title: Telehealth: experience of the first 120 consultations delivered from a new refugee telehealth clinic.
abstract: BACKGROUND
  In 2011, the Australian Government introduced Medicare item numbers for telehealth consultations. This is a rapidly expanding method of healthcare provision.
  
  
  OBJECTIVE
  We assessed the demographic and disease profile of refugee patients attending a new telehealth clinic, and calculated the patient travel avoided. We examined technical challenges and assessed the performance of two videoconferencing solutions using different bandwidth and latencies.
  
  
  METHODS
  We audited the first 120 patients attending the telehealth clinic. During consultations, the patient was with the general practitioner (GP) and linked by internet videoconference using VIDYO, GoToMeeting or Skype, to the specialist at a tertiary referral hospital. Travel avoided was calculated and technical problems were assessed by the participating specialist. Bandwidth and latency variations were examined within a university broadband testing facility.
  
  
  RESULTS
  The two most frequently managed conditions were hepatitis C and latent tuberculosis. Twenty-nine different GP were included and 42 consultations required an interpreter. Nearly 500 km of travel and 127 kg of CO(2) production was avoided per consultation. Technical issues were faced in 25% of consultations, most frequently sound problems and connections dropping out. A bandwidth of at least 512 kbps and latency of no more than 300 ms was necessary to conduct an adequate multipoint videoconference.
  
  
  CONCLUSIONS
  Telehealth using videoconferencing adds a new component to care of refugee and immigrant patients settling in regional areas. Telehealth will be improved by changes to improve simplicity and standardisation of videoconferencing, but requires ongoing Medicare funding to allow sufficient administrative support.
authors: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine, Melbourne Academic Centre, Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia.
authors: T R
authors: TR
authors: Schulz
authors: M
authors: M
authors: Richards
authors: H
authors: H
authors: Gasko
authors: J
authors: J
authors: Lohrey
authors: M E
authors: ME
authors: Hibbert
authors: B-A
authors: BA
authors: Biggs
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D058005:General Practitioners / Q000191:economics; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D055985:Latent Tuberculosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012036:Refugees; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration / Q000592:standards; D049269:Videoconferencing / Q000191:economics / Q000458:organization & administration* / Q000592:standards
keywords: immigrant; refugee; telehealth; telemedicine