Making a healthy call

If you’re working the night shift in a small regional hospital and the doorbell rings in the small hours, chances are you won’t be able to spring out of your seat to open the door.

You might, after all, be unable to leave a patient’s side.

Or you might be worried that folks who knock on hospital doors late at night can sometimes be looking for something other than medical attention.

In Western Australia, the latter scenario is now less fraught, thanks to a refresh of telecommunications systems in regional hospitals led by Howard Bunt, ICT Manager at West Australia’s Country Health Service (WACHS).

"Our front door phones plug into security systems and link to wireless phones,” Bunt explains. “You can also see images from the closed-circuit TV feed."

Between the ability to have a conversation with late night arrivals from anywhere in a hospital and the opportunity to see them on-screen, late-night staff can then make a better decision about how to respond to midnight arrivals. That’s just one of many positive outcomes from a refresh of the Service’s telecommunications systems that was undertaken as part of a standardisation drive, aimed at improving the organisation’s ability to deliver at the point of care.

Vast scale

That point of care is enormous.

"We look after 6.5 million square miles of regional West Australia,” Bunt says. “We serve 540,000 people, have a staff of 8,500 people, and operate six large regional hospitals, 15 district hospitals, 50 small hospitals and 39 posts staffed by registered nurses."

The scale of the operation means standards are important, lest the organisation become inconsistent in the way it delivers services.

"Standardisation is important because we want everything we do or try to do – finance, HR and IT – to have one look, one feel,” Bunt says. “We have a lot of nursing staff who do shifts in different places. The average age of our nurses is 62: not a lot of them are tech-savvy. Some would go from one site to another and not know how the equipment works."

The Service operated diverse equipment as a result of its genesis in many small health services. As a consequence of the amalgamation of these services in 2002 to form WACHS, the organisation found itself with a number of legacy systems. Many of these systems were also approaching their end of life, providing the perfect opportunity for a refresh of the whole system. A move to newer telephony systems was also seen as a likely route to lower-cost connectivity and voice charges, important potential savings for a far-flung organisation.

Bunt, who works in the regional city of Bunbury, settled on NEC as the Service’s supplier. Already in place at the State’s Metropolitan Health Service, the vendor also impressed Bunt based on past experiences. “I have known NEC for a while: we used it when I was the IT manager at the Department of Justice. It’s not the cheapest, but it is very robust. That’s important because it’s 50 degrees for half the year at some of our sites.”

"We like going leading edge, but we need a robust and sustainable system. At the end of the day, we need to make sure our platform works and is secure and robust. People don’t complain when email goes down, but when voicemail goes down, they have a major issue!"

Another important item is the terms Bunt was able to reach with NEC. “With this maintenance contract, we get software upgrades every year,” he says, a surety of innovation he finds welcome, given the likely pace of innovation in technology’s impact on health care.

LAN/WAN upgrade

The new PABX has been accompanied by a refresh of the Service’s local and wide area networks, and in harness with the new telecommunications systems, the new networks are enabling impressive savings.

"The new LAN has quality of service which means we can run voice over IP,” Bunt says. “Since we installed it, we have made 9,000 calls over the network and made a cost saving of $120,000 just on calls between sites."

The new systems have also made it possible to install 365 videoconferencing units in WACHS facilities, some of which sit on medical practitioners’ desks, and Bunt reports they are improving patient care while also saving money.

“We have a tele-health coordinator in each of our seven regions,” he explains. These staff schedule consultations with medical professionals across the whole WACHS network or at Perth hospitals, often arranging follow-up visits as videoconferences. A booking system means clinicians simply see a videoconference as their next scheduled appointment.

This initiative has already saved $1.4 million that would otherwise have been spent on transferring patients to Perth for consultations, with $384,000 saved on burns cases alone.

The move to the IP WAN helps, too.

"We have saved $400k on ISDN alone: Telstra was making a fortune from us."

Remote communications

WACHS’ work also takes it into remote areas, and in those locations Bunt and his team have used a combination of satellite and mobile telephony. The organisation has acquired a Balconi Tracker, a device that greatly extends the range of 3G networks. Sitting atop a vehicle, the device means WACHS can extend its videoconferencing and voice network into remote locations.

"We just use normal analog phones. We set up in a remote community and it is just like we have a normal phone on the system. Other agencies are looking at it now. All the emergency response organisations struggle for communications in remote locations."

"We are using the Royalties for Regions programs to get more mobile phone towers in blackspots,” Bunt adds. “We’ve had some incidents where there was no communication. One aspect of my role is getting better communications networks for the Service and the State."

And Bunt sees that role as continuing.

"We needed a robust infrastructure platform before we could contemplate e-health,” he says, satisfied that the upgrade to PABX, LAN and WAN was necessary and has improved productivity. “Now we need to be in a position to meet future demands."

Remote management

While technology is making WACHS a more effective health care organisation, Bunt faces a considerable management challenge to work with far-flung colleagues from the seven regions.

Himself based in the regions – Bunt calls Bunbury home – he says “it is very difficult to manage” his team of regional IT managers.

"The managers in the regions each have their own IT management teams. I chair the ICT network, and we meet in Perth on a regular basis."

Of late, the organisation’s videoconferencing equipment has also been pressed into service to help the IT team communicate across the State.

A further management challenge comes from the fact that WACHS is not entirely independent.

"We are dictated to a bit by the health information network – that’s where the LAN/WAN and security teams are located,” Bunt says. “We are under their strategic guidance and direction."