V Harris et al.

Mobile videoconferencing

Table 3 Proportion of mental health clinic visits by TMH in rural very small proportion of services when considered in
health regions, 2006 relation to total outpatient visits for mental health care.
Community mental TMH Percent At this stage, TMH in Alberta is established as a useful
health clinic visits consultations clinic visits technique for rural health regions, though with variable
Region per 100,000 per 100,000 using TMH coverage, but remains a niche technique when all mental
Northern lights 1615 66 4
health services are considered.
Peace Country 1700 246 14
Aspen 2507 379 15 Acknowledgements: We are grateful to Mel Slomp,
East Central 2145 32 2
AMHB, for providing data and advice on outpatient
David Thompson 1689 183 11
Palliser 2413 9 0.4 services.
Chinook 1710 3 0.2
References
1 Ohinmaa A, Roine R, Hailey D. The Use of Videoconferencing for Mental
assessment of mental health needs and efforts by the Health Services in Finland and Canada. Edmonton and Helsinki:
communities to achieve equitable resource allocation.3 Institute of Health Economics and Finnish Office for Health
Even in the regions where use of TMH has been higher, Technology Assessment (in press)
there is considerable scope to increase the volume of 2 Simpson J, Doze S, Urness D, Hailey D, Jacobs P. Evaluation of a
routine telepsychiatry service. J Telemed Telecare 2001;7:90–8
services delivered in this way. Recent trends in the use of
3 Doze S, Simpson J, Hailey D, Jacobs P. Evaluation of a telepsychiatry
videoconferencing for mental health services indicate
pilot project. J Telemed Telecare 1999;5:38–46
continuing growth in numbers of teleconsultations. Even 4 Urness D, Hailey D, Delday L, Callanan T, Orlik H. The status of
so, TMH remains an option for a minority of patients who telepsychiatry services in Canada: a national survey. J Telemed
use community mental health clinics, and accounts for a Telecare 2004;10:160–4

...................................................................................................................................................

" Education for regional health professionals

using mobile videoconferencing
Vivien Harris, Anthony C Smith and Nigel R Armfield
Centre for Online Health, University of Queensland, Brisbane, Australia

Summary
We delivered professional education into the wards of two remote hospitals using mobile videoconferencing units. The telepaediatric
clinical forums were provided to remote clinicians by medical, nursing and allied health specialists at the Royal Children’s Hospital in
Brisbane. The topics comprised formal and informal presentations, clinical case discussions and an opportunity to raise questions. At
the end of each videoconference session, participants were asked to complete a survey. During the first four months, a total of 23
clinical forums took place and a total of 201 remote clinicians attended the sessions. We received 166 evaluation surveys (83%
response rate). Overall, the results were very positive: 88% of participants agreed or strongly agreed that the sessions were relevant,
of adequate depth (86%) and provided new content (90%). Transmission quality was satisfactory, with the majority of participants
agreeing that the audio (82%) and video quality (91%) were acceptable. Participants consistently indicated that they had adequate
opportunity for questions and discussion. Ninety-seven percent of staff agreed or strongly agreed that the sessions should be
continued routinely. Regional clinicians reported that they were much more likely to be able to attend the sessions because they did
not have to leave their departments. The telepaediatric clinical forums appear to be an effective and efficient method of supporting
clinical staff working in regional areas of Queensland.

Correspondence: Vivien Harris, Centre for Online Health, Level 3,
Foundation Building, Royal Children’s Hospital, Herston 4029, Australia
(Fax: þ61 7 3346 4705; Email: v.harris@coh.uq.edu.au)
Introduction
.......................................................................
In Queensland, with its vast distances and remote
communities, the support of health professionals in their

S3:44 Journal of Telemedicine and Telecare Volume 13 Supplement 3 2007

V Harris et al. Mobile videoconferencing

Table 3 Proportion of mental health clinic visits by TMH in rural very small proportion of services when considered in
health regions, 2006 relation to total outpatient visits for mental health care.
Community mental TMH Percent At this stage, TMH in Alberta is established as a useful
health clinic visits consultations clinic visits technique for rural health regions, though with variable
Region per 100,000 per 100,000 using TMH coverage, but remains a niche technique when all mental
Northern lights 1615 66 4
health services are considered.
Peace Country 1700 246 14
Aspen 2507 379 15 Acknowledgements: We are grateful to Mel Slomp,
East Central 2145 32 2
AMHB, for providing data and advice on outpatient
David Thompson 1689 183 11
Palliser 2413 9 0.4 services.
Chinook 1710 3 0.2
References
1 Ohinmaa A, Roine R, Hailey D. The Use of Videoconferencing for Mental
assessment of mental health needs and efforts by the Health Services in Finland and Canada. Edmonton and Helsinki:
communities to achieve equitable resource allocation.3 Institute of Health Economics and Finnish Office for Health
Even in the regions where use of TMH has been higher, Technology Assessment (in press)
there is considerable scope to increase the volume of 2 Simpson J, Doze S, Urness D, Hailey D, Jacobs P. Evaluation of a
routine telepsychiatry service. J Telemed Telecare 2001;7:90–8
services delivered in this way. Recent trends in the use of
3 Doze S, Simpson J, Hailey D, Jacobs P. Evaluation of a telepsychiatry
videoconferencing for mental health services indicate
pilot project. J Telemed Telecare 1999;5:38–46
continuing growth in numbers of teleconsultations. Even 4 Urness D, Hailey D, Delday L, Callanan T, Orlik H. The status of
so, TMH remains an option for a minority of patients who telepsychiatry services in Canada: a national survey. J Telemed
use community mental health clinics, and accounts for a Telecare 2004;10:160–4

...................................................................................................................................................

" Education for regional health professionals

using mobile videoconferencing
Vivien Harris, Anthony C Smith and Nigel R Armfield
Centre for Online Health, University of Queensland, Brisbane, Australia

Summary
We delivered professional education into the wards of two remote hospitals using mobile videoconferencing units. The telepaediatric
clinical forums were provided to remote clinicians by medical, nursing and allied health specialists at the Royal Children’s Hospital in
Brisbane. The topics comprised formal and informal presentations, clinical case discussions and an opportunity to raise questions. At
the end of each videoconference session, participants were asked to complete a survey. During the first four months, a total of 23
clinical forums took place and a total of 201 remote clinicians attended the sessions. We received 166 evaluation surveys (83%
response rate). Overall, the results were very positive: 88% of participants agreed or strongly agreed that the sessions were relevant,
of adequate depth (86%) and provided new content (90%). Transmission quality was satisfactory, with the majority of participants
agreeing that the audio (82%) and video quality (91%) were acceptable. Participants consistently indicated that they had adequate
opportunity for questions and discussion. Ninety-seven percent of staff agreed or strongly agreed that the sessions should be
continued routinely. Regional clinicians reported that they were much more likely to be able to attend the sessions because they did
not have to leave their departments. The telepaediatric clinical forums appear to be an effective and efficient method of supporting
clinical staff working in regional areas of Queensland.

Correspondence: Vivien Harris, Centre for Online Health, Level 3,
Foundation Building, Royal Children’s Hospital, Herston 4029, Australia
(Fax: þ61 7 3346 4705; Email: v.harris@coh.uq.edu.au)
Introduction
.......................................................................
In Queensland, with its vast distances and remote
communities, the support of health professionals in their

S3:44 Journal of Telemedicine and Telecare Volume 13 Supplement 3 2007

 V Harris et al. Mobile videoconferencing

clinical work and ongoing education poses both economic

and human resource challenges. The potential for distance
education to address these challenges is well recognized,
and a range of programmes is available, although not
universally accessed. Anecdotal reports from clinical staff
indicate that participation in these education programmes
can be difficult as the facilities are not always located
conveniently to the workplace, may involve out-of-hours
attendance, may not be individualized or context-specific,
and may offer limited opportunity for interaction with
experts in the field.
The telepaediatric service in Queensland provides
specialist health services to selected regional and remote
hospitals throughout the state.1,2 Since 2004, we have
been investigating the use of mobile and wireless
videoconferencing systems, which allow consultations to
take place within the clinical department, and directly Figure 1 An endocrinologist at the Centre for Online Health
near the bedside if required.3 These systems are child- delivering a diabetes session to staff in Mt Isa
friendly in appearance, being built in the shape of a robot.
In 2006, two telepaediatric robots were installed in the
paediatric wards at Mount Isa and Emerald Hospital to
provide telepaediatric services with the support of
specialists at the Royal Children’s Hospital (RCH) in
Brisbane.3 Although the telepaediatric service is
principally focused on the delivery of clinical services, we
have expanded our service to address staff requests for
professional education.
A series of telepaediatric clinical forums were
subsequently developed and began to be held each week in
March 2007. The presenters have included paediatric
consultants, clinical nurse consultants and allied health
professionals with special expertise in paediatrics. The
sessions were conducted in an informal manner to
encourage interaction between the regional staff and the
tertiary specialists. Presenters have delivered PowerPoint
presentations, used question-and-answer formats, shown
documents transmitted via a document camera and
performed demonstrations using the telemedicine Figure 2 Mt Isa staff and Robot ‘Eliza’ during a telepaediatric
facilities at the Centre for Online Health (COH) (Figure 1). forum
At the regional hospitals the mobile videoconference unit
was positioned in a staff meeting room within the
paediatric ward (Figure 2).
The overall aims of the telepaediatric clinical forums
were: Methods
.......................................................................
(1) to encourage use of telehealth/videoconferencing to
We surveyed paediatric nurses in Mt Isa and Emerald to
augment health practice;
identify clinical topics of interest to them. Routine
(2) to support remote/regional hospital staff
telepaediatric clinical forums commenced in March 2007
(multidisciplinary);
and were delivered using the mobile videoconferencing
(3) to provide opportunities for case discussions and systems. Telepaediatric records were reviewed to
facilitate interprofessional dialogue; determine the duration and number of sessions that took
(4) to promote closer working relationships between place. At the end of each videoconference session,
physicians, nurses and allied health practitioners in participants were asked to complete an evaluation survey
remote regions and colleagues at the tertiary hospital on participant satisfaction with the relevance, depth and
(RCH). content of the sessions, as well as the technical elements
of audio and visual quality. The survey included 10
The aim of the present study was to determine statements with responses based on a 5-point Likert scale.
the feasibility of this form of distance professional Completed surveys were faxed to the COH after each
education. session for analysis.

Journal of Telemedicine and Telecare Volume 13 Supplement 3 2007 S3:45

V Harris et al. Mobile videoconferencing

Results programmes which are delivered throughout the state on a

....................................................................... routine basis. These include medical education Grand
Rounds which are shared via videoconference each week
During the first four months, from March 2007 to June with 25 hospitals.4 Other regular sessions are facilitated for
2007, a total of 23 clinical forums took place. A broad subspecialties such as child development, speech
range of topics were addressed, including emergency pathology, diabetes and child nutrition.5,6 To complement
medicine, diabetes, gastroenterology, respiratory the clinical management of children requiring post acute
medicine, burns and safe sleeping practices. A total of 201 burns care, a state-wide education programme has been
clinicians attended the sessions, most of whom were developed for regional occupational therapists to help
nurses (Table 1). them provide care for children in rural and remote
regions. This programme provides valuable professional
support to therapists working in very remote locations in
Staff satisfaction Queensland.7
We received 166 surveys (83% response rate) and the Conventional methods used to deliver education at a
results indicated very high satisfaction: 88% of distance normally rely on dedicated, room-based
participants agreed or strongly agreed that the sessions videoconferencing systems, usually situated some way
were relevant, of adequate depth (86%) and provided new from clinical areas. The delivery of clinical training
content (90%). Transmission quality was satisfactory, with opportunities directly into the ward is an advantage. The
the majority of participants agreeing that the audio (82%) positioning of a mobile videoconference system directly
and video quality (91%) were acceptable. Participants in the ward facilitates a high attendance at the sessions.
consistently indicated that they had opportunity for Staff can gather in their lunch room/lounge for the
questions and discussion. Ninety-seven percent of staff videoconference and do not have to leave the ward
agreed or strongly agreed that the sessions should be area. Regional clinicians have reported that they are
continued routinely (Table 2). much more likely to be able to attend the sessions
because they do not have to leave their departments.
In the present study, there was a consistently high
Discussion attendance pattern in both regional hospitals, with
....................................................................... some staff coming in for the sessions even on their days
off work.
The delivery of education using videoconferencing is not Participants also appreciated the opportunity to access
new. In Queensland, there is a range of teaching specialists who were located in the tertiary hospital.
Clinicians gained confidence in the use of the system and
Table 1 Telepaediatric clinical forums – activity relationships were fostered between regional staff and
Average Average specialists in Brisbane. Currently, there is no other service
duration Total number of which provides this type of access. The need for ongoing
Number Duration per session number of participants professional development and support of isolated health
Site of sessions (min) (min) participants per session
professionals is evident. The telepaediatric clinical forums
Emerald 7 210 30 78 11 demonstrate a method for supporting clinical staff
Mount Isa 16 480 30 123 7 working in regional areas of Queensland and there is
obvious potential for this type of service to be expanded to
Total 23 690 30 201 9
other hospitals.

Table 2 Satisfaction with the sessions delivered via the mobile system (n=166)
Strongly Agree Neutral Disagree Strongly Not applicable
Statement agree (%) (%) (%) (%) disagree (%) (%)

The programme provided me with new information 43 47 8 1 0 1

The content was not relevant 4 6 2 39 49 0
The content was covered in the appropriate depth for me 36 50 8 4 2 0
The session was well presented 42 48 8 2 0 0
There was insufficient opportunity to ask questions 10 7 4 30 49 0
and discuss issues
The picture quality was satisfactory 42 49 7 2 0 0
The quality of the sound was satisfactory 35 47 7 10 1 1
These sessions should be continued on a routine basis 70 27 2 0 0 0
Visual aids (if applicable) were not transmitted clearly 5 17 11 27 23 17

Excellent Very Average Below Very Not

(%) good (%) (%) average (%) poor (%) applicable (%)
Overall impression of the session 43 46 7 3 0 1

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 A Kaan et al. Virtual heart failure clinic

Acknowledgements: We are grateful for funding provided
by Xstrata (Community Partnership Programme) and the
Royal Children’s Hospital Foundation. The telepaediatric
service is also funded by the Commonwealth Department
of Health and Ageing (Medical Specialist Outreach and
Assistance Programme).
References
1 Smith AC. Telepaediatrics in Queensland. In: Wootton R, Batch J,
eds. Telepediatrics: Telemedicine and Child Health. London: Royal
Society of Medicine Press, 2005:25–39
2 Smith AC. The Feasibility and Cost-Effectiveness of a Novel
Telepaediatric Service in Queensland. Brisbane: The University
of Queensland, 2004. See http://adt.library.uq.edu.au/public/
adt-QU20050121.145040/index.html (last checked 26 July 2007)
3 Smith AC, Coulthard M, Clark R, et al. Wireless telemedicine for the
delivery of specialist paediatric services to the bedside. J Telemed
Telecare 2005;11 (Suppl. 2):81–5
4 McCrossin R. Successes and failures with grand rounds via
videoconferencing at the Royal Children’s Hospital in Brisbane.
J Telemed Telecare 2001;7 (Suppl. 2):25–8
5 Bailey M, Smith A, Fitzgerald A, Taylor E. Delivery of child
development services by videoconferencing: a review of four
year’s experience in Queensland. J Telemed Telecare 2005;11
(Suppl. 2):1–3
6 Smith AC, Batch J, Lang E, Wootton R. The use of online health
techniques to assist with the delivery of specialist paediatric
diabetes services in Queensland. J Telemed Telecare 2003;9 (Suppl. 2):
54–7
7 Smith AC, O’Brien A, Jakowenko J. Post-acute burns education
via videoconference for occupational therapists in Queensland.
J Telemed Telecare 2006;12 (Suppl. 3):73–6

...................................................................................................................................................

" The development and feasibility of a virtual

heart failure clinic
Annemarie Kaanw, Scott Learz and Biljana Maricz
Heart Centre, St Paul’s Hospital; wUniversity of British Columbia; zSimon Fraser University, Vancouver, British Columbia,
Canada

Summary
Heart failure (HF) self-management includes monitoring and reporting of changes in symptoms. We have explored the
feasibility of an interactive, easy-to-use Web-based system that provides a link between the patient and the health professional.
New HF clinic patients were enrolled into a six-month study. Patients were identified according to their ability to use the
Internet daily and whether they would be able to complete baseline and follow-up visits. In the first 12 months, nine patients
completed the study. There was an improvement in physical functioning as measured with the 6-min walk test, from 395 m
(SD 105) to 457 m (SD 90). There was also an improvement in quality-of-life scores, from 47 (SD 29) to 40 (SD 26) (the lower
the score, the better). Patients expressed high levels of satisfaction with the intervention. The system was shown to be safe and
feasible when used with appropriate supports. The virtual HF clinic is simple, cheap and has potential for use in a range of
chronic illnesses.

Introduction management techniques. Clark et al.2 defined self-

.......................................................................
Heart failure (HF) is defined as the inability of the heart to
provide adequate blood to the tissues.1 HF is usually a
chronic disease and, therefore, it is important for patients
to learn to take control of their illness through self-
Correspondence: Annemarie Kaan, Room 5256, Providence Building,
St Paul’s Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
(Fax: þ1 604 806 8800; Email: akaan@providencehealth.bc.ca)
management as ‘ythe day-to-day tasks an individual must
undertake to control or reduce the impact of disease on
physical health status’. In HF, self-management includes
adherence to a low-salt diet, remaining active and,
most important, monitoring and interpreting changes in
weight and symptoms, and seeking appropriate medical
assistance when needed.3 It has been shown that HF
patients, once diagnosed, are at high risk of re-admission
to hospital within a short time because they may not
have been provided with the necessary self-management
skills.4

Journal of Telemedicine and Telecare Volume 13 Supplement 3 2007 S3:47