The emerging role of telehealth in a New Zealand ambulance service

Telehealth systems – using ICT to manage health from a distance – have been developing for decades, including within the ambulance sector. The author undertook this research to better understand how telehealth could improve patient outcomes, improve effectiveness, or create efficiencies for the St John ambulance service. To achieve this, current literature was reviewed and a small group of experts were interviewed whose experience lies in either the ambulance service or the health sector. Key recommendations are described below:  • It is of strategic importance to design ambulance telehealth systems with interoperability and interconnectivity – this will maximise health sector integration and governmental support.  • Telehealth solutions should be based on simple, well-established, easy to use, and ubiquitous technologies. This reduces fear, limits technical challenges, enables technology adoption, and improves chances of success. Of all available technologies, video-calling provides the most opportunity at present.  • Consistent with the 111 Clinical Hub model, St John should centralise specialists to provide telehealth support. This approach is cost effective as only a small number of specialists is required. It also supports effective clinical decision-making as this group routinely make complex decisions.  • It is realistic for St John to integrate video-calling as a telehealth solution into the 111 Clinical Hub. As a patient-to-clinician tool, 111 Clinical Hub staff could use video connections to call back low acuity patients to perform a secondary triage. As a clinician-to-clinician tool, paramedics could video-call the 111 Clinical Hub for clinical support. This would increase the richness of communication, and enable better clinical decisions to be made.  • While it is unclear the role that remote monitoring will play in improving an ambulance service, it is clear is that medical alarms will evolve to have much greater functionality, including sharing of biometric information. St John needs to make a strategic decision as to whether it wants to play the role of monitoring those with long-term conditions – and therefore being responsible for taking action when there are any signs of deterioration – or whether that should be the role of general practitioners (GPs).  • When designing telehealth solutions, St John must consider whether it is creating unequal access to healthcare and, where created, take actions to mitigate these inequities.  • It is important that St John clearly communicates any new telehealth interventions – resistance to change must be anticipated and therefore strong communication strategies must be part of the design process.  • There is limited evidence to support telehealth solutions in terms of improved patient satisfaction, improved patient outcomes, or greater efficiencies. With the impending implementation of electronic patient report form (ePRF) there is opportunity to evaluate a telehealth solution in these terms.  • It’s important to note that, regardless of the telehealth system adopted, no single solution will be effective – real improvements will require multiple integrated systems.