Universal Telehealth in Australia Begins Today - Here's What You Need To Know

"Universal Telehealth" was announced by Australian Federal Health Minister Greg Hunt yesterday. That means from today, we're all eligible for bulk-billed Medicare telehealth consults in Australia.

Telehealth = over the phone, or over video call eg. Skype, FaceTime, Zoom, WhatsApp. This is really useful for things like appointments to follow up on blood results; counselling; referrals; anything that doesn't require a physical examination. You may be already using Telehealth, whether you’re a clinician practicing it for remote patients; or as a patient who’s received care online or over the phone.

You may still need to attend in person if the doctor needs to examine a lump, excise a melanoma, or other condition.

GPs, Specialists, Midwives, Psychologists, Aboriginal and Torres Strait Islander Health Workers, Social Workers- a range of providers are able to do this (if they choose to), saving you the visit to a clinic, and saving the healthcare worker the added exposures from them going to clinic or seeing more patients in person in an era when we're all social distancing and at risk of bringing #COVID19 home to our loved ones (and lacking Personal Protective Equipment to protect ourselves).

This also helps vulnerable healthcare workers #workfromhome or from other safe, protected premises so the 70-year-old specialist with diabetes for example could continue working safely if they wish.

The ABC has a great article for patients.

Many providers are also offering privately-billed Telehealth consults for those items that are not covered by Medicare, such as Physio and Dietitian consults for non-eating-disorder-related conditions. Your clinic or provider will be able to inform you.

Healthcare workers, check your indemnity covers Telehealth- it should. A phone call or visit to your indemnity provider's website will help.

Also, be aware of the privacy of free software. As mentioned on Avant: "The Department of Health has noted that free versions of these applications (i.e. non-commercial versions) may not meet applicable laws for security and privacy. You should check whether the platform you wish to use complies with Australian privacy and security laws. You can do this by asking the vendor or checking the vendor’s website."

Grateful to the Australian government and to EVERYONE who campaigned hard for this, including the Australian Medical Association​, RACGP, RACP, RACS and other colleges, and healthcare workers and community groups nationwide.

For insights from the Australian Telehealth Conference; read our post here!

For insights from New Zealand healthcare workers from telehealth, including Virtual Ward Rounds, read our article here.

Some thoughts on preparing for the Novel Coronavirus COVID-19

With the alarming spread of COVID-19 on everyone’s minds, it can be easy to feel helpless and dismal about the future. Life’s about accepting what we can’t control, and managing what we can. Here are a few suggestions for you to take action now, and not wait for a pandemic or otherwise to be declared.

  1. WASH YOUR HANDS PROPERLY. WITH SOAP.

We’ve had many people asking; “should I wear a mask? Should I avoid certain areas of town?” All the masks in the world would be useless to prevent infection transmission if we didn’t have proper hand washing technique, that anyone can do, as endorsed by the World Health Organisation (WHO). 

Sing “Happy Birthday To You” twice while washing. That’s the recommendation. (Aloud, if you wish!)

SOAP is key. And frequently. If you cough. If you sneeze from hay fever. Before and after you eat. 

If no soap, use alcohol-based hand rub. 

This goes for the flu as well. Influenza is not just spread by airway droplets; it is actually spread through contact transmission, ie. hands and other surface contact, just like gastroenteritis. Coronavirus (which is a name for a group of respiratory viruses, hence COVID-19 for the name of this particularly virulent subtype) is also spread in this way, just like the common cold. Hence, HANDWASHING WITH SOAP is important. 

I can’t emphasise it enough. Handwashing saves lives. And it’s annoying when people cough and sneeze without covering their mouths and noses in public (an accident is an accident, but if you’re being a tool, that’s just rude). And in Australia, we’re not at the stage right now where our Government is saying we have to wear masks as a precaution. And even if we were, we’d still say- WASH YOUR HANDS WITH SOAP. 

2. Minimise hand-to-hand transmission

So yes, avoiding handshakes is reasonable. 

3. Pay attention to the latest health updates from your local Government health authority. 

Your Federal or State Government; or the equivalent authority wherever you live, will be able to give you up to date advice in your area; on whether it’s safe to go out; to go to work/school; to attend particular events. Listen to the real news, not fake. 

Speaking of real news; drive-thru coronavirus testing has apparently taken off in Daegu, South Korea. Seems like a great way to reduce exposure risks to the community- and to healthcare workers (and their families), too.

4. Prepare for Online Work/Study/Telehealth

One of the only business models that would actually benefit from COVID-19 is telemedicine. 

The RACGP is calling on the Federal Government to allow a short-term Medicare rebate for Telehealth services to help enable consultations while minimising risk of infection transmission. In the US, where Telehealth is more mature, telemedicine providers are ramping up their capabilities and patients are being warned to expect more consultations online.

It won’t just be healthcare. Schools and universities are already in the midst of online classes for those stranded by travel bans and restrictions. EY and other multinational firms have cancelled some business travel and moved to online conferencing to reduce risks to their employees. We foresee professional development conferences and workshops increasingly being moved online across all industries.

So, if you have a remote working/studying option, prepare early for this, as a snap decision could be made by your Government/institution in a day.  Or if you’re self-employed, now would be a great time to see what services you could move online.

5. Pay attention to your travel insurance.

If you’re planning to travel somewhere, check what your travel insurance’s Product Disclosure Statement covers.

6. Be kind and compassionate

There’s absolutely no excuse for racism. Ever. 

It is NOT the fault of someone’s ethnicity or appearance that this virus has appeared. It’s APPALLING how ignorant people can be, and how widespread rudeness is. 

Health systems and local industries beyond health are already overstretched. By putting your prejudices in front and pointing fingers at people of particular appearance (and we’ve been victims of this!), you’re simply displaying how ignorant you are, and wasting time and energy alienating the very people who are trying to help you, or who are your neighbours in your local communities

No one wanted coronavirus to happen. It’ll be easier to get through together without hatred and fear.

How Can Facebook’s Spaces VR Program Help Patients and Consumers?

First published April 20, 2017

Overnight at Facebook’s F8 conference, Mark Zuckerberg officially announced the launch of Facebook Spaces in beta. Using the Rift platform and available on the Oculus store, purportedly all that’s needed is Oculus Touch and an Internet connection.

 

Essentially, this means Facebook is adding virtual face-to-face interaction. This is a huge win for patients and healthcare consumers.

There are several ways in which we think virtual reality through Facebook will help patients, consumers and clinicians.

Patient communities are a burgeoning interest in healthtech. The Mayo Clinic Connect is an online messaging and education platform where patients and carers can chat with others suffering the same or similar illnesses. Australian app CancerAid is also building patient communities and sharing the burden of cancer with the millions affected by cancer worldwide, through their app for iOS and Android. Imagine the potential for communities to virtually “talk” with each other.

 

Patients can create avatars and share vivid experiences with each other, including their Facebook photos and 360 degree videos. Imagine taking a 360 video of your community hospital’s dialysis unit in Chile with your smartphoneand sharing that in real time with your friends in Norway.

 

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Screenshot from Facebook Spaces Oculus’ launch video.

The potential for healthcare education is huge. Facebook Spaces includes a drawing function, meaning that potentially, clinicians could educate patients and families in a more hands-on way, without needing to be in the same room as them. Of course, this helps students and clinicians train for procedures and study for exams, as well.  This could come in handy for rural and residential communities who may not be able to travel to the city for care so readily. Hospitals, clinics and education centres producing educational video content (such as the Royal Children’s Hospital) could potentially integrate their videos into Facebook Spaces, and nurses and staff could help teach with the added drawing function inside the virtual classroom. Imagine teaching a patient about what to expect from a hospital visit through a virtual tour on Facebook Spaces. (Or through our anaesthetist friend’s made-for-VR video!)

 

Facebook Spaces also adds another potential dimension to telehealth. Using Facebook Messenger, video calls can be made, including outside of Facebook to the “real world”. We imagine chatbots for Messenger like Amelie, the mental health chatbot, will have incredible functionality here, where the user’s virtual avatar can consult “face-to-face” with the chatbot counsellor. Sometimes it’s easier to chat to someone you can’t look directly in the eye, and we can imagine people who are too uncomfortable to talk to a face-to-face counsellor or who can barely get out of bed when in a bout of depression may find it easier to start with a chatbot. (One of Amelie’s functions is to guide the participant to further help, rather than replace a professional psychiatrist or psychologist.)

And from a global health perspective, users will be able to virtually “travel” with chatmates and experience different environments. This could help with disaster resource planning, for example sharing VR videos and 360 photos of earthquake – ravaged zones with aid organisations to help their planning for resources and deployment. Similarly, can you imagine how design of healthcare spaces will be impacted? Oculus’s YouTube video above shows a user sharing photos of the apartment she just bought. Again, the virtual tour aspect of public buildings and clinics can help plan for better patient care through architecture and design. Imagine sharing 360 pictures of your Emergency Department layout with other EDs around the world at conferences; or performing emergency simulation training through VR tours and demonstrations.

Are you an app developer or health tech startup founder? Now you have a whole new avenue of possibility to think about when integrating social functions into your product.

Of course, cautions about security and encryption of call content apply here, but just imagine the potential…

Got any ideas for how you will use Facebook Spaces in healthcare or for leisure? Comment below and please share this article if you enjoyed it. Sign up for our mailing list if you’d like more updates like these. 

Job Opportunity: Psychiatrists For Telehealth Consults With Conduit Health

First published April 19, 2017

 

Australian Telepsychiatry service Conduit Health are seeking Expressions of Interest from Consultant Psychiatrists registered with AHPRA to join their service.

 

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health was formed when psychiatrist Dr Gregory Sam realised he and his colleagues around Australia needed a solution to serve isolated patients in rural, remote and even residential communities in a high-quality, efficient way. Conduit Health provides services including general psychiatry as well as child and adolescent psychiatry, aged care, and other subspecialties. Benefits of working with Conduit include:

  • job flexibility;

  • working from home;

  • the ability to build your private practice;

  • an electronic medical record service (EMR);

  • all administrative tasks being taken care of (billing, scheduling and typing).

If interested, please contact Sara Ng (Business Development Manager) with your CV, your Expression of Interest and a copy of your qualifications at sara.ng (at) conduithealth.com.au.

Read about founder Dr Greg Sam’s story here. 

How Can We Be Leaders Through Healthcare Technology? Day 3 of HiNZ and the New Zealand Nursing Informatics Conference

First published November 7, 2016

This week, we’ve been inspired by the many speakers who have made career leaps: from clinician  to academic; from clinician to ICT (Information and Communications Technology) specialist; and even from accountancy to the public service in healthcare. Here are some of their insights from Day 3 of HiNZ, and the concurrent New Zealand Nursing Informatics Conference:

1) Videos of nature scenes played via app, with or without music, can help reduce pain perception and level of anxiety in the perioperative period. Professor of Nursing, Margaret Hansen of the University of San Francisco,  was inspired to investigate the power of visualisation in dealing with pain, after experiencing a severe illness herself. Her feasibility study, performed as a randomised controlled trial, has shown these promising effects, and will lead to further study- perhaps even in Virtual Reality!

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Prof Margaret Hansen of USF demonstrates one of the app’s Nature videos at the NZ Nursing Informatics Conference 2016. Pic: The Medical Startup

2) “We need to collaborate with our international colleagues,” said Lucy A. Westbrooke, who is the New Zealand ambassador for the International Medical Informatics Association – Nursing Informatics (IMIA – NI). From her diverse career in nursing, leading to executive and chairperson positions in New Zealand health informatics and telehealth, she described some of the various international meetings and opportunities helping to achieve this goal.

 

3) “You don’t design systems for the most technologically agile; it has to be for the users,” Dr Simon Kos, Chief Medical Officer of Microsoft advised. Having experienced healthcare both as a clinician and as a software engineer, Dr Kos gave insights into the future of medical education with virtual reality through Hololens. 

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Dr Simon Kos, Chief Medical Officer of Microsoft at HiNZ 2016. Pic: The Medical Startup

4) Finally, NZ Ministry of Health Director General Chai Chuah posed the question: What kind of leader are you (in healthcare)? “Today’s global leaders understand and lead the art and science of disruptive change,” he said, acknowledging the combination of both art and science in medicine, technology and healthcare.

Leadership isn’t always about being the first to present an idea, or the first to use a new technology. Leadership can occur at an individual level. As an example, guiding a patient to a tech solution enabled by a District Health Board (DHB), such as A.Prof Robyn Whittaker has done with her project with Waitemata DHB. Her research findings from a messaging reminder service for behaviour change showed that patients benefited from this service. Or coordinating an entire Australian Territory’s telehealth services, as Michelle McGuirk does in the Northern Territory; or encouraging a patient to keep an app-based symptom journal.

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A/Prof Robyn Whittaker, Medical Doctor and Digital Health lead at Waitemata DHB presents her Behaviour Change Messaging project findings. Pic: The Medical Startup

You can view sessions from 2016 and 2015 at HiNZ.org.nz with membership. Catch up on Day 1 and Day 2 highlights as well.

We thank HiNZ for providing media access to the conferences and opening our eyes up to these incredible experiences.  

The Virtual Ward Round Is Here: Highlights from Day 2 HiNZ, Successes and Failures in Telehealth, and the Global Telehealth conferences

First published November 2, 2016

We’ve been very inspired from the talks and positive atmosphere at HiNZ, SFT and the Global Telehealth conferences this week. New Zealand is a country that deserves a lot more credit for their innovation in medicine and global healthcare. Here are some of today’s highlights:

1) Virtual Ward Rounds and Consults help patients and clinicians alike feel supported and at ease with care. Dr Eddie Tan, nephrologist from Waikato Hospital, spoke about the “hub and spokes” model of care that Waikato Hospital and its satellite rural hospitals and clinics run. With hundreds of kilometres between sites, Dr Tan and his colleagues are on planes at least every fortnight for clinics that may last just a few hours before returning back to Waikato. This is problematic when rural patient emergencies develop; however, Telemedicine with videoconferencing to the satellite clinics has helped the Renal team conduct assessments, minus the hours and dollars spent on travel (and minus hours of patient/family stress). It has also prevented unnecessary hospital presentations, and brought critical patients to hospital sooner.

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Dr Eddie Tan, kidney specialist at Waikato Hospital NZ discussing Telehealth in Renal failure. Pic: The Medical Startup

Dr Tan’s colleague, Waikato District Health Board (DHB) renal nurse Jenny presented her research paper on how palliative care decisions were made easier with telehealth’s videoconferencing capabilities. This meant that difficult and time-critical family and patient conversations could be had in the comfort of the patient’s home, without wasting precious time in the potential final days of life arranging hours or even days of transport for the same consultation.

Dialysis ward rounds also help Dr Tan assess end-stage renal patients who may deteriorate very rapidly and become fluid overloaded.

Similarly, Rehabilitation ward rounds by telemedicine has helped patients in a rehabilitation ward feel happy and secure with their care. Registered Nurse and PhD candidate Sophie Gerrits’ research has so far found that rehab patients and staff at Thames Hospital, Waikato DHB New Zealand, are happy with the consults, and the elderly patients have adapted well to the new technology. The Ward Registrar goes from bed to bed with a telecart, and the Rehabilitation Physician or Geriatrician video-calls weekly in from the tertiary hospital, in addition to their usual weekly face-to-face visit.

 

Staff appreciated having a second chance during the week to ask questions and raise issues that had arisen in the days since the last visit. The main issue to overcome was “patient jitters” at not knowing what to expect from a video consult and what was expected of them. This reinforces the need to counsel patients prior to a consult; that they can speak, behave and ask questions just as they would if the clinician was in the room with them.

2) Telestroke Improves Door-to-Needle Time in New Zealand

Yesterday, Dr Chris Bladin of the Victorian Telestroke Program discussed the very promising findings from the Victorian Telestroke Program research in rural hospitals, with hopes to expand to other Australian hospitals. Today, New Zealand Neurologist Dr Anna Ranta showed that since Telestroke has piloted from 3rd June in the Capital and Coast DHB, door-to-needle median time has reduced from 80 minutes down to 54. With cerebral ischaemia being a critical matter of seconds, this is a significant early finding, and along with other positive outcomes, will hopefully help push for a Telestroke rollout in other DHBs.

 

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1,100 delegates attending HiNZ this week. HiNZ Awards Dinner at Shed10, Auckland, sponsored by Microsoft. Pic: The Medical Startup

3) The finalists for the Sysmex Award for Health Informatics at the University of Auckland have promising ideas for mobile health applications. The winner, Daniel Surkalim, was announced tonight at the HiNZ Awards dinner. By creating visually appealing, simplistic views of patient data, his project, GRID(Graphical Relational Integrated Database) will help solve the clinician bugbear of “too much data, not enough sense” that occurs in many existing EMRs (electronic medical records). The other finalists deserve commendation for their work; Frances Toohey with Dr.Doctor for clinicians and patients to track eReferrals, and Kyle Frank’s MedScript to facilitate e-prescribing solutions for patients and doctors.

4) Tele-ophthalmology in India aims to cut waiting lists for a population short of ophthalmologists. Dr Sheila John of Chennai, India has done extensive work with diabetic retinopathy and machine learning, and inspired us with her dream to help rural villages be screened for diabetic retinopathy accurately and safely without a long waiting period for an eye specialist. Dr John quotes 60 million people in India as suffering from diabetes, with nearly 20% experiencing diabetic retinopathy, a cause of blindness if left untreated.

 

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Speakers from four different nations closing the Global Telehealth conference today; L-R: Global Telehealth co-chair Dr Kendall Ho of Canada; Dr Karen Day of NZ; Dr Laticha Walters, South Africa; and Dr Sheila John, India. Pic: The Medical Startup

With four events running this week, it’s impossible to catch all sessions at once. Watch the conference on demand, even after this week, with a Virtual Ticket, including one year’s worth of membership with HiNZand HIMSS Asia-Pacificamong other benefits. We thank HiNZ for providing media access to the conferences and truly enjoyed the experience.  

Part 3: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 29, 2016

 We hope you’ve enjoyed Greg’s series on starting his telepsychiatry business and his journey to success! Here he talks about dealing with the process of failure, and rising from that, along with future plans for Conduit Health.

You can now view Parts 1 and 2 as well.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Can you talk more about your failure process? How did you deal with criticism and get through failure? (Greg had to resit his exams a few times before qualifying as a consultant.)

Firstly, it’s a humbling thing, and there are some good resources. You should find those consultants or colleagues who can give you meaning to your failure.A lot of people will say, “oh, you did this wrong or maybe you did this wrong.” I’m not saying there should be an external locus of blame, I’ve been through that too- “oh, the college is out of its mind failing me because everyone I know is telling me I’m ready to be a consultant, couldn’t really figure that out. But one thing I was told is, “look at this person who’s now a professor, I know during his training he failed 4-5 times,” so I guess there are some comforting things like that. But it’s also about yourself being able to apply that meaning to your failure. Otherwise you go through all this pain, and you can’t get some benefit from it. And that’s pointless, absolutely pointless except to hurt you.

Failure is just an opportunity disguised as pain. 

So I thought, “I won’t let it hurt me or fail me.” With my career, I did think, “should I be doing this?” but I felt resolved that before failing and before I was in that frame of mind, I knew this was what I wanted to do, and this shouldn’t change it. Just because some people failed or I didn’t pass an exam, I will pass eventually.

My reflection of my failure brought about so many positive opportunities.

Medical people tend to become very disillusioned when they fail. We’re not used to failing, we’re high achievers, and when we do fail, it’s a huge fall, and some people don’t recover from that. Those who fail need support, and I know myself because when I did fail, I spent endless nights on YouTube looking up motivational videos and how to get through failing and how to get meaning from that. I felt alone.

I had colleagues who also failed, so we formed a bond and pushed each other through. They’re not entrepreneurial per se, but we had some support in that we failed together.

I think people should apply some meaning about failure. It’s all too painful an experience to do for nothing. Even if you eventually don’t pass, it’s okay, as long as you did something meaningful. Even if I didn’t pass and dropped out of my training, I took meaning from it, and reflected on it.

In fact, Conduit Health is thanks to failing. Had I not failed, I’d have sailed through my training program, with this inside disgruntlement of “this is what I am”.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

One of my bosses said, “I think this will make you a better psychiatrist, and this is because you now know what it’s like to fail. Previously you had no idea what it was like to fail. You excelled and  succeeded in everything. And now you can see that when your patients fail, you can feel a bit of that.”

The medical field, I think they kind of shun people who fail. And people who do fail, don’t talk about it, because they want to be seen as brilliant, successful, and never a failure. Whereas in business, the more I look, they talk about failure with pride. They go, “I started up ten companies, and all failed before I made Google.” They talk about failure with pride, and those who don’t talk about failure and don’t own it, they’re missing that opportunity to share with people. Everyone fails at something, in one way or another everyone fails at something. And people then tend to hide it and put it in a box and not share it with anyone.

We need to change the culture and say, “it’s okay to fail, lots of people fail, but what will you do with it?”. The famous words from Edison I think were, “It’s not that I’ve found the way to make a lightbulb, I’ve only found ten-thousand ways NOT to make a lightbulb.” 

It’s about mindset change.

It’s like, “ok, I failed four times.” It’s not to say, “I failed and I’m useless,” it’s, “I’ve failed and found four different ways to not pass an exam, and I just need to find that one way to pass it.”

Reflecting on my failures in the exams, what held me back wasn’t anything to do with my knowledge. A lot of people think it’s the knowledge (that makes them fail), not knowing enough. For me, it was the anxiety levels. I went into the exam thinking, “what do the examiners want to hear?” But the time that I passed, I gave that away, I said “I don’t care what the examiners think.”

I think there could be more constructive ways in which our colleges could address failure. One way I think is to talk about it more, and to show that it’s not life or death if we fail, we can get through this, and be more supportive, be able to talk about it. 

By having the courage to say “yes I failed my exams”;  other people find doctors as quite intimidating, they’re seen as being super successful and smart, and when you can bring yourself down a bit and be humble and say “I failed”- everybody fails at something, whether it’s their driving test or something, failure is something everyone has in common, so when I bring it up, a lot of people can suddenly relate to it.

In business, that’s super important, so people are not intimidated by you, they have something to relate to you, and it builds relationships. A lot of my GPs, mental health nurses and staff, they like me for being open about it, rather than hiding it away, rather than bringing across this facade that I’m super brilliant, never failed in my life, top notch.

How do you view competition in business? Doctors have that win mentality, how do you manage that in business?

I welcome competition in business. I feel that if somebody can – if somebody else comes forth, it’s always anxiety related, like, “I must be better than them.” But what I do is look at the competitor, and ask, “did they actually evaluate? Did they actually have new ideas about improving telepsychiatry, did I do that, and if I didn’t do that, why can’t I do that? If there are no competitors, you are at risk of becoming complacent, and competitors bring excitement. So I ask, is there value-add, or do I just have to do my job?It can become about less value, more competing on price point. But I know it’s hard for other companies in this space to compete on price point.

What are your other plans for 2016?

Trying to balance. It’s tempting to focus just on private practice, but Conduit would fall by the wayside. For me, what I’m trying to do is allocate time to Conduit Health and allocate other times for private practice . I’ll try organise more talks for GPs including interstate, hosting events.

I love going out to rural communities and seeing them, they really don’t have much psychiatry services. Same with their GPs, they don’t have much support and can get very isolated without someone coming from the metropolitan areas to offer help.

We’ve received the odd referral from the Great Barrier Reef, the Northern Territory, Tasmania, but I want to increase that. In business I think this is something we do- go back to fundamentals, think “why did I start the company, what did I want to achieve?”

The more isolated rural places, I’d rather focus on them. In the semi-metropolitan places, people travel 1-2 hours, whereas in the NT there’s no psychiatrist for a few hundred k’s.

The other thing will be statistics. Looking at 2015, we’ve been collecting data about how many patients we’re seeing, the outcomes, sending surveys to patients and GPs. Being able to publish them and say “this is where psychiatry services are at, this is what we’ve done.” Entrepreneurship is 24/7. It is on my mind 24/7. Even if you’re not doing something on it, it’s on my mind. My admin staff, everything, it’s on you. It’s like having a baby, it’s 24 hours, no escaping. Something people wanting to get into business need to be aware of. It can be like medicine, it can be all-consuming.

A few years from now, I’d really like to get government involved so that I can provide telepsychiatry services to public hospitals. Public services can be quite stretched, but for a private company like mine, that’s what we can offer.

What are lessons that medical professionals and people from other industries can learn about starting in business?

Guy Kawasaki’s lesson is, it’s not about how are we doing things now and how can we do things better; it’s about, “what is the next curve?” Conduit Health is jumping on the next curve. Not just about how to improve how doctors see patients face-to-face, sure there’s a lot of work to be done there, but if you want to jump on the next curve, (you’ve got to create) innovation.

Not too many doctors by nature are entrepreneurial. A large part of that is because we get comfortable doing our daily job. See patients, make a living. Innovation and startups are a huge risk. It’s out of our comfort zone. We stop seeing patients, and suddenly your startup becomes the neediest patient you’ve ever had. 

It’s important to get this out there. It’s people like you, me, people who dare. And hopefully this will help a lot of people find, “this has been inside me, this has been in the back of my mind, but I’m too scared to do anything about it.

 

Thankyou for your support of The Medical Startup and Greg’s interview. You can view Parts 1 and 2 of Greg’s interview by clicking here and here

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please emailenquiries@conduithealth.com.au. Conduit Health is also on Facebook

Please note: In the medical world, “consultant” refers to a fully-qualified ie. board-certified specialist. “Registrar” is a doctor who’s a member of a training program and preparing to qualify for this certification. “Resident” is pre-registrar; “Intern” or “Houseman” is first-year out of medical training.

 

Part 2: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 28, 2016

We hope you enjoyed Part 1 of our interview with Dr Gregory Sam of Conduit Health. His telehealth psychiatry service provides nationwide consulting services which benefit rural and remote or mobility-affected communities. Consults can be done from the comfort of a patient’s local GP clinic or residential care facility, with no sign-up fee for GPs, and bulk-billing for patients.

Greg hopes to expand one day into other areas of the globe. Learn more about his journey below.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

How did you go about funding your project?

I’m a big fan of lean startups. Not needing huge capital. Also a huge advocate of self funding. Conduit Health was completely self funded. I was confident I could make the business model work.

I didn’t seek outside funding. There are alot of strings that come with outside funding, and you’re suddenly answerable to the government or your VCs (venture capitalists) or your angel (investor), and I didn’t want to do that. So I self funded everything. The benefit of the lean startup was, it didn’t cost me anything. I set my budget and said, “this is what I have to work with, what can I do with it?”

I started my company in the garage at home and a small office– which used to be for boys’ nights! So I said, no more poker nights, and converted it into an office. Conduit started from there. No overheads, no rents or anything. Yes, it was a home, and my wife helped me with marketing, pictures- I remember days sitting in the back office packing thousands of letters to send to GPs nationally- just me and my wife. More and more, big successful companies have that kind of beginning, they don’t have the multimillion dollars to spend at the start.

Sometimes you have to be able to sacrifice the ego and go, I’m doing the secretarial work. I typed up letters for my psychiatrists. I needed to do all this for the company, and if I didn’t have the money to employ a secretary or typist, I’m doing it. It’s rewarding at the same time, you get to see the company growing. From one referral to multiple referrals a day.

You must be critical of what you do. I always think, is this the right thing to do? Reflect and analyse, ask, “in terms of the business strategy, is this a good idea?” Not being complacent, “oh I can spend all this money now,” it’s about growing your business. Some people create meaning without making money.

Often if a company has created meaning, they then create money. But often people focus on making money first.

What got you interested in entrepreneurship in general? 

Wanting to make a change on a larger scale, to create something and grow it organically. And it’s exciting. Hard to describe the feeling but it’s a huge challenge. Something that can consume every moment of every day. But very rewarding. 

What sort of doubts or worries did you come across?

I didn’t study business. The difficulty within the medical field is, there aren’t many entrepreneurial people. I keep thinking of so many examples where my medical colleagues have such great ideas but don’t have the support or environment to foster that development. 

And I think taking myself out of that comfort zone,being with my business friends, listening and learning from them, really addressed those doubts.

One thing I know is that I’m a doctor, I know the medical part as well as the business side of things. Psychiatrists I work with feel comfortable with me because I know what it’s like to be a psychiatrist, I know the difficulties they face, I know what it’s like to treat patients. Whereas if it’s a purely business person,  you wouldn’t know what to give the patient, or how to be a psychiatrist, you’d possibly be like “oh it’s good for business, let’s do it.” That’s my advantage.

I think a lot of doctors should see it as an advantage, “I’m in business but I have a medical background.” So my doctors and nursing staff, they all understand. Which is why I’m all for doctors getting into business. As a doctor you would be able to empathise, with a business heart.

The other fear was, I got into medicine to be a doctor, and do my clinical training and be a psychiatrist. The path is very set. Once you start thinking of deviating from that, it’s quite scary. The reality is, actually it’s very refreshing. Because all we’ve known for ages is patients, medicine, being a clinical doctor. So actually, its very liberating.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

 One of the problems when starting out with telehealth is the many barriers. Like technology, for example, Internet speed, willingness to try out technology, video technology, and costs.

I thought, what are all the barriers? One by one, I addressed them and ticked them off. We bulk bill, so patients don’t pay. GPs win because patients get seen by specialists for no sign-up fee. Patients win because they don’t have to travel. Psychiatrists win because they don’t have to have room fees, which can amount to $70-80K a year. It’s an untapped market. Lots of patients need help. Whereas the metropolitan market is completely saturated. So we’ve tried to knock down all these barriers, and create a win-win situation for everybody. 

I think less so that people choose entrepreneurship, more so entrepreneurship chooses people. I think about ideas all the time. There are all sorts of naysayers who will come and tell you it’s not going to work. Why does this person say it won’t work, and how do I prove them wrong? I take what he says, think of the meaning behind what he says, and maybe he’s thinking it won’t work for xyz reason, how do I address xyz?

I think more and more power to doctors who become entrepreneurs in the medical field, or outside of medicine. So that studying medicine doesn’t become this one-track path, you will see patients and that’s it. People can become disillusioned by it, it’s so straight, the path doesn’t have any chance to vary. Yes, medicine does offer many specialties to choose from. But it’s still so contained like a nucleus, and no one’s thinking of addressing the outer shells.

Specialty training itself is all-encompassing. It will suck your life dry so that you just focus on training and that’s it. Same thing happened to me til I failed a few times, then you step back, and I said I don’t want my life to just be about training and fellowship. I want it to mean more, and that’s where the value is. 

Did you have a mentor?

 I had a few different mentors for different things. I try to draw upon the things that I want to gain.Positives and negatives. I draw analogies with badminton training. I had a coach for 6-12 months, and I drew as much as I could their positives. A certain coach would be good on physical stuff, another would be on mental aspects of the game. Same with psychiatry training. One would be clinically good so I’d take those aspects off them. Another had a good lifestyle setup, so I wanted to draw upon that.

For a business, it’s more offsite. I’m a member of business groups. The guy who did my websites runs an IT company in Malaysia, from a business perspective I love bouncing ideas off him, and learnt lots of things from him.

It’s important to be able to have many mentors for different things, because there’s a risk, if you follow just one person, you absorb all their flaws, and are unable to see their flaws. That’s a risk in medicine, too. 

I also learnt heaps from watching talks by Guy Kawasaki and Elon Musk and a few others. 

Part 3 will be released soon! In the meantime, if you’ve got any comments or questions about our article, comment below.

You can view Part 1 here and visit Conduit Health here. 

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please email enquiries@conduithealth.com.au. Conduit Health is also on Facebook

Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health: Part 1

First published April 26, 2016

 Dr Gregory Sam is a consultant psychiatrist who founded Australia’s first bulk-billing telehealth psychiatry consulting service, Conduit Health, in 2014. Focusing particularly on rural and remote communities, Greg currently runs Conduit Health along with his private practice work in the city. In this three-part interview series, Greg kindly shared his tips for success, the road to Conduit Health, mixing business with medicine, and rising from failure.

Image credit: Dr Gregory Sam

Image credit: Dr Gregory Sam

How did you get the idea for Conduit Health?

I think the idea started during my rural rotation of training in 2009. It was often a whole-day affair to see these clients, 4-5 hours’ trip each way, and that was disheartening to see people suffer so much. It’s supposed to be easy access. But they had to wait ages before seeing a psychiatrist.

So I aimed to fill that gap.

I started because I was so frustrated at the way things were.

I found so many deficiencies in rural mental health care, and thought, how do I improve things? There area lot of difficulties and shortcomings in the system. I was always into tech stuff. So I tried to think of the amalgamation of the healthcare and mental health care sectors. Telehealth was in its infancy then. So I thought, why can’t we assess the patient through telehealth conferencing?

I struggled to get through my exams, failed 3 or 4 times, and started to get a bit disillusioned about my career in general. I wasn’t sure why I wasn’t getting through. A lot of thoughts were going through my head. Is this the life for me? Should I be changing careers? A whole heap of stuff. But I thought, there’s still good things I can do in this field, whether it’s as a registrar or consultant or not. I’ve learnt a whole heap about my specialty through this. 

How long did it take you from having the idea to taking action, alongside your clinical work and studies?

Honestly, a few years. My idea has been since 2009, and it’s very tempting to get distracted by training. I was so focused on training that all these other things I could do fell by the wayside. I had the idea for a few years, but only started something solid in 2014.

I think 2014 was when overcoming all the inertia of starting a business occurred, planning and actually doing things. 

Failing my exams gave me that opportunity to start thinking outside the box. I took 3 months off work to have a break. I think that’s the best thing I did during training. I focused on badminton and other things I like doing, and started to make moves on my company. I had meetings with colleagues and friends in business, picked their brains, tried to absorb as much as I could from them, both guys and girls, to understand what it’s like to get into business. My business friends said, “it sounds like a brilliant idea, why don’t you do something about it?” So that gave me a kick to start.

When I went back to work, I left business for awhile and focused on passing exams. Once I passed, during our year of Advanced Training, I set learning goals on things like, “I want to learn more about drug and alcohol,” and other goals which I did in my day job, and also focused my energy on Conduit Health. That’s when the wheels started turning.

2015 was the launch date. Our first consult was February 2015, so 2015 has been a big year in that it’s a startup, and for most startups it’s about sustaining that growth, so 2016 is another big year. A lot of planning happens with regards to how to continue that growth, otherwise it’s too tempting to have a firework effect where it starts then fizzles up. 

Overcoming inertia is hard, but once you overcome it, things start rolling, and you can’t stop.  It’s a lot of commitment but so rewarding, more rewarding than my day job. I find treating patients rewarding, I can help them and their families as a psychiatrist. Whereas with Conduit Health, I’m helping so many more people across the country. We’ve had referrals from far and wide, from every state, and remote locations like the Kimberley and the Great Barrier Reef. I’m working with primary health networks (PHNs) across the country to expand our reach. 

How does a typical consult run?

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Either the psychiatrist dials in (from their location), or the patient (who’s hosted at their GP clinic) dials into us, then the psychiatrist introduces the consult. We need to say at the start that we’re doing it via teleconferencing, that there’s no one else in the office, and check who’s in the office. This sets the scene so the patient can understand that there are no unseen people in the room. We discuss confidentiality, unless risks in which case we need to notify particular people. It’ll go between five minutes to an hour, we state our aims, then start the diagnostic interview.

The video quality is quite good, but if there’s any lag or dropout, we disconnect and call back. We check at the start, “can you see me? Can you hear me?” We check camera position so the webcam points directly at the patient and so the patient can see us. We also make sure it’s appropriate, eg. the psychiatrist is in a quiet isolated room, not at the beach. We set rules for our psychiatrists. They use the Conduit Health backdrop. 

Sometimes a mental health care nurse will be there. We offer to GPs, if you want to be present for the whole assessment or in the last 5-10 minutes, you can. Some GPs stay for the whole interview, others come in the last 5 minutes and ask the psychiatrist, “what’s your diagnostic impression and what’s your plan?” They can get immediate feedback, (and sometimes help with scripts and so on).

We also get constant feedback from other GPs. My role is partly to ask patients and GPs, “how are you finding the process? Can we make things better for you?” Constantly evolving the company.

One benefit of Conduit is confidentiality. You don’t need to go into a psychiatric facility where everyone knows it’s a psychiatry facility, and sit in a waiting room with other mentally ill patients. Patients have said that’s a benefit, so people don’t have to know they’re seeing a psychiatrist. In a way that’s also bad. We’re not trying to promote stigma of mental health, but unfortunately this is a barrier to receiving care.

How did the name Conduit come about?

I was building a house at the time, and working with the builders, one said, “I want to dig a tunnel under your garden to create a conduit for your electrical wires to go through.” Also from my cardiothoracic surgical rotation in med school, “they harvest the conduit” in bypass surgery, and they explained what a conduit was to me. I then thought about what Conduit Health does, it takes away big distances and gaps.

The logo is a bridge, to embody bridging gaps.Suddenly, 300 kilometres to go to an appointment doesn’t matter anymore. It’s a link, a conduit, from point A to B. So patients don’t have to travel.

I don’t think telehealth will replace traditional face consults, but it can address geographical barriers.

Would you expand Conduit to non-psychiatry services?

The immediate next need would be psychology. It would be great to have psychologists who can do tests and consults. But at the start, I want to focus on psychiatry. Some companies have one of every specialty, but I want to focus (for now). If there is demand later on, for say, neuropsychology, social work, we will expand to fill the need.

What about your plans for aged care?

A big arm we’re developing in 2016 is to work with residential aged care facilities. There’s such a huge need, patients can’t often go see a psychiatrist. Aged care services are often floundering, “can we get the psychiatrist to come here?” but not many psychiatrists want to do that to see one or two patients, it’s not feasible. But we can go in and have a session there, and it’s immediate. So 2016 will be a big year for Conduit Health Aged Care branch. We want to expand to all the big aged care facilities. 

To learn more about Conduit Health, click here

Stay tuned for Parts II and III of Greg’s interview, in which he discusses his business inspirations, his insights on failure, and running a business as a medical professional.