We present two views at variance here, based on the headlines:
From Pulse+IT, ‘Australasia’s first and only eHealth and HealthIT magazine’, Telehealth to go high tech for aged care: “University of Queensland researchers have received a grant for almost (AU)$1 million from the National Health and Medical Research Council to conduct a four-year study into the use of telehealth in residential aged care facilities, involving a web-based clinical support system and clinical-grade video conferencing technology.” While primarily telemedicine as your editors define it (see ‘What is telecare?’), there is a structured assessment tool for interpreting clinical observations. The purpose is to reduce transfers to ER (ED/A&E) with a projection of about 20%.
From (reader) Dr. George Margelis’ blog: Is telehealth dead in Australia? The new Australian healthcare 2013 budget will limit telehealth consults (largely defined as we do in the definitions sidebar at right, but also in context including telemedicine) to those who meet the government standard of ‘remote areas.’ That means no suburbs or cities. These changes, in Dr. Margelis’ view, take the decision away from clinicians and marginalize telehealth so that its growth is ‘strangled’ and will not move towards wider use. The irony is that telehealth was widely seen as ‘an enabler of health reform’ and to become a world leader in delivering care in a more effective, efficient way. It was also a justification for building out the national broadband network at a cost of AU$40 billion. It’s a blow to development that Dr. Margelis cannot reason away, given its cost is only AU$130 million over four years, in an annual healthcare expenditure of AU$130 billion.
UPDATE Fri 2 November: Here’s a related local news itemt: Illawarra cut off from telehealth services.
Dr George Margelis
The big problem we have down under at present with telehealth is the confusion generated by the lack of a coherent strategy and vision. The healthcare community has accepted its value, and it seemed like the government payer did too with the introduction of some reimbursement codes specific to telemedicine type services. It looked like we were heading forward, and then we had two back to back reversals in reimbursement, a huge delay in a promised pilot project, and a smattering of small disjointed research grants.
As a result coal face clinicians are losing patience and interest, and shying away from telemedicine. The challenge is the need for a critical mass of practitioners to make telemedicine a viable solution. If you have to spend all your time trying to find a clinician to connect to, you may as well jump in the car and drive to see a provider in their office.
There remains huge potential for telehealth and telemedicine in Australia, as in the rest of the world, as long as the artificial barriers to its adoption are removed.
Perhaps some of the confusion is in the definitions of telehealth that are used in different countries. In the UK, we use a rather narrow definition of telehealth which relates to the practice of using technology to support patients measuring their vital signs once of twice a day and reporting the results through a home telephone portal which allows clinicians to view results and trends remotely. Hopefully, this will be extended before long to include continuous (or intermittent) measurement of vital signs, activities, and other parameters that new technologies will support both for measurement and for analysis and onward transmission. Add to this opportunities to support self-care through telecoaching and video consultations for discussion of symptoms, for the reassurance and support of doctors and nurses for dealing with chronic diseases, and for showing wounds and accidents, then telehealth becomes a rather a more complete proposition.
In Australia, although well over half the population live in the biggest 4 or 5 cities, there are hundreds of thousands who live in very rural settings where remote consultations (referred to as telehealth or telemedicine) would offer a far more practical way of satisfying the unrelenting demand for high quality healthcare. These consultations would naturally combine point of care measurement with video consultations, and the New Broadband Network currently being developed in Australia would provide an ideal opportunity to push forward the boundaries of technology to include steerable and zoomable multi-camera views in high definition. Only then could the virtual consultations begin to offer the same level of experience as can be obtained through a face-to-face visit. Virtual presence achieved in this way would allow telehealth services to support many new groups of patients including those with mental health problems, long term conditions and carers who can’t leave their loved ones to attend appointments away from their homes.
The Australian government understood this potential and has tried to promote it by offering payments for remote video consultations. Unfortunately, it takes little to add a video camera to an existing vital signs measurement portal, and to offer a telehealth service that might appear to be revolutionary. Not surprisingly, the demand was immediately great. But then it was realised that the available services lacked the required quality, and were perhaps being used without justification because of the available funding.
Despite the u-turn in government payment policy, Australia’s New Broadband Network will provide an ideal platform on which to build the high quality telehealth services that are actually needed. The technology providers need to be more innovative in designing the equipment and services that can be achieved once the bandwidth issues are resolved.
In the UK too we need to prepare for the arrival of improved networks both delivered by wire or fibre, and through mobile advances such as 4G. When people see what can be done when current limitations are removed, any lingering doubts about the relevance and cost-effectiveness of telehealth will surely be removed.