Improving the National Telehealth Landscape

National E-Health Transition Authority

www.nehta.gov.au

1

Improving the National

Telehealth Landscape

21 March 2013

Dr Mukesh Haikerwal

NEHTA Clinical Lead

The National E-Health Transition Authority

National E-Health Transition Authority

www.nehta.gov.au

22 National E-Health Transition Authority

www.nehta.gov.au

�General Medical Practitioner

�Head Clinical Leadership, Engagement Unit & Clinical Safety: NeHTA,

�Professorial Fellow, Flinders University, Adelaide

�Chair of Council, World Medical Association

�Broadband Champion (DBCDE)

�Chair beyondblue Doctors Mental Health Programme

�19th President, Australian Medical Association

�Ex-Commissioner, National Health & Hospitals Reform Commission

�CSIRO / Australian E-Health Research Centre: RIAC

�Brain Injury Australia: Board Member

Mukesh Haikerwal AO


www.nehta.gov.au

NEHTA’s purpose

Lead the uptake of eHealth systems of national

significance; and coordinate the progression and

accelerate the adoption of eHealth by delivering

urgently needed integration infrastructure and

standards for health information.

eDiagnostics eDischarge eReferral eMedicationsTerminology

Secure

MessagingIdentifiers Authentication

Priority eHealth Solutions eHealth Foundation Services


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Work Programme 2013-14

o Continue to drive the national adoption and uptake of eHealth and support the Australian health sector’s transition to the effective use of eHealth.

o Building on the progress achieved to date with the lead eHealth sites we will focus on driving take-up and transitioning the sites to national adoption.

o Further enable the improved continuity and coordination of care; medications management; and the use of diagnostic information to enhance specifications and standards development.

TELEHEALTH is not on the programme but there is knowledge hat we must work with this technology, integrate it with the eHealth build, leverage from it and provide eHealth collateral to Telehealth.


www.nehta.gov.au5

• Every year Australians have an average

of 22 interactions with the health

system, including:

� 4 visits to a GP

� 12 prescriptions

� 3 visits to a specialist.

• Most of the information from these visits

is currently held in paper-based records

in separate locations. Most of these

records are not shared electronically.

Why do we need an eHealthrecord system?

Approximately 13% of

health provider

consultations have missing

information


www.nehta.gov.au6

• By 31/12/2012:

Australians had: 61,000 interactions

using the MBS for Tele-health system,

including:

� 7200 Practitioners

� 28000 Patients involved

• MBS Settings changed

• On-going Telehealth by States non-MBS

• Opportunity to enhance Patient Journey

Using Telehealth: supported by the eHealth record system?

The PCEHR with Telehealth

settings has the benefits of

enhanced patient care with

better information during

the consultation.


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Australia geosciences map

Telehealth: the challenge for Health Care


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Royal Flying Doctor Service: iconic Telemedicine

Using Telehealth: not so new? Iconic Health Care


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Mt. Isa 2 weeks ago!


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The National Broadband

Network: NBN

Debate about need for good broadband access

Broadband for health: internet to GP & Pharmacy

Speed: 1Gb/S Fibre 25Mb/s Satellite / Fixed Wireless

BB to ALL Homes and Businesses:

optic fibre (93%)

fixed wireless and

next-generation satellite


www.nehta.gov.au

The NBN: National Digital

Economy Strategy

The Strategy’s eight goals aim to:

• increase Australian households’ online participation

• increase Australian business’ and not-for-profit

organisations’ online engagement

• smartly manage our environment

• improve health and aged care

• expand online education

• increase teleworking

• improved online government service delivery and

engagement

• increase digital engagement in regional Australia.


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Availability

Now?


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Telehealth in Remote areas


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Telehealth: exposing the possibility


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Telehealth in Australia

Focus has been on:

Face to face video consultation

Dealing with issues associated with geography

Access to specialist care

Distance support of local practitioners to deliver

care locally, minimise travel for ALL

Store and Forward technology

Increasing interest in:

Home monitoring

Home rehabilitation


www.nehta.gov.au

Regional telehealth program links to:

GPs

Specialists

Aged care

Access to any kind of care

Telehealth being used in settings from acute care

to aged care

Telehealth in Europe


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Long term conditions: monitoring - , focus on chronic conditions (e.g. Diabetes COPD Heart Diseases)


In Europe the focus is on

improved management of long

term conditions, providing

access to care.

Geography makes easy to

understand the different emphasis


www.nehta.gov.au

UK Whole System Demonstrator (WSD) Results

Telehealth in the UK is typically remote monitoring rather than Face to Face consultation

Headline significant enough to persuade the UK to invest in the technology.

6,191 people in 238 GP practices and was the largest of its kind in the world so far

Kent, Cornwall and Newham (London): 45% reduction in mortality

(equating to 120 surviving where they may not have if no such care )

Significant reductions in:

Emergency admissions : 21%,

Planned hospital admissions: 24%

Visits to A&E: 15%

Days in hospital: 14%

Tariff costs for treatment: 8%

Focused on the long-term conditions diabetes, chronic obstructive pulmonary disease and

coronary heart disease”.



www.nehta.gov.au

28 August 2012 Rebecca Todd

Telestroke service in Lancashire and Cumbria:

343 advice calls

319 telestroke assessments

131 patients being thrombolysed

Estimated 40 more patients to make a full

recovery from a stroke with no lasting disability or

brain damage

30 fewer people will require full-time care

The service was estimated to save £7m: on track!

Prisons example is a good one to quote.

Guys at Airedale in Yorkshire supporting Prisons all over the UK.



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North Pole View


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Western Europe


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Africa & Europe


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Asia & E. Europe


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North and Central America


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Australasia & S. E. Asia

Video and your services

1. Video will become a bigger part of consumer

expectations and your service

2. There are big changes on the near horizon

3. Don’t spend money on infrastructure

4. Focus on how services come together & how

client & patient behaviour changing

Value of face to face

communications

• Human communication

– establishes an inherent confidence

– a sense of the environment

– stronger commitment to actions

– a deeper level of connection between parties,

especially if they have just met

• Even silences have meaning

• Visual examination

Organisational value

• Increased access, productivity, convenience,

service levels

• Reduced isolation, costs

• Compressed timescales

• Better use of available workforce

• Up skilling professionals and carers

• Better outcomes, through more timely access

and enhanced human communication

WebRTC is game changing

• Web Real Time Communications (WebRTC)

• High quality, secure, multipoint video communications now function of browsers

• Highly functional, not just video

• Free, open internet standard, ratified soon

• Chrome, Firefox, IE (plugin), Android (beta)

• Mainstream support in all browsers, and mobiles + more capabilities expected by 2014

• Will be present in range of vendor solutions

Web standards have a

profound and immediate

impact on the way we

communicate

Click a link to view

text information

Click a link to

view an image

Click a link to

watch a video

Click a link to

communicate

in real time

Click a person

to be their

friend and

exchange news

Click a service

for a video

consultation

Click a person

to send an

email

data

Quality video

Audio

SE

RV

ICE

LAY

ER

Multiple health care settings and combinations of providers

Health orgs Carers EducatorsIndividualsAncillaryClinicians

MA

NA

GE

ME

NT

LAY

ER

Easy to get right service, in the right way and move between services

Service

entry

points

Planned /

unplanned

access

Call dist.

to pools of

providers

Reporting

Process

integration

support

NHSD /

PCeHR

TE

CH

NO

LOG

Y

LAY

ER

Simple, secure, high quality, ubiquitous access - no cost, accounts or downloads

Standards

based

Devices

that people

use

Real time

video /

data

MonitoringPrescribing

/ referringDiagnostic

How services come together with clients & patients

Video and your services

1. Video will become a bigger part of consumer

expectations and your service

2. There are big changes on the near horizon

3. Don’t spend any money on infrastructure

4. Focus on how services come together and how

client expectations are changing


www.nehta.gov.au

Conclusion:

• Telehealth like eHealth mHealth uHealth all are integral

to Health

• The Technologies are not the hard part: change

management is

• Significant gains are achievable in each sector, but

combined the nett value is likely considerably greater

• Deployment of these technologies are been driven by

Clinicians and Consumers

• This is about Healthcare using technology as a tool and

not technology driving health

• Sharing knowledge internationally will optimise uptake,

usage and benefit

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Category:	Health & Medicine
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Improving the National Telehealth Landscape

Health & Medicine