Extending the reach of healthcare with telehealth
Google "distant healing" and you will be amazed at the range of spiritual religious and quasi-scientific services offering to heal all manner of ailments via telephone, Internet or "healing energies". To Telehealth, however, offers something rather more conventional and yet every bit as diverse - from a couple of health professionals discussing a case over the phone to something as sophisticated as robotic surgery controlled by a specialist surgeon in a distant land.
"In absentia care” simply means care at a distance. In the past this could simply mean medical consultation and advice by post, updated with the arrival of the telephone and now, thanks to modern communication technology, can include face to face video consultation or what we know as modern telemedicine. An extension of this is when there is a health professional at both ends: for example, a country doctor notes an unusual mark on a patient’s skin, photographs it and e-mails the picture to a specialist for assessment.
Radiology, pathology, dermatology, and ophthalmology in particular rely on a lot of visual information, with images or video sent electronically to remote specialists for accurate or complex diagnosis. This can entail sending very high resolution images, and information too sensitive to be trusted to public services, so specialist “store and forward” services are available for secure telemedicine.
The benefits of such TeleHealth are obvious for the practitioners: expert opinion available to help or confirm diagnosis; time saved in making diagnoses and more timely intervention as a result; more time caring and less spent travelling; a chance to review and discuss cases when convenient and at shorter notice.
Patients too benefit from all this, but telemedicine offers even more, especially in rural areas. Taking something as sophisticated and costly as a CTI scanner on the road is a major undertaking, but it saves sick people the added risk of travelling for hours to a central facility – and high speed networking means that only the technicians, and not the doctors, need spend days on the road. Patients simply schedule an appointment at their nearest health centre knowing that their scans will be transmitted to top specialists in the city hospital. In all cases: early diagnosis that stops a condition developing can mean a massive saving in money as well as lives.
At a more basic “telecare” level, many frail, convalescent or handicapped patients – who in the past would have to stay in hospital in order to receive adequate care and monitoring – can now be allowed the comfort of their own homes, as long as there is an Internet link to keep them in touch with their carers.
For hard data on these benefits, the UK Department of Health launched one of the world’s largest randomised control trials of telehealth and telecare, involving over six thousand patients and over two hundred and thirty GP practices across three very different locations and evaluated by six different academic bodies. The survey suggested that properly applied telehealth can deliver a 15% reduction in A&E visits, a 20% reduction in emergency admissions, a 14% reduction in elective admissions, a14% reduction in bed days and an 8% reduction in tariff costs. More strikingly they also noted a 45% reduction in mortality rates.
All this is highly relevant to a country as huge and scattered as Australia – so why are we not leading the world in telehealth? As early as 1999 the 5th Rural health Conference in Adelaide was calling for major investment in telehealth as a better solution than trying to raise funding for rural health centres while luring city doctors “into the sticks”. At last New South Wales is setting an example with its Blueprint for eHealth in NSW announced in December 2013.
Over ten years NSW plans to invest $1.5 billion, including almost $400 million for ICT programs such as electronic medications management and community health and outpatients care. Patient information will be available across the state to allow clinicians in metropolitan areas to support services in regional and rural centres and performance standards are being set to meet the needs of both clinicians and patients. Programs already underway include telehealth, electronic medications management, statewide access to digital imaging and the use of voice recognition software as part of the second phase of the electronic medical records program.
One thing should be clear to anyone with experience of IT solutions: you will never reap the real benefits of eHealth with a cobbled-together system. As NSW has found: “Despite progress, we know that the Local Health Districts still all operate on different IT systems and have differing eHealth capacities.” So NSW is committing to a “whole of government” strategy, and work has already started on a unified high bandwidth HealthWAN linking key sites across the region.
This is surely the way to go. Community health is one of the greatest benefits that any government can provide, and we salute NSW eHealth for its whole of government commitment.