Telehealth in the home: Testing technology to enhance support and service provision to those either living with or caring for someone with a terminal illness in the community

This project using telehealth will investigate the effect of online support to the homes or primary residence of aged and palliative care patients and carers. The project will involve the provision of an iPad, with specially designed applications. The iPad home screen will have all the options loaded that are specific to the project with all other Apple applications removed. There will be an application for the patient and one for the carer. There will be a 'contact nurse' function, as well as a Facetime button to facilitate video conferencing between the nurse and patient or carer. Cisco jabber is loaded onto the iPad as the virtual case conferencing platform. The community nurse will organise a virtual clinic with the patient as part of a monitoring function and this time will be scheduled with the patient as clinically indicated. The patient is asked to complete the symptom severity tool that is loaded into the patient application function each day. An increase in symptom scores will send an automatic email alert to the community nurse who will respond when able. The patient and carer will be taught how to assess the patient functional status and this will be recorded weekly. A drop in functional score below 70% signals the need for a virtual case conference between all key health care providers. The patient and carer will be informed of the working hours of the nurse as this is not a 24 hour service, so routine provisions to access the On call service will be in place to support out of hours and on weekends. This project will not only facilitate regular and responsive online access to health professionals but will provide brokered access to quality information and resources to support palliative care patients and their carers. The education is loaded onto both the patient and carer application functions. This information is provided from the website CareSearch and is peer reviewed and evidenced based. The types of information provided include how to access community services, general information on how to care for someone with a life limiting illness, and information on Advance Care Planning. The palliative care service will test if use of information technology can be incorporated into current care processes and whether this will reduce service requirements and/or increase the number of patients that can be managed in the community as well as sustaining a patient at home for the same time or longer. The formal project will conclude at the end of May 2014 however all patients will remain supported via this technology until death.