologies and applications enable people to use modern information technology and broadband networks to interact with a real sense of security and presence when geographically distributed.

[212] Echocardiography is an ultra-sound based diagnostic imaging technique used to visualise the heart.