Telehealth in transition - The importance of telehealth cannot be overstated

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This was the key sentiment from the NSW Minister for Health, the Hon. Jillian Skinner MP, at the recent Australian Telehealth Conference 2016.

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The shift was reflected in many of the discussions at the conference, affirming that telehealth is in a state of transition, with increasing numbers of clinicians advocating for its use.
Associate Professor Andrew Kornberg, Director, RCH Global and Susan Jury, Telehealth Program Manager, from the Royal Children’s Hospital (RCH), Melbourne, spoke about the successes and challenges of the wide scale integration of telehealth in a major hospital, and how a bottom-up approach to implementing telehealth was crucial for success. A view echoed by renowned Head of Surgery at Sydney Medical School, Professor Mohamed Khadra, who predicted the emergence of telepresence and artificial intelligence as big players in the future of telehealth.
Among their successes, the RCH reported that telehealth is now embedded in the daily roles of staff, including triaging, booking, rescheduling and billing, and that clinicians are now taking the lead in initiating novel models of care using telehealth – something which they can now get grants to do.
Part of their lessons learnt, included the “little things”, such as paperwork errors and cancellations, which are also hindrances in face-to-face consultations. They also acknowledged the constraints imposed by Medicare billing and the additional complexities that arise when local doctors are included in telehealth services.
Answering the question “Is it worth it?” they pointed to children with leukaemia. They described the significant long term, positive psycho-social impact on children and their families, of avoiding repeated visits to hospital by instead receiving locally delivered chemotherapy, with online support from RCH. They also quoted Psychiatrist Dr Campbell Paul and his experience using telehealth.
“I can get a lot more insight than I do seeing a child or young person in my clinic room,” he said. “I get to ‘go into their leer’ – their ‘safe zone’. They can say whatever they feel comfortable saying. They can disconnect if they need to. And I think this means they have more sense of control.”
The RCH, who see over 1,000 children per day, reported the results of their most recent survey of regional paediatricians in which 10% responded that they use telehealth “regularly” (once or twice a month) and 40% said that they would like to use telehealth more often.
Julia Martinovich and Chloe Moddel, Telehealth Implementation Officers from the NSW Agency for Clinical Innovation, described the Agency’s methodology for developing new models of care in response to requests from across the NSW Health system. The methodology ensures that the underlying problem is clearly identified before a solution is designed; and covers the implementation and sustainability of the solution. Innovations from the work of the Agency have included the Trauma App and the Chronic Pain Telehealth Tool Kit.
Economics Professor Paul Frijters provided a different and provocative perspective on telehealth. He described a Credence Good as one where patients don’t know what’s wrong with them, what they need and what they get. So in a private healthcare system they tend to be over-treated and overcharged because the diagnosis helps the care provider to make more money. He argued that because health is a Credence Good, it’s necessary to separate diagnostic work from the work of the care provider, and that telehealth had the subversive potential to do this. He suggested that unless health policies are developed that dramatically cut costs, private and offshore markets will emerge.
Factors critical for scaling up telehealth and making it part of everyday healthcare were identified during the Panel Session including: making telehealth as simple and as easy as possible; combining top level support with bottom (operational level) initiatives in organisations; setting up facilitator/support positions; and ensuring that health consumers are informed of telehealth options early during the diagnostic phase.
HISA: Australia’s Digital Health Agency will use outcomes of the conference to continue to advocate for telehealth.
FAST FACTS

• Telehealth is being used more as a regular part of service delivery and daily staff activities.


• A bottom-up approach to implementing telehealth is crucial for success.


• Grants are available for innovative models of care using telehealth.


• Challenges include paperwork and scheduling errors and Medicare constraints.


• Telehealth offers long-term psychosocial benefits for children through remote follow-ups and locally delivered chemo.

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“NSW Minister for Health, Jillian Skinner, mentioned the shift from small pilots to having telehealth as a regular part of service delivery, as the release of the NSW Health Telehealth Framework and Implementation Strategy: 2016-2021 was announced.”

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Dr Louise Schaper
Dr Louise Schaper is CEO of HISA with a passion and enthusiasm for health informatics. With an OT background and a PhD in technology acceptance amongst healthcare professionals, Louise is a world leader in allied health informatics and is intimately connected to Australia’s substantial health reform efforts, where e-health is a key enabler to achieving high quality, safe, sustainable and patient-centred care. Louise is part of NEHTA’s Clinical Leads team and previously chaired the E-Health International Advisory Group of the World Federation of Occupational Therapists.