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Australian Telehealth Challenges and Opportunities

Cisco Health Practice

Dr Brendan Lovelock

Health Practice Lead

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Overview

Telehealth

Landscape in

Australia

Solution

Outcomes Challenges for

Telehealth

Drivers for

Telehealth

Practical

People Centered

Transformation of Care

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What do we Mean by Telehealth

• It is about creating a clinically productive dialogue between care providers and between care providers and patient

• Integration of data-voice-video: producing an information rich dialogue

• Developed within, between and external to health care facilities

• Australia has been a leader is Telehealth from 1929 RFDS Morse code communications program

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Australia and Telehealth

Date Telehealth Mile-stones

1929 Tele-health program began using a pedal powered wireless and Morse code

Mid 1930s The tele-health program moved to voice radio

1939 The medical chest system was first suggested

1942 The medical chest program began with each component numbered. The ‘where does

it hurt chart’ was introduced

1951 The tele-health program moved to predominantly fixed-line telephone services

1980s Tele-health program incorporated fixed line

1990s Mobile and satellite telephone services with the occasional use of video-conference

facilities

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The Clinical Ecosystem

GP

Specialist

Acute

Home

Community

22,471 Specialist

24,029 GPs

736 Public Hospitals

8.5 million

separations

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The Clinical Ecosystem

GP

Specialist

Acute

Home

Community

22,471 Specialist

24,029 GPs

736 Public Hospitals

8.5 million

separations

Around 3000 bridging based endpoints

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The Clinical Ecosystem

GP

Specialist

Acute

Home

Community

22,471 Specialist

24,029 GPs

736 Public Hospitals

8.5 million

separations

Around 3000 bridging based endpoints

Federal Governments Telehealth Program 495,000 services by end of 2015

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The Clinical Ecosystem

GP

Specialist

Acute

Home

Community

22,471 Specialist

24,029 GPs

736 Public Hospitals

8.5 million

separations

Around 3000 bridging based endpoints

Federal Governments Telehealth Program 495,000 services by end of 2015

Leverage Infrastructure and skills

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Telehealth Drivers in Australia

• Cost of Care

• Acceleration of healthcare costs as a % of GDP (Currently 9.2% of GDP)

• Equity of care

• How do we more effectively reach and engage consumers: the geographic, cultural and demographic divides

• Resource Availability

• Limited supply of specialist resources facing increasing demand

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Resource Availability

• Population effect compounded by population density

• 24.3% of rural and remote medical practitioners are over the age of 55.

• Young doctors do not see rural locations as desirable due the

professional and social isolation.

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The Challenges The Healthcare Management Myth

Health is a well disciplined organization ready to immediately obey their leader.

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The Healthcare Management Reality

• Healthcare is a Complex Adaptive System

• Well disciplined agents of comparable authority that interact in often highly nonlinear ways to maximize their individual output. (1,2,3)

• Health evolves as a result of many small innovations leading to a change in the whole system

• This is what fuels change and evolution in healthcare but makes uniform implementation difficult

• Rapid innovation is the opportunity presented to us by the Gov Telehealth Strategy (1) William B. Rouse, Health Care as a Complex Adaptive System, The Bridge, Spring 2008

(2) Sholo m Glouberman, Brenda Zimmerman, Complicated and Complex Systems: What Should Successful Reform of Medicare Look Like,

Commission on the Future of Health Care in Canada, Discussion Paper No2, July 2002

(3) Joseph Tan, Joseph Wen, Healthcare and Services Delivery Systems as Complex Adaptive Systems, Communications of the ACM, May 2005, 48,

5, 38-44

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Challenges: Readiness Spectrum

Specialist General

Practitioner

Acute

Care

Hospital

• Less than 20% practice

computerization

• Low computer literacy

• Little network support

• Low motivation to change

• Greater than 95% practice

computerization

• Moderate computer literacy

• Basic network support

• Moderate motivation to

change

• High level of computerization

• Good computer literacy

• Sophisticated network support

• Existing telehealth

infrastructure

• Existing funding programs

• High motivation to change

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Challenges: General Practitioner Perspective

What do you predict the

take-up to be like for access

to specialist services by

telehealth?

What proportion of your work

could be done by telehealth?

Telehealth Assessment Final Report

28 June 2011 UniQuest Project No: 16807

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Challenges: Specialist Perspective

• Coordination

• Need for high level of support

• Time allotment

• Fit with Current work practices .

• Patient perspective

• Concern with maintaining patient engagement

• Equipment

• Simplicity and cost effectiveness

• Facilities

• Facilities must be fit for purpose

• Education

• Change management is needed

Uniquest Telehealth Review

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Patient Perspective

Affordable, quality, patient centred care

Cisco HealthPresence™ • 99% were satisfied with the experience • 93% would recommend

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External Challenges to Telehealth

• NICTA Telehealth Review

Telemedicine in the context of the National Broadband Network July 25, 2010

Report by NICTA for Department of Broadband, Communications and the Digital Economy

Business Experience

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Telehealth System Requirements

• Integration with the clinical workflow

• Integration with clinical systems and the way care is delivered

• Integration with the business workflow

• Integrating with business systems: availability, booking, billing reporting

• Reducing the complexity of use:

• User interface, Interoperability, reliable access

• Reducing complexity of support

• Easy and cost effective to support

• Linkage with existing telehealth and clinical resources

• Leverage state based, acute care linked telehealth systems

• Systems must be adaptable: One size does not fit all

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Thank you.