Episode 9- Healthy Distance

Speaker 1:                        Welcome to Loop Me In, the podcast community for parents and carers on raising children with disabilities. Join presenters, Dr. Lisa Interligi and Kristine Christopoulos, and their guests, in sharing experiences, information and support ideas to help children with disabilities flourish. Loop Me In is brought to you weekly on platforms like Apple Podcasts, Spotify, and Stitcher, to name a few. You can learn more. Connect to the Loop Me In community and listen to more episodes on our website, loop-me-in.com.au.

Kristine Christ…:             Welcome back to Loop Me In. Today, we speak with Dr. Annie Banbury. She’s the Head of the Clinical Research of Coviu. It’s an engagement platform that enables providers to deliver care virtually. Welcome, Annie, to our podcast.

Annie Banbury:               Thank you so much for having me, Kris and Lisa.

Kristine Christ…:             I think I’ve said it right. Coviu, is that correct?

Annie Banbury:               Coviu. That’s right, as in both seeing something together. Co-viewing.

Kristine Christ…:             Excellent. Now, tell me a little bit about it.

Annie Banbury:               Coviu is a virtual care platform and it originated actually at CSIRO. Our founders, Nathan and Silvia, developed the platform there, and it was then spun out into a commercial organization. We started our life as a startup and now we are growing and growing exponentially, because COVID has really increased the use of virtual care or telehealth care, whichever way you want to call it. We have had some tremendous growth. I think it’s something like 6000% growth over the last couple of years.

Kristine Christ…:             Wow. Do you think that’s continued because it’s so successful? Obviously, now, we’re not in any type of lockdown. Do you think that’s why people are continuing it?

Annie Banbury:               Well, I think what COVID did, it accelerated use or clinician’s understanding of how virtual care platforms can be used to deliver care overnight. It forced many clinicians and it perhaps forced many let’s call them patients, consumers, let’s call them consumers, to use telehealth for the first time.

There’s lots of advantages for using telehealth, and so these hybrid models have now been kept. The idea that you have some appointments in-person and some appointments virtually, depending on the type of consultation that you need to have. Those are the models that we’re seeing more and more increasingly being utilized in the healthcare environment.

Dr. Lisa Interl…:              It’s amazing, isn’t it? Because I think telehealth has been talked about for gosh, a long time. I remember working in the IT industry and it was one of the benefits that internet would deliver, was telehealth. Particularly in Australia, because we are so big. But it’s taken probably till now for it to be, I guess, accepted and used to its potential really.

Annie Banbury:               Yeah. You’re definitely right, Lisa. I think prior to COVID, there was use of telehealth, particularly in rural and regional areas. Definitely in the rural and remote areas. And definitely in states like Queensland, which has a very dispersed population. Not so concentrated on those major metropolitan areas. But now, as we’ve said, it has forced people or forced clinicians, everyone, to use it for the first time. And there are advantages for using it in metropolitan areas.

We all know how long it can take to get to appointments, how costly car parking can be, the strain on people to go, whether that’s from their own physical comfort or just psychologically not feeling like they can do that today. Or whether it’s a parent’s point of view, where I’ve got to take one child and I have two other children to go. Many of us have been there. It’s stressful.

Yeah. It’s something that can be used wherever you live. But obviously, the advantages in regional and rural areas are huge, because that distance to traveling to appointments is quite concerning.

Kristine Christ…:             Yeah. Because you recently did an article regarding the rural areas and how they’re not using their NDIS, as well as other areas, up to 30% of their funding. Which is crazy, isn’t it? That’s obviously because there’s A, no one around, and B, probably really hard for families to drive around trying to find a good allied health supporter.

Annie Banbury:               Yeah. You’re completely right, Kris. You can go on the NDIS data website and actually, it will show you which areas have got what they call underspend of participant funds. In some areas, I think in South Australia, it was up to 58%. Enormous amounts. There’ll be a variety of complex reasons why that’s there, but we do know that in regional areas, there’s a complete lack of allied health professionals to be able to deliver care. You may have a particular need that is not delivered by the allied health clinician in your area.

For example, you have an issue that can’t be just done by any physio or any psychologist, and that one’s not accessible to you in your locality. There is this issue where it means if they are only being offered, if consumers are only ever being offered an in-person appointment, there might be significant traveling to take place. We also know the wait lists for some allied health professionals are just extraordinary. OTs, speech therapists. We hear it all the time. Yeah. Telehealth has a real role to play in those regional areas.

Dr. Lisa Interl…:              We had a forum a couple weeks ago that spoke to parents about NDIS, particularly in context of COVID and being able to spend their budget. The result they felt of that was that their plans were, funding was being cut if they were underspending. So it’s a vicious cycle, isn’t it?

Annie Banbury:               Yeah, it does seem to be. I think from where I observe, what I find incredibly frustrating is, no one’s actually talking about how telehealth can be used with consumers. There’s a real lack of information there. I press really hard, the NDIA, where’s the information from consumers? Who is saying to a consumer, “You know what, this type of therapy that we need to provide for you or your child is actually possible to do by telehealth, and it is as effective as an in-person appointment”?

There’s lots of evidence in the area of telehealth. Things like speech therapy can be delivered by telehealth, physiotherapy education. But no one’s having those conversations, whether it be a planner, whether it be the case manager. It’s not actually being developed for consumers to be able to read and to make that informed decision.

Kristine Christ…:             Yeah. I agree. I saw in lockdown that we used the psychiatrist a lot for Matthew over Zoom. We also did a lot of speech therapy, which you can’t imagine that a child with autism will sit in front of the computer. But they just learn to get used to it, the same way we all did as well.

Annie Banbury:               Yeah. Our platform that we use, it’s been specifically designed for the healthcare environment. We have a lot of what we call clinical tools that are integrated into our platform. Assessments, perhaps that are being done by psychologists, they’re all integrated in. Both the consumer, or the participant, as in the NDIS case, and the clinician, can see those questions together and they can fill in those assessments together.

There’s lots of assessments that require the participants to view something, like stimulus books, certain peers and assessments. A lot of our listeners may have taken part in those assessments. We have them all integrated into the platform. And then on top of that, we have things like drag and drop games that clinicians can use to keep children engaged in the therapy process.

We are really passionate about building a platform that is just the healthcare, that makes it the highest possible consultation for both clinicians and consumers.

Dr. Lisa Interl…:              For kids that are like Louis, who has had anxiety in the past about going into medical context, being over his iPad or something is really helpful. Because he doesn’t have to deal with the anxiety, which often can be detrimental to the therapy.

Annie Banbury:               Yeah. I am a researcher. I’m an active researcher as well. I did my PhD in telehealth and particularly around the use of groups via telehealth, to support older people with chronic disease. What we found in the groups that I developed the program for was that those participants who had anxiety, depression, they would never have gone to a group. They just said it wouldn’t be possible. However, when we did the group’s via video conferencing, it actually helped them. It gave them a sense of safety.

They could actually leave the group if they wanted to. They actually got to know people in the comfort of their own surroundings and not feeling like walking into a room where all these strangers were. And that they’re having to deal with all those emotions and that anxiety. Over time, this group, I’ve run many groups over video conferencing, and these groups do connect with each other. We’re able to bring people from large distances together.

I think at the beginning of the program, Kris, you mentioned that the biggest support to you has been Lisa, in your journey with parenting. I passionately believe that bringing people together to talk about the lived experience really helps with either clinical conditions or social support, and how to deal with the conditions they’re dealing with. Now, sometimes it’s really nice to bring together people who are not in your area. Particularly if you live in rural or regional areas, they’re pretty small towns. I live in one myself.

But if you’re brought together in a group with people from all over Australia, where you have a common problem or a common issue, and you develop that trust between the participants, then the participant can really start to feel trustworthy in the group and start talking about issues that they don’t have anybody else in their own network to discuss. Because no one might be facing the same issues that they’re facing.

Talking to someone who has the lived experience with what the issues they’re dealing with is really important, and telehealth can help with that.

Kristine Christ…:             How does a consumer use Coviu? Explain to us. Can you find service providers on your platform?

Annie Banbury:               We don’t really have a directory. Coviu is used throughout Australia. We are the backend of Healthdirect video calls, so some people might have experience with using that. But clinicians join up to use Coviu in their practice. But my own research has told me a lot of clinicians don’t think about offering the telehealth to consumers. I really urge consumers to say, “Hey, I’d really like to do some of these appointments by telehealth. I think that would really work for my family.” There are times when my child has anxiety or there are times I just cannot get them to an appointment.

I was talking with someone the other day, who mentioned her child was on the NDIS, that there are numerous appointments that she does have to cancel because she can’t get there. But she mentioned to me that those appointments still come out of her budget. What you’ve actually got is a situation where the consumer isn’t able to go to the in-person appointment, but the cost is still being taken away. Maybe there’s an opportunity there to say to the clinician, “I can’t come, but I would like a telehealth appointment instead.”

Now, in some of those professions, those disciplines, like a psychology appointment, there’s very little difference to doing it in a room. In fact, there are definite advantages to doing it in home. I do really urge the consumers to say to their clinicians, “I’d really like to do this by telehealth.”

Dr. Lisa Interl…:              What would you like NDIS to do? Because it seems like they have a bit of a role as well. If they know that there’s an issue with underspending due to access and other issues, as you explained, then there should be a viable opportunity for people to access their services and not just burn money by being charged for something they can’t attend.

Annie Banbury:               Yeah. Absolutely. I think it seems to be a little bit of a football between the N-D-I-A or the NDIS and the clinicians that are providing. Because when I’ve spoken, I have spoken to NDIS people. They say, “Yeah, but that’s a clinical decision. Therefore, it’s up to the clinicians to decide whether that’s an appropriate consultation.” But there are some guidelines.

There are definitely clinicians out there who A, haven’t been trained in telehealth well, and B, it’s not always in the forefront of their mind to say, “Would you like it by telehealth?” Because clinicians can’t make an assumption as to who can use telehealth and who can’t, which we know from the research, it’s not always correct. Clinicians have to learn to use a different tool in their clinical care, and that’s the issue.

Dr. Lisa Interl…:              What about the role of the colleges or the Australian Psychological Society or the Royal Australian College of GPs? Do they engage with their members to try and give them that education?

Annie Banbury:               Well, the psychologists have done some fact sheets. I don’t think any of them have really been tailored to the NDIS sector, and I think that’s the bit that’s missing for me. I would really like to see the professional bodies do some work around, okay, for the NDIS I would like to have information and training for the consumers and the clinicians. We’d love to see that and we’d really love to work with people about it.

There’s lots of evidence, peer-reviewed evidence, published evidence around how telehealth can be used, and for what type of consultations, and in what circumstances. And it’s about getting that information to those clinicians as well as consumers. They’re two different types of information, but definitely, the professional bodies do have a role to play. Yes, Lisa.

Kristine Christ…:             I think it also helps, like you mentioned before in those rural areas, where it’s hard enough in CBD of Melbourne to get a speech therapist or an appointment with a psych. I can only imagine in your research, what you’ve found in those regions of Queensland and Far. There wouldn’t even be anything around there for them to go to, would there?

Annie Banbury:               No, I did meet quite a senior NDIS person who had been out in Queensland. He said he’d been to these engagement meetings with community members, and they were cross. He said, “I’ve got this money, but I can’t spend it anywhere” There’s lots of strategies to help with that, and telehealth is one strategy. That’s what we would say. It’s not the answer to everything, but it’s certainly a strategy that should be explored better than what it’s currently being explored.

Kristine Christ…:             How did you get yourself involved with this, Annie?

Annie Banbury:               In terms of working in telehealth?

Kristine Christ…:             Yeah.

Annie Banbury:               Yeah. Okay. I’ve been a researcher for quite a while, and my passion is around the implementation of telehealth, specifically groups. I think before this, I’d actually been working with carers of people with dementia. Probably like some of the NDIS participants, if they are a carer and it can be very difficult to get out, and there’s complete stresses on carers, it’s developing these groups virtually that I was really keen to do. Because I think, as we’ve already discussed, how important it’s to bring people together.

I happened to meet our founder, Silvia Pfeiffer, at a conference, and we started chatting. It was probably about a year before COVID happened. And then when COVID happened, the acceleration of the use of Coviu was enormous. It was at that point, I was offered the opportunity to come on board. It’s a different avenue. It’s a technology company, and I’m really passionate, and Coviu is passionate about creating technology that really meets the end user’s needs. I see that both as what the clinician needs and what the consumer needs.

I work on projects. We are doing some AI digital tools at the moment for wound care analysis, which I know is an issue with the NDIS as well. We’re just about to bring to market an AI tool to help with range of motion. All of these AI tools are not to take away clinical decision-making from a clinician. They’re actually to help them make better clinical decisions. We just give them metrics that mean that they’re not as subjective.

The range of motion, you have an operation and you can say, “Okay, the angle now is 60%. 60%, now I can lift my arm up from, or in a wound analysis. We can see that over time, your wound has decreased in size and the tissues indicate that actually, it’s healing.” It’s all about helping them, the clinicians, say, “Okay. Now what will be my next decision as to how the treatment moves forward?”

Dr. Lisa Interl…:              Yeah. Sounds fascinating.

Kristine Christ…:             I think it’s what you said before. I know myself lately, I’ve been encouraging Matthew’s therapist to do telehealth. I just find it’s very difficult to always take him there, especially when it’s an OT or a speech. He’s not that excited to go. Doing it over telehealth has really worked for him.

Annie Banbury:               How does he find it? Does he like it?

Kristine Christ…:             I think in the beginning, it was confusing. But now, I think he gets a lot out of it, just as much as he would if we were in the room with the therapist. Yeah.

Annie Banbury:               Yeah. I think when you change anything, even a clinician change in how they practice or a consumer using telehealth, you have to give it a bit of a go. And then it’s like riding a bike, really. You go, “Okay, this is how it’s done.” We found that. We did a study recently where we were working with Roth, our west clinicians, delivering speech therapy and OT for preschool children into a childcare center.

Before we started it, the educators at the childcare center were like, “All right, I don’t really see how this is going to work.” But by the end of the two years, it’s like, “Oh yeah, this is how we do our speech therapy. This is great. We know how it works. We know that it does work.” It’s just about getting used to a different way or modality.

Dr. Lisa Interl…:              We’ve had plenty of that, haven’t we over the last couple of years? Getting used to different things?

Annie Banbury:               Yeah. Yeah. That’s true.

Dr. Lisa Interl…:              It was so lovely to meet you, Annie.

Annie Banbury:               Yeah. Likewise, it’s been fantastic. I’m so delighted that a consumer-facing podcast has come out, because I do firmly believe consumers have the right to ask for this type of care. I encourage people that if you think it’s for you, ask your clinician to give it a go.

Kristine Christ…:             Absolutely. Thank you so much for your time today.

Annie Banbury:               Brilliant. Thanks, Lisa. Thanks Kris.

Dr. Lisa Interl…:              Thank you.

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