In November 2000, the Queensland Telepaediatric Service (QTS) was established in Brisbane, Australia, to support the delivery of telehealth services to patients and clinicians in regional and remote locations. The QTS was built on a centralized coordination model, where telehealth services could be effectively managed by a dedicated telehealth coordinator. In doing so, telehealth referral and consultation processes were efficient and clinicians felt better supported as they adjusted to new processes for engaging with patients. We have conducted a retrospective review of activity associated with the QTS and summarized key activities which have arisen from this extensive program of work. Telehealth service records and associated publications were used to describe the evolution of the QTS over a 15-year period. From November 2000 to March 2016, 23,054 telehealth consultations were delivered for 37 pediatric clinical specialties. The most common service areas included child and youth mental health, neurology, burns care, surgery, and ear nose and throat services. A range of different telehealth service models were developed to align with different clinical service needs and location of services. Whilst most work involved video consultation between hospitals, some services involved the delivery of telehealth services into the home, schools or community health centres. Despite its longevity, the QTS was not immune to the usual challenges associated with telehealth implementation, service redesign and sustainability. Experience reported from the QTS will be useful for other health services seeking to develop comprehensive telehealth services in a rapidly changing healthcare environment.

Aim To evaluate rural paediatric diabetic telehealth clinics including whether they meet clinical standards, provide equivalent care to central clinics, families were satisfied and difficulties were encountered. Methods An audit of a telehealth service for children and adolescents with type 1 diabetes mellitus at four rural sites was conducted. The case notes for each patient for 2019 were reviewed to determine if standards of paediatric diabetic care were met. Interviews were conducted at a clinic at each site with the child, parent(s) and staff attending the clinics. A retrospective review of difficulties in service provision was undertaken with staff. Results Nineteen children and adolescents were seen in the telehealth clinics over the year. Eighteen (95%) were seen four times with point-of-care measurement of glycosylated haemoglobin (HbA1c) and growth by the consultant paediatrician and diabetic nurse educator. Complication screening was achieved on time for 15 (78%) patients, with the remaining patients having had the tests ordered. Eleven (56%) patients were reviewed by a dietician, six (33%) by social worker and five (27%) by psychologist. All patients and parents reported receiving good support for their diabetes without any preferring to attend the central clinic. There were no significant technical difficulties. Conclusion Providing paediatric diabetic care through a telehealth service at rural hospitals meets standards of care and was provided without technical difficulties. It is preferred by patients and their parents to attending a central clinic. A model of service is presented that may be replicated elsewhere in Australia.

We reviewed telehealth consultations for acute paediatric patients presenting at rural sites in the Mackay district in 2012. Patient data and outcomes were collected prospectively, and a survey of the referring clinicians was undertaken. Thirty four patient consultations were conducted via telehealth with 14 referring clinicians. Most of the referrals were for respiratory illnesses, including bronchiolitis. We received feedback surveys for 16 consultations (57% response rate). In 47% of the cases, the paediatric team felt that transfer was avoided by using teleconsultation. In 80% of consultations, the referring clinicians felt that video consultation was more effective than telephone alone. In 30% of cases, the referring clinicians felt that the patient would have been transferred to higher facility in the absence of the telehealth facility. Clinicians thought that almost all consultations had educational value and reduced their anxiety in dealing with acute paediatric problems. There were no adverse outcomes or delayed transfers of patients staying at their rural sites. We recommend that telehealth consultation occur for all enquiries about acute paediatric patients at rural sites, especially if transfer of the patient is being considered.

In Queensland, the majority of rural hospitals and some regional hospitals lack paediatricians or paediatric sub-specialists. Many specialist referrals result in a transfer to a tertiary paediatric hospital in Brisbane - up to 3000 km away. Travel is difficult, time-consuming and expensive, especially from rural and remote areas in Queensland. The telepaediatric service managed by the Centre for Online Health (COH) at the Royal Children's Hospital (RCH) in Brisbane, delivers general and specialist paediatric support directly into selected neonatal and paediatric wards in a convenient and child-friendly manner. We conducted a review of telepaediatric service records to determine which clinical and educational services had been delivered through the mobile videoconference systems. Telepaediatric service activity records for all consultations conducted between January 2005 and July 2010 were summarised. Since 2005, seven mobile telepaediatric systems have been established in selected regional hospitals throughout Queensland. For some hospitals, the service was used mainly for consultations with specialists based at the RCH or at The Townsville Hospital (TTH) in north Queensland. During a 67 month period, a total of 966 consultations were conducted during 465 videoconference sessions, totaling about 228 hours of activity. In addition, 39 education sessions were delivered to regional staff through the mobile robot systems by specialists based at the RCH in Brisbane. The telepaediatric robots have proven useful for general paediatric support for hospitals without a local paediatrician; sub-specialist paediatric support and professional education and support for regional clinicians. Our service model provided a streamlined method of delivering specialist health services to children and families living in rural and remote regions of Queensland.

However attractive the idea of telehealth may appear to them, clinicians in regional hospitals will be preoccupied with clinical matters and are unlikely to have either the time or the expertise necessary to address the infrastructure and organizational aspects of establishing a telehealth service. Our experience of telepaediatrics in Queensland has shown that the support of the central service and coordinator has been essential in overcoming initial difficulties and has freed us as clinicians to concentrate on appropriate clinical referrals and consultation via telehealth. The central service is also able to assist in data collection, and in the analysis and interpretation of telehealth activity, for example in measuring cost-effectiveness. We have found that consolidating most consultations into planned clinics creates efficiency. The central coordinator can teach and support those new to telehealth in the regional and primary care setting, thus relieving the local clinician of this responsibility. As telehealth services expand in a regional centre, having a dedicated local telehealth coordinator may become appropriate. A central telehealth support service, which is clinically focused and responsive to clinicians' needs, is an essential foundation for successful telehealth.

Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day–1 7 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequent elective transfer at the appropriate time for treatment. Only one child (1%) required urgent transfer to the tertiary centre for specialist care and surgery. Telecardiology was effective in accurately identifying congenital heart disease. Paediatric telecardiology is an evolving modality of assessment and communication, and is likely to result in continued improvements in patient care, patient outcomes and parental satisfaction, in provincial centres removed from the tertiary cardiac centre.

summary We compared the costs incurred by families attending outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane with those incurred by families who had a consultation via videoconference in their regional area. In each category 200 families were interviewed. The median time spent travelling for videoconferences was 30 min compared with 80 min for face-to-face appointments. Families interviewed in the outpatient department had travelled a median distance of 70 km, while those who had a videoconference at the local hospital had travelled only 20 km. It cost these families much more to attend an appointment at the RCH than to attend a videoconference. Ninety-six per cent of families (193) reported at least one of the following types of expense: 150 families had expenses related to parking (median A$10), 156 had fuel expenses (median A$10) and 122 reported costs related to meals purchased at the RCH (median A$10). Only 21 families who had their appointment via local videoconference reported any additional costs. Specialist appointments via videoconference were a more convenient and cheaper option for families living in regional areas of Queensland than the conventional method of attending outpatient appointments at the specialist hospital in Brisbane.

Queensland is a state with a population of 3.4 million people and a land area seven times greater than that of Great Britain. The uneven distribution of specialist health services presents difficulties for patients in rural and remote areas. Paediatric cardiology is a case in point, since the only subspecialists are located in the state capital, Brisbane, in the south-east corner of Queensland. Some 300–350 operations on children under 14 years with serious congenital heart disease are performed annually in Queensland. Infants with suspected congenital heart disease are referred to the tertiary centre in Brisbane for assessment and diagnosis, although some of these infants turn out not to have significant disease. The cost and use of resources involved in transporting these infants for assessment are substantial. We describe the management of a 12-day-old infant with a suspected cardiac abnormality.

We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two hospitals in Queensland (Mackay and Hervey Bay). We used data from all other hospitals throughout the state as the control group. Although both intervention hospitals were provided with the same service, the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different. There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region. In addition, there was an increase in the number of Mackay patients treated locally (as outpatients). In contrast, little change was observed in Hervey Bay. We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service. These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary centre. We believe that the screening method used for patient referrals was the most important determinant of the use of the telepaediatric service.

A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.