Health Innovation - Transformative Interconnected Digital Ecosystem (HI-TIDE): Effect of advanced videoconferencing and emergency telehealth services on emergency patient transfers from remote locations.

The HITIDE project is the evaluation process following the implementation of an advanced medical video-conferencing and emergency telehealth service for remote communities. Implementation will occur as part of the expected roll-out of a clinical improvement process which provides remote support to remote clinicians from a central emergency telehealth service assisting in individual patient management (not part of this research project). The current health service options for the remote centres is a local health professional (doctor or nurse) providing face-to-face consultations and emergency health care. There is no formal clinical support available other than within the medical service, and ad hoc support by telephone to the Royal Flying Doctor Service or to tertiary hospital consultants in the Perth metropolitan area (over 1000km away). The intervention will consist of a supplied videoconferencing computer cart which includes videoconferencing hardware and software, including multiple cameras, electronic patient monitoring and examination devices, and an integrated medical health record. Additionally, the remote sites will have continuous access to the WA Department of Health Emergency Telehealth Service which provides 24/7 on-call videoconferencing with emergency physicians and nurses to provide clinical support and facilitation of communication and logistics for patient transfers. Participants from several remote health facilities in Western Australia will be asked to participate in the co-design of the evaluation process (preparatory phase - Phase I), and to complete patient satisfaction evaluate forms for each occasion using the new technology and telehealth service (evaluation phase - Phase II). Phase I will consist of community consultation processes at an Aboriginal Medical Service and a Western Australian government remote area hospital. Focus groups will be formed using volunteers at each of these sites (community members and staff members) and discussion will occur with the investigator group (emergency physicians and nurses) to draft an evaluation process and staff and patient experience surveys. There will be 4 focus groups in the first round (one for community members and one for staff members at each of 2 sites) which will be exploring the important evaluation outcomes and processes. Once the feedback has been provided during the initial round of workshops, the evaluation outcomes and processes will be refined taking into consideration the feedback provided. Approximately 4-8 weeks after the initial round (timing depending on travel logistics and availability of personnel), another round of 4 focus groups will reconvene to provide further feedback and finalise the evaluation program for the research project. The evaluation methods considered will include staff and patient online surveys to be completed after each telehealth consultation to obtain person-centred evaluation information about the experience in using the technology (from staff and patients). In addition the evaluation will also obtain health systems information from medical records which will describe the effect of the intervention on patient management on site or transfer to another health facility. Phase II will follow after completion of the design of the evaluation process and tools. The evaluation will include staff and patient experience questionnaires. Participants will consent to completing the experience questionnaires which will be available online or on paper forms. Patient participants will also be asked to consent for the investigators to extract routinely collected clinical information from the relevant health systems databases. No additional investigations or interventions will be required. The questionnaires will be completed at the end of each consultation as a single snapshot of the experience for staff and patient. The clinical information from health data systems will be obtained as a one-time extract of data that had occurred during the evaluation period (January 2023 to December 2025 for both the pre-implementation and post-implementation periods). The routinely collected health service data will provide clinical and health system information including the number of patients managed in place or transferred to a larger hospital (regional or metropolitan), and clinical outcomes including representation to a hospital or emergency department, admission to an intensive care unit, or death. The evaluation of the clinical and health system data will be as a before-after design with comparison of the remote support and patient transfers from the remote site to higher level health care.