The Modern Outpatient: A Collaborative Approach 2017-2020

Annex 4: Video Clinics to Support the Delivery of Outpatient Services

Background

The use of video conferencing technologies has grown within both the consumer and the health sectors. Products such as Skype and Facetime are now in widespread use, while the number and range of clinical uses of video conferencing technology is growing.

Evidence from a systematic review carried out in Australian ^[2] shows a significant increase in the development of video mediated services and details a wide range of specialties using the technology. These include mental health, oncology, geriatrics, endocrinology, orthopaedics and cardiovascular, along with a range of other specialties.

There is growing evidence to support the use of telehealth (including video conferencing) for patients and healthcare providers with outcomes showing: reduced length of stay; reduced demand on emergency services; improved access to healthcare; improved quality of services; improved clinical outcomes; decreased costs; reduced inconvenience; improved management of chronic and complex conditions; and provision of peer support, networking and education.

Use within Scotland

Since March 2016, it has been possible to establish point-to-point video links to a patient/citizen in their own home, using their own equipment. This is now being used in a number of specialties in Scotland including: speech and language therapy; treatment of diabetic leg ulcers; occupational therapy home visits; infant feeding; and paediatric counselling. A number of specialties such as bone marrow transplant, diabetes, oncology and sexual health are currently undertaking testing to assess its applicability in their environment.

Technology

Traditional video enabled services have largely been developed using point-to-point video conferencing solutions. These often require the use of expensive infrastructure, travel to a video conferencing suite, or complex scheduling to work around the limitation of only be able to set up single point-to-point links.

Recent advances of web-based solutions and standards have facilitated the development of easy to use systems that allow the service user to simply click on a web link and take part in a video sessions. Combined with a back-end system to provide appropriate call management along with a range of deployment tools, guidance notes and training materials, this provides an easy to use, easy to deploy, full virtual clinic environment.

Deployment within Scotland

Following procurement, Attend Anywhere (working in conjunction with HealthDirect Australia) have been selected to provide an introductory video clinic platform for Scotland. Launching on 1 December 2016, this will provide capacity to support up to 50 units ^[3] .

Early adopters will include primary care (being formally evaluated by the University of Edinburgh following CSO grant) and TEC programmes in Borders and Dumfries and Galloway.

Support for outpatients

There is scope to utilise the service to support the delivery of outpatient services. Likely benefits of introducing video clinics include:

• Reduction in 'Do Not Attends'.
• Reducing patient travel and associated costs.
• Reducing clinician travel bringing associated efficiency savings.
• Allowing for the re-design of services to incorporate a stepped approach to service provision that includes a wider range of technology solutions and face-to-face consultations with a wider range of clinicians and professionals.
• As the clinician would no longer be required to physically attend the clinic a more flexible approach to workforce can be taken. This could include working from home, working outwith the geographic area and working in collaboration with other boards.