title: Challenges faced in implementation of a telehealth enabled chronic wound care system.
abstract: BACKGROUND
  In the rural Midwest region of Western Australia (WA), wound care is a major burden on the healthcare system. Optimal wound care was found to be impeded by issues that included the involvement of multiple healthcare providers, incomplete and inconsistent documentation, and limited access to expert review. A telehealth solution was trailed in 2007.
  
  
  OBJECTIVE
  To describe the systemic barriers encountered in implementing a telehealth program in rural WA and to provide recommendations for future telehealth initiatives.
  
  
  METHODS
  This study trialled the use of a shared electronic wound imaging and reporting system in combination with an expert remote wound consultation service for the management of patients with chronic wounds in the Midwest of WA. The trial sites included rural hospital out-patient clinics, a private domiciliary nursing service, residential aged care facilities, general practices and a podiatry clinic. The implementation conformed to accepted best practice in introducing telehealth initiatives.
  
  
  RESULTS
  During the trial 12 sites had the relevant software installed and were able to access a central server. Although a total of 41 patients with chronic wounds were enrolled, four sites did not enroll any patients and only two sites successfully incorporated the system into regular practice. Major obstacles were workforce issues and significant delays in installing the software at some sites. Only 47% of the healthcare providers trained to use the software at the beginning of the trial were still employed when the trial ended. Prolonged periods of vacant positions at one remote clinic and an aged care facility made it impossible for the remaining providers to allocate time for using the wound care software.
  
  
  CONCLUSIONS
  The disease burden of the patient group, funding models and workforce shortages frustrated the successful adoption of an evidence based strategy that was known to improve health outcomes.
authors.affiliation: Combined Universities Centre for Rural Health, Geraldton, Western Australia, Australia. melissab@cucrh.uwa.edu.au
authors.forename: M
authors.initials: M
authors.lastname: Barrett
authors.forename: A
authors.initials: A
authors.lastname: Larson
authors.forename: K
authors.initials: K
authors.lastname: Carville
authors.forename: I
authors.initials: I
authors.lastname: Ellis
mesh_terms: D002908:Chronic Disease; D004059:Diffusion of Innovation; D006801:Humans; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized; D011873:Radiology Information Systems; D019035:Rural Health Services / Q000458:organization & administration; D017216:Telemedicine; D014904:Western Australia; D014947:Wounds and Injuries / Q000628:therapy*