Virtual care has a long history; initially driven by a need to overcome distance. Now, as Dr Shannon Nott explains, virtual care is about mobilising knowledge to optimise healthcare delivery through the distribution of expertise.
In today’s current context, when I read articles about virtual care or telehealth, they are usually framed through the lens of COVID-19. Statements like “The COVID-19 pandemic has transformed…” and “During the pandemic, widespread adoption of telehealth…” are commonplace when writing about virtual care. While these statements are somewhat factual, they fail to recognise that virtual care is by no means a new thing, and nor is it a modality ringfenced to combating the challenges of a global pandemic.
In 1927, Alfred Traeger collaborated with the Reverend John Flynn to give Australia its voice – the pedal radio. The device, which leveraged principles used by German soldiers during World War 1, allowed remote station owners to access radio consultations from a doctor via Morse code. This was perhaps the first time virtual care was used in Australia and, at a fundamental level, has paved the way for the modern videoconference consultations that we undertake today. Although this occurred just shy of a century ago, the principal challenge of distance that spawned the pedal radio has continued as a driver for virtual care innovation.
Across NSW Health, several highly successful care models have been borne out of the need to span vast distances. The Mental Health Emergency Care (MHEC) model, which is well-embedded across several rural local health districts, has been running since the late 1990s to provide rural patients with access to specialist mental health expertise 24/7. Additionally, the state's Critical Care Overbed Camera Network (CCON) was first established to bring intensive care support to every rural community.
While virtual care can bridge geography, if you peel back what the above models (and many others) have achieved, it is much more than a tool to span distance. The underlying premise of virtual care is the ability to mobilise knowledge and optimise health delivery through the distribution of expertise. This is true for metropolitan environments, just as it is in rural and remote areas.
Knowledge mobilisation can occur in many ways, from clinician-to-clinician consultations, to undertaking a patient consult via myVirtualCare, or using artificial intelligence to assist care decisions for your patients.
Knowledge mobilisation has undoubtedly been an underlying principle of virtual care over the past 12 to 18 months, with significant uptake of virtual care models across urban settings. For our systems to understand the full potential of virtual care, it will undoubtedly be crucial for us to evaluate what worked well (and what didn't), both during the pandemic and from those models of care established before 2020. This is also true for individual clinicians taking up virtual care – ensure that you can leverage the lessons learned both during and before the pandemic.
As more virtual care models are established, it is important that appropriate evaluation occurs to ensure quality and safety. A NSW Health Virtual Care Monitoring and Evaluation Framework has been developed to help clinicians and service providers ensure safe, high-quality care. This Framework will also ensure knowledge sharing across the system.
In addition to this, the Virtual Care Accelerator has documented Virtual Care Initiatives to ensure healthcare providers can learn from existing models across the state.
For anyone interested in finding out more about virtual care or contributing to virtual care in NSW, please join the Telehealth Capability Interest Group and the Virtual Care Community of Practice.
About Dr Shannon Nott
Dr Shannon Nott is the Rural Director of Medical Services for Western NSW Local Health District (WNSWLHD). He oversees 35 rural and remote hospitals and multipurpose services. Shannon also works for the Royal Flying Doctors Service, South Eastern Section, as a retrieval and primary care registrar completing his Australian College of Rural and Remote Medicine Fellowship.
At WNSWLHD Shannon has led implementation of the vCare critical care hub, a 24/7 virtual support and logistics centre that assists rural and remote communities. He also created Australia’s first Virtual Rural Generalist Service and is Chief Investigator in developing a Virtual Clinical Pharmacy Service for rural communities.
Shannon was awarded a prestigious Churchill Fellowship in 2014, is an expert in the field of virtual care and has been appointed:
- Clinical lead of the Virtual Care Community of Practice for NSW Health, coordinating the virtual care COVID-19 response for the state.
- Inaugural Clinical Director of the Virtual Care Accelerator, a multi-agency business unit embedded within NSW Health to advance virtual care across the state.
He is also a member of the World Health Organization’s Roster of Digital Health Experts; advises the Rural Doctors Network; and sits on the Rural Council of the World Congress of Family Physicians (WONCA) and the NSW Health COVID-19 Clinical Council.