prof. colin carati, flinders university - impact of the nbn on ehealth in australia

Impact of the NBN on

eHealth in Australia

Colin Carati

e-Health is …..

‘the combined use of electronic

communication and information technology

in the health sector’ (WHO)

• electronic health records

• digital information flow in healthcare

• telehealth, remote monitoring and

videoconferencing

• “participatory” health

NBN will accelerate development of e-

Health ……

……. and shift the focus of healthcare

from institutions and healthcare sites into

the community

……. but how ?

1. observations so far

2. challenges along the way

3. next steps ?

national ehealth strategies and programs

state and territory ehealth strategies and

programs

commercial sector / private practitioner

developments

• National eHealth Strategy 2009

• NEHTA - PCeHR, eFoundations including standards, interoperability,

security and access, health identifiers and clinical terminology

• National Digital Economy Strategy 2011 (updated 2013) - Health and

Ageing Goal

• Medicare Benefit Scheme Online – payments for certain Telehealth

consultations

• NBN enabled ehealth / TeleHealth projects

National eHealth Strategy 2009

“….E-Health is the means of ensuring that the right

health information is provided to the right person at the

right place and time in a secure, electronic form for the

purpose of optimising the quality and efficiency of health

care delivery …..

E-Health should be viewed as both the essential

infrastructure underpinning information exchange

between all participants in the Australian health care

system and as a key enabler and driver of improved

health outcomes for all Australians. “

could something like the NBN enhance

healthcare through ehealth ?

• evidence from international and

national trials

• evidence from “NBN – enabled”

trials in Australia

• evidence from jurisdictional (State /

Territory) trials and programs

• evidence from professional uptake /

commercial development

do you need the NBN for ehealth ?

health ‘networks’ OK at institutional level,

but poor reach into the broader community

• NBN improves community level access,

including to the home,

• allows greater proportion of healthcare to

be pushed out into community settings

• NBN improves rural and remote access (via wider rural and remote distribution and

satellite and wireless services)

do you need that much bandwidth ?

depends on what you are trying to achieve

• some eHealth solutions can operate on

existing technology (ADSL, 3 or 4G)

• BUT ….. increasing the bandwidth

improves the service and permits more to

be done

Palliative care / rehab / aging at home

• health status monitored at home via

questionnaires on iPad –

deterioration triggers alerts

• rehab / activity levels monitored in

home

• videoconferencing – regular and ‘on

demand’

• capacity to bring in carers,

specialists and GPs (case

conferencing)

relatively low cost, low bandwidth (up to 1

mb/s) solutions can be very effective, but ….

• poor quality and reliability of service

(increasing bandwidth reduces contention)

• useful upload speeds become important,

especially for videoconferencing

• successful service leads to requests for

more options and increased scope leading

to demands for more bandwidth !!

more comprehensive home monitoring

increases bandwidth requirements with

increasingly instrumented homes eg in

dementia care

bandwidth requirements escalate with

multi-residential dwellings

video, video , video

= bandwidth, bandwidth, bandwidth

htt

p:/

/ww

w.t

ele

me

dca

re.c

om

.au

video is becoming more prevalent

visual cues are critical to human

communication, and to health care

• visual assessment

• establishes a more direct and deeper

relationship - even silences have

meaning

• provides a sense of the environment

• stronger commitment to actions

reproduced with permission from Chris Ryan, Attend Anywhere

reproduced with permission from Chris Ryan, Attend Anywhere

so, ….

• current evidence is that ehealth does

enhance healthcare, and has great

potential

• NBN will improve community access,

especially to the home, and push

healthcare towards primary care

• bandwidth demands are likely to increase

2. challenges along the way – its

not as easy as it looks !!

• NBN rollout schedule

• mainly organisational, rather than

technical

• digital literacy

fragmentation

• different approaches taken by

institutions, private practitioners and

commercial suppliers

• growth has been ‘organic’ and

opportunistic – “pilotitis”

• trials ‘bolted on’ rather than through re-

engineering work practices

despite good evidence for value of telehealth, uptake

has been slow ….. because it involves complex

change management, new models of care and new

business models

“Telehealth is a good example of a complex innovation;

it changes

– the way in which health care providers work.

– referral patterns, clinical pathways and the patient journey.

– professional roles: who does what aspects of the clinical work.

– the type, frequency and nature of communication between

health care providers.” [and the recipients and community]

V Wade, How to Make TeleHealth Work http://www.e-unicare.com.au/

interoperability and security

• jurisdictional networks secure within States

/ Territories but not always well connected

with other states, private practice,

community, businesses, homes

• security / privacy not always adequately

addressed

• operational standards are still being

addressed

digital literacy and the digital divide

• implementation of eHealth requires

– upskilling of health care professionals

– upskilling of many healthcare recipients,

especially elderly and vulnerable

– making things simple

– access to affordable technology

• the digital divide is reducing, but how will

digital literacy / access affect health care ?

3. next steps ?

“ADVANCING AUSTRALIA AS A DIGITAL ECONOMY 2013”

HEALTH AND AGED CARE (Labour Govt, 2013)

Action 16. Consider the expansion of the Medicare Benefits Schedule for telehealth

items

- costs and benefits to be reviewed in 2013 ?

Action 17. Evaluate outcomes from telehealth trials and develop action plans to

address key challenges

- during 2014-15, the Government will evaluate the current telehealth trials, share trial findings

and lessons with the healthcare community, and use the findings to develop action plans to

address key telehealth issues.

Action 18. Implement video consultations for the after-hours GP Helpline and the

Pregnancy, Birth and Baby Helpline – phased in over 2013

Action 19. Support increased use of digital platforms to provide aged care services

The Government will introduce a range of reforms such as:

> revision of relevant aged care program guidelines to recognise and encourage the use of

innovative and digital delivery options for the provision of aged care services

> expansion of the Community Visitors Scheme into home care including through the use

of technology

> launch the My Aged Care website to provide coordinated information for aged care services.

www.aths.org.au

KS1: focus on national priority groups

KS2: apply ‘fit for purpose’ models

KS3: optimise the locus of implementation

KS1: focus on national priority groups

• aged care

• poorly mobile / disabled

• outer metropolitan, rural and remote

KS2: apply ‘fit for purpose’ models

develop technical, business and financial

models that support clinical change by

• being sustainable and scalable

• working across multiple providers / funders

/ jurisdictions

• being demonstrably ‘fit for purpose’.

KS3: optimise the locus of implementation

by focussing on;

• appropriate vehicle for encouraging primary

/ team based implementation (State based

services, Medicare Locals ?)

• clinical pathways and use cases for specific

health care disciplines.

• identifying demand, enablers and barriers

for uptake by consumers.

• will accelerate development of e-Health

• will shift the focus of healthcare from

institutions towards primary care and into

the community

• will be improved by nationally coordinated

strategies and implementation

• requires sound business models and

careful change management

conclusions - leveraging the NBN :

National eHealth Strategy 2009

The World Health Organisation defines E-Health as ‘the

combined use of electronic communication and

information technology in the health sector.’ …..

….E-Health is the means of ensuring that the right

health information is provided to the right person at the

right place and time in a secure, electronic form for the

purpose of optimising the quality and efficiency of health

care delivery …..

E-Health should be viewed as both the essential

infrastructure underpinning information exchange

between all participants in the Australian health care

system and as a key enabler and driver of improved

health outcomes for all Australians.

Telehealth in the Home: Palliative

Care, Aged Care and Clinical

Rehabilitation in SA

Michael Kidd, Maria Crotty, Jen Tieman,, Kate Swetenham, Alan

Taylor, Colin Carati, Craig Whitehead, David Currow, Dr Sarah

Mahoney, Tom Symonds

Funded by the Australian Government under the National Broadband

Network (NBN) Enabled Telehealth Pilots Program’

Project Partners: Flinders University

South Australian Local Health Networks (Palliative Care,

Aged Care and Rehabilitation), Country Health SA

Southern GP groups, ACH

Three clinical streams

• Palliative care: Integration of online tools, remote monitoring, information and

resources and regular online communication to support home-

based patients and their carers.

• Aged: Video conferencing to support clinical care in RACF.

• Rehabilitation in the elderly: Introduction of e-rehab including online tools, information provision

and communication to support home-based rehabilitation services

for the elderly, including people recovering from stroke or fractures.

National eHealth Strategy 2009

“National broadband services – A key foundation of the

national health information highway will be access to

national broadband services that provide connectivity

between all Australian care providers. ………

……. As part of this process, there should be a focus on

ensuring that national communications infrastructure will

be fit for E-Health use and is priced in a manner that does

not discourage the sharing of health information across

geographic and health sector boundaries.”