How Can We Be Leaders Through Healthcare Technology? Day 3 of HiNZ and the New Zealand Nursing Informatics Conference

First published November 7, 2016

This week, we’ve been inspired by the many speakers who have made career leaps: from clinician  to academic; from clinician to ICT (Information and Communications Technology) specialist; and even from accountancy to the public service in healthcare. Here are some of their insights from Day 3 of HiNZ, and the concurrent New Zealand Nursing Informatics Conference:

1) Videos of nature scenes played via app, with or without music, can help reduce pain perception and level of anxiety in the perioperative period. Professor of Nursing, Margaret Hansen of the University of San Francisco,  was inspired to investigate the power of visualisation in dealing with pain, after experiencing a severe illness herself. Her feasibility study, performed as a randomised controlled trial, has shown these promising effects, and will lead to further study- perhaps even in Virtual Reality!

Prof Margaret Hansen of USF demonstrates one of the app’s Nature videos at the NZ Nursing Informatics Conference 2016. Pic: The Medical Startup

2) “We need to collaborate with our international colleagues,” said Lucy A. Westbrooke, who is the New Zealand ambassador for the International Medical Informatics Association – Nursing Informatics (IMIA – NI). From her diverse career in nursing, leading to executive and chairperson positions in New Zealand health informatics and telehealth, she described some of the various international meetings and opportunities helping to achieve this goal.

3) “You don’t design systems for the most technologically agile; it has to be for the users,” Dr Simon Kos, Chief Medical Officer of Microsoft advised. Having experienced healthcare both as a clinician and as a software engineer, Dr Kos gave insights into the future of medical education with virtual reality through Hololens. 

Dr Simon Kos, Chief Medical Officer of Microsoft at HiNZ 2016. Pic: The Medical Startup

4) Finally, NZ Ministry of Health Director General Chai Chuah posed the question: What kind of leader are you (in healthcare)? “Today’s global leaders understand and lead the art and science of disruptive change,” he said, acknowledging the combination of both art and science in medicine, technology and healthcare.

Leadership isn’t always about being the first to present an idea, or the first to use a new technology. Leadership can occur at an individual level. As an example, guiding a patient to a tech solution enabled by a District Health Board (DHB), such as A.Prof Robyn Whittaker has done with her project with Waitemata DHB. Her research findings from a messaging reminder service for behaviour change showed that patients benefited from this service. Or coordinating an entire Australian Territory’s telehealth services, as Michelle McGuirk does in the Northern Territory; or encouraging a patient to keep an app-based symptom journal.

A/Prof Robyn Whittaker, Medical Doctor and Digital Health lead at Waitemata DHB presents her Behaviour Change Messaging project findings. Pic: The Medical Startup

You can view sessions from 2016 and 2015 at HiNZ.org.nz with membership. Catch up on Day 1 and Day 2 highlights as well.

We thank HiNZ for providing media access to the conferences and opening our eyes up to these incredible experiences.  

The Virtual Ward Round Is Here: Highlights from Day 2 HiNZ, Successes and Failures in Telehealth, and the Global Telehealth conferences

First published November 2, 2016

We’ve been very inspired from the talks and positive atmosphere at HiNZ, SFT and the Global Telehealth conferences this week. New Zealand is a country that deserves a lot more credit for their innovation in medicine and global healthcare. Here are some of today’s highlights:

1) Virtual Ward Rounds and Consults help patients and clinicians alike feel supported and at ease with care. Dr Eddie Tan, nephrologist from Waikato Hospital, spoke about the “hub and spokes” model of care that Waikato Hospital and its satellite rural hospitals and clinics run. With hundreds of kilometres between sites, Dr Tan and his colleagues are on planes at least every fortnight for clinics that may last just a few hours before returning back to Waikato. This is problematic when rural patient emergencies develop; however, Telemedicine with videoconferencing to the satellite clinics has helped the Renal team conduct assessments, minus the hours and dollars spent on travel (and minus hours of patient/family stress). It has also prevented unnecessary hospital presentations, and brought critical patients to hospital sooner.

Dr Eddie Tan, kidney specialist at Waikato Hospital NZ discussing Telehealth in Renal failure. Pic: The Medical Startup

Dr Tan’s colleague, Waikato District Health Board (DHB) renal nurse Jenny presented her research paper on how palliative care decisions were made easier with telehealth’s videoconferencing capabilities. This meant that difficult and time-critical family and patient conversations could be had in the comfort of the patient’s home, without wasting precious time in the potential final days of life arranging hours or even days of transport for the same consultation.

Dialysis ward rounds also help Dr Tan assess end-stage renal patients who may deteriorate very rapidly and become fluid overloaded.

Similarly, Rehabilitation ward rounds by telemedicine has helped patients in a rehabilitation ward feel happy and secure with their care. Registered Nurse and PhD candidate Sophie Gerrits’ research has so far found that rehab patients and staff at Thames Hospital, Waikato DHB New Zealand, are happy with the consults, and the elderly patients have adapted well to the new technology. The Ward Registrar goes from bed to bed with a telecart, and the Rehabilitation Physician or Geriatrician video-calls weekly in from the tertiary hospital, in addition to their usual weekly face-to-face visit.

Staff appreciated having a second chance during the week to ask questions and raise issues that had arisen in the days since the last visit. The main issue to overcome was “patient jitters” at not knowing what to expect from a video consult and what was expected of them. This reinforces the need to counsel patients prior to a consult; that they can speak, behave and ask questions just as they would if the clinician was in the room with them.

2) Telestroke Improves Door-to-Needle Time in New Zealand

Yesterday, Dr Chris Bladin of the Victorian Telestroke Program discussed the very promising findings from the Victorian Telestroke Program research in rural hospitals, with hopes to expand to other Australian hospitals. Today, New Zealand Neurologist Dr Anna Ranta showed that since Telestroke has piloted from 3rd June in the Capital and Coast DHB, door-to-needle median time has reduced from 80 minutes down to 54. With cerebral ischaemia being a critical matter of seconds, this is a significant early finding, and along with other positive outcomes, will hopefully help push for a Telestroke rollout in other DHBs.

1,100 delegates attending HiNZ this week. HiNZ Awards Dinner at Shed10, Auckland, sponsored by Microsoft. Pic: The Medical Startup

3) The finalists for the Sysmex Award for Health Informatics at the University of Auckland have promising ideas for mobile health applications. The winner, Daniel Surkalim, was announced tonight at the HiNZ Awards dinner. By creating visually appealing, simplistic views of patient data, his project, GRID(Graphical Relational Integrated Database) will help solve the clinician bugbear of “too much data, not enough sense” that occurs in many existing EMRs (electronic medical records). The other finalists deserve commendation for their work; Frances Toohey with Dr.Doctor for clinicians and patients to track eReferrals, and Kyle Frank’s MedScript to facilitate e-prescribing solutions for patients and doctors.

4) Tele-ophthalmology in India aims to cut waiting lists for a population short of ophthalmologists. Dr Sheila John of Chennai, India has done extensive work with diabetic retinopathy and machine learning, and inspired us with her dream to help rural villages be screened for diabetic retinopathy accurately and safely without a long waiting period for an eye specialist. Dr John quotes 60 million people in India as suffering from diabetes, with nearly 20% experiencing diabetic retinopathy, a cause of blindness if left untreated.

Speakers from four different nations closing the Global Telehealth conference today; L-R: Global Telehealth co-chair Dr Kendall Ho of Canada; Dr Karen Day of NZ; Dr Laticha Walters, South Africa; and Dr Sheila John, India. Pic: The Medical Startup

With four events running this week, it’s impossible to catch all sessions at once. Watch the conference on demand, even after this week, with a Virtual Ticket, including one year’s worth of membership with HiNZand HIMSS Asia-Pacific, among other benefits. We thank HiNZ for providing media access to the conferences and truly enjoyed the experience.  

Highlights from HiNZ, Successes and Failures in Telehealth, and the Global Telehealth Conference Day 1

First published November 1, 2016

We’re Tweeting live from #HiNZ2016 in Auckland this week. Follow us on Twitter @themedstartup and @journalmtm, the Journal of Mobile Technology in Medicine. We’re also on Instagram @themedicalstartup.
Virtual tickets with HiNZ membership are still available at hinz.org.nz. 

What were some of today’s highlights?

1.Experiencing the Maori welcome ceremony. It was incredible seeing the haka and other traditional ceremonies performed to commence the event. Kia Ora!

Pic: The Medical Startup

2.Learning about New Zealand’s healthcare system. New Zealand’s DHBs (District Health Boards) manage the various hospital regions in the country of two islands, supported by the national Ministry of Health (MoH). With a large rural and regional population, their DHBs have managed to put together various digital health solutions to overcome the geographical, cultural and at times, linguistic barriers that occur. (We’ve written about what Australians are doing with telehealth here, and Dr Gregory Sam’s telepsychiatry service here.)

3. Discovering what sensor wearables can do for the elderly.
Professor Marjorie Skubic of the University of Missouri’s Computer and Electrical Engineering Department, has carried out extensive research into sensor wearables, inspired by her own journey to help her parents feel safe yet independent while living a considerable distance away from her. Gait analysis using Microsoft Kinect depth cameras; sensor mats in beds that measure respiration and heart rate; and other sensors embedded in the home environment are all part of her research, giving hope for the elderly to feel supported and independent while their children can continue work.

Prof Marjorie Skubic discusses Eldertech at HiNZ2016. Pic: The Medical Startup

4. Experts acknowledging that technology is a means to a human-centred solution for healthcare. As Lord Nigel Crisp of the United Kingdom said below during his address:

The Medical Startup@themedstartup

"Healthcare is a human contact sport" - Lord Nigel Crisp quotes his friend at @HINZ_NZ #hinz2016 @nhsdigital

8:12 AM - Nov 1, 2016

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Additionally, Homecare Medical, who won the tender for New Zealand’s National Telehealth Service, understand that citizens don’t expect healthcare to be limited by geographical boundary anymore.

The Medical Startup@themedstartup

"The Virtual world doesn't respect the boundaries of District Health Boards (&other local health systems)" Andrew Slater, Homecare Medical

9:27 AM - Nov 1, 2016

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This leads into the topic of Precision Medicine & Personalised Medicine. As technology evolves, patients will feel more empowered to take control of their healthcare (as they already do by Googling symptoms and performing other forms of accessible research), and clinicians will have to evolve to understand their patients’ perspectives better. Patients will expect medicine doses and timing to be tailored; their leaflets or apps about their conditions will  be personalised; and more forms of personalisation to enable better living.

5. Learning what Clinicians think of Big Data. Big data is important, but what good is it if it’s of no use to you in future? With big data comes big responsibility, and collecting unnecessary data wastes valuable time and resources.

jMTM@journalmtm

"I thought Technology would be v important with all this,but it's actually Change ie.human behaviour-"Prof Chris Bladin @TheFlorey #Hinz2016

8:46 AM - Nov 1, 2016

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– above quote from Prof Chris Bladin when presenting his journey as a neurologist with the Victorian Telestroke program, which has successfully treated rural and remote patients throughout the state. They’re now looking to expand to other States.

The Medical Startup@themedstartup

"Elective #surgery is a great target for #bigdata but you need #goodquality data"Dr Mark Fletcher #anaesthetics #registrar#hinz2016 #ehealth

11:11 AM - Nov 1, 2016

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6. Watching the Finalists of the Clinicians’ Challenge, supported by New Zealand’s Ministry of Health. It strikes a chord with us that a national government supports and empowers their clinical staff as innovators, being the ones at the coalface of medicine. Finalists include an Anaesthetic Fellow; a Pharmacist undertaking doctoral studies; a Public Health doctor; and a Junior Doctor working in Dunedin. Stay tuned for further details, as well as updates on last year’s Ophthalmology and Surgical winners.

For more information on HiNZ, visit hinz.org.nz.