Telehealth specialist consultations a win for regional patients

Participating GPs and specialists can now offer video telehealth consultations as part of the Federal Government’s $620 million “Connecting Health Services with the Future” program, cutting down onerous travel time for regional patients. Jarrod Fitch reports.

Melbourne-based epilepsy specialist Professor Terrance O’Brien has begun trialling telehealth services which could significantly improve health outcomes for his patients.

“At the moment we have people travelling for up to eight hours for a 15-minute appointment which is obviously a big inconvenience for the patient and it’s a barrier to people getting the appropriate specialist input that someone in the city would have,” he said.

O’Brien says telehealth will especially benefit epilepsy-affected rural patients.

“Epilepsy is a chronic disease which is very common, and patients need to see a specialist with expertise in epilepsy on a regular basis, and that’s just not possible in country areas,” he said.

“The way I operate in my practice is with people I already know, I've seen them and done an examination so I don’t actually have to touch them. It’s all about talking to them and being able to look at each other in the eye, talk about issues with treatment and their condition, and then plan the next step of management.

“Having a GP involved makes it even better because they've got a person on the ground there who’s involved with the conversation as well.”

O’Brien says current government funding arrangements makes consultations manageable for health providers.

“The video conferencing technology is not all that expensive and the actual legislation doesn't dictate the technology you've got to use, and therefore people are using all different technologies,” he said.

“I think there’s a long way to go but this is an important first step.”

One of his first telehealth patients is epilepsy sufferer Margo Green who in December last year began her specialist treatment with Professor O’Brien.

“I think it’s absolutely marvellous. You just visit your local GP, and sit and talk to the computer. You can see your specialist at the other end, and your GP can sit beside you if you like, or leave the room, it’s up to you,” she said.

Green, who plans to utilise the service up to three times a year says she was impressed by user-friendly technology.

“The video went through pretty smoothly as far as I’m concerned. I am not that technology savvy – I find it hard enough to get a DVD to work on the television – but this is just so wonderful,” she said.

“I think it’s such a great weight off my mind. In the last 12 to 18 months when I had the last epileptic episode I had to drag my grandson to Melbourne when I had to see the specialist. It’s a whole day. Whereas this way, it’s three-quarters of an hour and it’s done.”

Commercial outlook

Telstra in December launched the new range of telehealth devices and software as part of its existing video conferencing products.

David Giddy, Telstra’s Product Portfolio Manager, Health, Payments & Retail Solutions, says telehealth technology will continue to develop.

“What we've launched so far we see as Stage 1 as an extended period of evolution. The basic capability is now there and it will meet all the requirements for a doctor and a specialist to be able to have a consult and claim the rebates through Medicare,” he said.

Giddy added that one of the challenges remains in improving interoperability within the health system.

“Clearly the doctor or specialist doesn't want to have multiple solutions sitting on their desktop. The industry as a whole has got to start to converge on a few basic standards if we want interoperability to be successful; that will be challenging given a number of proprietary solutions like Skype that aren't based on open standards,” he said.

Take-up within the medical profession also needs to be greater for the technology to become more accessible.

“The second barrier is inertia in the medical community to change because adopting telehealth does mean significant work-flow changes, and changes the way people practice medicine. I think that’s a bigger barrier that everyone anticipated,” Giddy said.

Rollout of National Broadband Network (NBN) will also improve video quality, Giddy says, meaning telecos will not need to install dedicated access for doctors as is currently the case.

“To get the high-resolution video that’s also where NBN will make a difference; whereas you could do it today if you had ADSL2+ and you’re close to an exchange, or if you had a cable100 MB service, but a lot of people can’t as the infrastructure stands today,” he said.

“NBN will encourage more hospital in the home environments where not only will you have video conferencing but you will also have in-home monitoring of patients. In-home monitoring could be done today – you don’t need high bandwidth to see and receive vital signs, etc. – but when you couple it with videoconferencing you can then start to create a remote-consulting environment that doctors can not only look and talk at them and to collect whatever monitoring is necessary for that patient.

“You won’t get all that until you get high-quality video that people are comfortable to use. Not only that, but once people have started to adopt that in the way they conduct medicine and become used to it.”

Telstra is expecting wider use of the telehealth services as technology and e-health consultation become more commonplace.

“Over the next couple of years we’ll go through a period of doctors becoming comfortable doing consultations remotely. As we begin to get to that point NBN will start to become reasonably widely available; that’s when you’ll start to see those things appearing,” Giddy said.

Personally controlled electronic health records (PCEHR)

In line with the Federal Government’s commitment for PCEHR implementation by 1 July NHETA says delivery of the service is on track.

“From 1 July Australians will see a major milestone for e-health: all Australians will be able to register for a PCEHR – enabling more accurate, better informed health decisions as people move around the health system – and giving Australians unprecedented access to a summary of their own health system,” Dr Chris Mitchell of NEHTA’s Change and Adoption Team for PCEHR told Australian Hospital and Healthcare Bulletin (AHHB).

“The [model] document is based on an initial draft concept of operations developed with stakeholders in early 2011, followed by an extensive public consultation process,” he said.

But critics, including Opposition Minister for Health and Ageing Peter Dutton, are sceptical that PCEHR will meet the 1 July timetable.

“I’m as frustrated as anybody when it comes to e-health. I don’t think the government is going to be able to deliver on its timeline, and clearly it’s been over budget and there’s very little evidence to suggest the government’s going to get on track quickly,” he said.

“In the 21st century we should have e-health records; we should have further investment in e-health generally, particularly when people want to receive care in-home. We should be looking at ways of remunerating services for people, for example, remote monitoring in the home.”

Additional reporting by Kathryn Edwards