Download 1 Mr.P.Appapillai, B.Sc Engineering. Email Address: premraj1

 Mr.P.Appapillai,
Consultant Telecommunications Engineer
B.Sc Engineering.
Email Address: [email protected]
26.02.2009.
To: The Standing Committee on Finance and Public Administration,
Inquiry into Public Hospital Performance Data,
Council Committees Office,
Department of the Legislative Council,
Parliament House,
East Melbourne, 3002.
1.0 INTRODUCTION
The object of this submission is to address , the terms of reference, of the
Inquiry into Public Hospital Performance Data. The terms of reference are;
“To inquire into and report on the capacity of hospitals to meet demand, standards and
quality of care, resourcing and access levels, and the accuracy and completeness of
performance data for Victorian public hospitals.”
Thank-you for the opportunity to make a submission to the committee’s inquiry into
Public Hospital Performance Data. If required , I shall be pleased to provide
supporting evidence at a Public Hearing .
The scope of this submission, will focus on the need to
a) Improve the Quality of care in Emergency Medicine by ,Reducing Time Delays in
treating Ambulance Patients, by utilising Laptop based Telemedicine Equipment,
in delivering Online Medicine, from remote locations of rural Victoria,
b) Improve Quality of Care in Emergency Medicine, utilising Laptop based Online
Medicine , expedite the consultation, between Ambulance Crews & Specialists, in
the capital cities, across Australia.
1 Fig.1- Typical Layout of National Broadband Network linking multiple locations, with
Broadband Telecommunication Connectivity
c)
Improve the Quality of Care, by upgrading selected Base Hospital Medical Call
Centres, to be similar or equivalent to that depicted in Fig.2 below.
2 Fig2- Typical Layout of Typical Corporate/ Base Hospital Medical Call Centre with Patient
History File Server & comprehensive Video Conferencing linked via the National Broadband
Network ( NBN).
d) Improve the Quality of Care, by upgrading e-Health facilities, at Rural Hospitals
by facilitating integration with Federal Governments Super GP e-Health facilities
e) Improve the delivery of Emergency Medical services, by reading the Royal Flying
Doctor(RFD) National e –Health Database, in conjunction with the relevant online
Patient History.
2.0 REDUCING DELAYS IN TREATING AMBULANCE PATIENTS
Some of the major causes of delays in treating ambulance patients, are;
a)Ambulance “Ramping” AND Diversion which occurs when patients cannot be
accommodated, at destination hospitals, due to bed shortage. Ambulances are
compelled to, queue, until accommodation is found OR diversion advice, is
issued.
b)In -hospital delays( eg. Admission , CathLab).
3 The above causes of delay, can be minimised, by High Resolution 12 Lead ECG
Transmission, Laptops , utilising the National Broadband Network (NBN) , which will
cover 98%1 of the population .Wireless broadband modems, linking remote Laptops,
to the NBN, will enable Cardiologists, interpret High Resolution ECGs & deliver
preliminary advice to Paramedics.
The other, 2% of the population, not covered by the National Broadband
Network(NBN), will be covered using the Optus Thuraya Telephone or equivalent Dual
Mode –Satellite cum Mobile telephone. These dual mode Telephones, are equipped,
with 1.3 Megapixel Cameras, which will enable Ambulance personnel, to transmit
Photos to Hospital Cardiologists ,for advice.
“For every 30Min. Delay , there is a 7% increase in mortality at one year”2
Delay times, in Australia are
This view is supported by the following extract from the Medical Journal of Australia
“the earlier the treatment, the better the resulting cardiac function and the lower the
incidence of morbidity after MI.” 3
Further , remote transmission of ECGs, to Hospital Cardiologists, with early
implementation of Thrombolytic Therapy by Paramedics,has been successfully
effected in Qld.4
3.0TELE DERMATOLOGY APPLICATIONS( EG.BURNS etc)
In the event of bushfires, in remote locations of Victoria , specialists in Melbourne
/Perth, can be consulted on line via the NBN , using a Laptop & urgent treatment
commenced.See Fig.3 below
Fig.3- General Examination Camera with Digital Imaging Capability
For further detail, see my article, entitled “TELEMEDICINE AND ITS APPLICATION IN
SOUTHWEST VICTORIA WITH PARTICULAR REFERENCE TO PARAMEDICAL
PERSONNEL/ REMOTE CLINICS By Prem Appapillai- Consultant
Telecommunications Engineer
4.0ENHANCING THE QUALITY & ACCURACY OF PATIENT DATA
Upgrade of the existing call centres, to those compatible with centres depicted
In Fig.1. This will
a) Enable the Maintenance of accurate digitised e-Health Records (see Fig.4)from
Remote Locations
4 b) Support Video Conference & improve the quality of Diagnostics
c) Optimise the usage of the Tax payers investment in the NBN.
The present & future Fiscal Stimuli, can be used to fund the installation of Multiple
Call Centres, linked Australia Wide, by the impending NBN, thereby providing vital eHealth Services & Video Conferencing, which is not available Australia Wide over
98% of the population.
After the spate of Bush Fires which have caused damage, in excess of A$2BN , in
Victoria, the Royal commission, is likely release funds for Thermal Imaging &
Emergency Medical Services(Fig 5).
Examples- Sinus Arrhythmia
Example- Ventricular Fibrilation
Examples- Premature Atrial Contraction
Fig.4- Example of 12 LEAD ECGs indicative of Coronary Heart Disease( CHD) which can be
transmitted toHospital cardiologists for Preliminary Diagnosis & Advice
A significant benefit, arising from the upgrade of the Medical Call Centre, is that
In the event of Thermal Imaging / Fire Surveillance Systems, installed by the
Emergency Management Australia(EMA).
EMA , could have alarms duplicated,for Evacuation Alerts in Regional Hospitals,
Via the NBN .
5 Fig.5- Typical Fire Surveillance / Thermal Imaging Systems with Backhaul Microwave with NBN
Access which will provide Duplicate alarm displays in Area
5.0 ON LINE MEDICINE TO BE USED BY ROYAL FYING DOCTOR SERVICE
Facilitates integrated use, with Royal Fling Doctor (RFD) service National Database5&
delivery efficient outcomes in Rural Australia, minimising patient transfer.
The unification of fragmented Patient Databases, in different areas, will simplify the
delivery & quality of medical services , by eliminating fragmented /conflicting
databases.
6.0References
1.0National Broadband Network: Full Coverage‐ Australian – Dec.04,2008 http://www.australianit.news.com.au/story/0,24897,24715607‐15319,00.html 2.James McCarthy,MD, Assistant Professor‐Department of Medicine at UT Medical School –Houston http://publicaffairs.uth.tmc.edu/media/newsreleases/nr2007/HeartAttack.html 3.Australian Patients Delay in Response to Heart Attack Symptoms‐Kathleen Dracup,Sharon McKliney,Debra K Moser‐ Medical Journal of Australia‐ 1997. http://www.mja.com.au/public/issues/mar3/dracup/dracup.html 4.Qld . Ambulance first to administer ON –Site Anti Clotting Drug‐ June 25. 2008 http://www.abc.net.au/news/stories/2008/06/25/2285591.htm 6 5.Flying Docs pilot first National e‐Health Database –Darren Pauli‐ 03/02/2009 http://www.pcworld.idg.com.au/article/275281/flying_docs_pilot_first_national_e‐health_database 7.0 CONCLUSION
In conclusion, I shall be pleased to provide supporting evidence at a Public Hearing. if
required.
Thank-you for the opportunity to make a submission to the committee’s inquiry into
Public Hospital Performance Data.
Yours Sincerely,
Prem Appapillai,
Consultant Telecommunications Engineer
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