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Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
Telehealth in Australia - Emerging Trends and Challenges
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Telehealth in Australia - Emerging Trends and Challenges

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Dr Anthony Smith …

Dr Anthony Smith
Deputy Director and Associate Professor at the Centre for Online Health, The University of Queensland, Australia
Executive Committee Member for the Australasian Telehealth Society

Published in: Health & Medicine
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  • NBN Co is a government business enterprise formed in 2009 to design, build and operate the national broadband network (NBN). The NBN will enable high-speed broadband to be delivered to all Australian households, businesses and enterprises through a combination of fibre to the premise, wireless and satellite. To facilitate the further development of a competitive telecommunication market, NBN Co is operating a wholesale-only, open-access network, and making its wholesale services available to retail service providers on non-discriminatory terms.
  • Give a brief overview of the presentation. Describe the major focus of the presentation and why it is important.Introduce each of the major topics.To provide a road map for the audience, you can repeat this Overview slide throughout the presentation, highlighting the particular topic you will discuss next.
  • Give a brief overview of the presentation. Describe the major focus of the presentation and why it is important.Introduce each of the major topics.To provide a road map for the audience, you can repeat this Overview slide throughout the presentation, highlighting the particular topic you will discuss next.
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    • 1. Telehealth in Australia:Emerging Trends and Challenges Dr Anthony Smith, Associate Professor Deputy Director Centre for Online Health
    • 2. Acknowledgements HIHNZ and the National Health IT Board, NZ Pat Kerr, Roy Davidson and Terri Hawke Centre for Online Health, UQ  Prof Len Gray, Dr Nigel Armfield and colleaguesAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 3. Centre for Online Health  Broad interest and experience in telehealth  New models  Evaluation  Service delivery  Teaching and consultancy  Queensland Telepaediatric Service >12y  Adult/geriatric telehealth services  SFT Conference  www.uq.edu.au/cohAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 4. Mud-map (Overview) Australia in context Examples of telemedicine in Queensland Measuring outcomes Government investment –Medicare and the NBN Success factors CollaborationAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 5. Australia Population 22m One third of the population live outside major cities Indigenous population – approx. 520k Most specialist services – centralised, major cities Transport requirements significant Equity of access issuesAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 6. Current practice and research Contemporary use of telehealth, on the whole is:  Focused on specialist consultation to patients in rural and remote locations  Used in selected specialties least compromised by the limitations of VC  Hardware video-conferencing based (good quality but $$$)  Mostly hospital based To date there is little research around the use of telehealth in primary care…Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 7. Key issues in Queensland  Extensive distances and location of specialist health services  Equity of access to health services for regional and remote population  Large videoconference networks … but relatively slow uptakeAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 8. Logistical challenges  Incorporating telehealth into mainstream practice  Complimentary method of consultation  Existing referral pathways – or new?  The complete picture – FTF, outreach, telehealthAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 9. Telehealth coordination  INCENTIVE  Single point of contact  Manages referral  Liaises with specialists  Schedules appointment  Facilitates medical records  Manages videoconference session  Collects activity data  Organises follow-up if required Smith AC, Isles A, McCrossin R, Van der Westhuyzen J, Williams M, Woollett H and Wootton R. The point of referral barrier - a factor in the success of telehealth. Journal of Telemedicine and Telecare 2001; 7 (Suppl.2): 75-78
    • 10. Telepaediatrics in Queensland General paediatrics Sub- Home Specialist telehealth referrals Telepaediatrics Indigenous health Critical care screening Neonatal intensive care
    • 11. Telepaediatrics in Queensland Neurology (n = 11,250 consultations) 10% Burns 14% ENT 7% General Paediatrics 5% Endocrinology 5% Child Psychiatry Oncology 27% 3% Nephrology 3% Orthopaedics 2% Cardiology 2% Ophthalmology Other 2% 18% Dermatology 2%Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 12. Telepaediatrics in Queensland 14,350 consultations over 12 years 2400 consultations per y 2800 2400Consultations 2000 1600 1200 800 400 0 2000 2002 2004 2006 2008 2010 2012Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 13. Telepaediatrics - ENT 2 years – 152 consultations (97 pts) Retrospective audit of medical notes Diagnosis – 99% Management – 93% Smith AC, Dowthwaite S, Agnew J and Wootton R. Concordance between real-time telemedicine assessments and face-to-face consultations in paediatric otolaryngology. The Medical Journal of Australia. 2008, 188 (8): 457-460Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 14. Indigenous health screening ~90% significant disease/deafness rate Long-term impact:  1-3y; severe disease burden (discomfort)  4-5y; slow language  5-7y; slow learning  10-11y; behaviour problems, truancy  15y; illiteracy, substance abuseAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 15. Indigenous health screening Indigenous health workers Specialist outreach services and telehealth support  ENT  Dental  Dermatology  Ophthalmology  Psychiatry  RespiratoryAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 16. Telepaediatrics - Burns Compare FTF to VC assessments 12 months – 25 patients  1.One observer, alternating process FTF/VC - VC/FTF  2. Two observers, FTF consults Smith AC, Kimble R, Bailey D, Mill J, and Wootton R. Diagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients. Journal of Telemedicine and Telecare 2004, 10(4):193-198Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 17. Telepaediatrics - Burns FTF FTF / VC Consultant A Concordance % Concordance % Consultant B n=25 n=25 Appearance 68 60 Scar thickening 60 64 Contractures 92 92 Range of motion 92 92 Activity level 100 100 Breakdowns 96 96 Decision making 100 100 Smith AC, Kimble R, Bailey D, Mill J, and Wootton R. Diagnostic accuracy of and patient satisfaction with telemedicine for the follow-up of paediatric burns patients. Journal of Telemedicine and Telecare 2004, 10(4):193-198Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 18. Telepaediatrics - Burns  ~ 17% of all burns outpatients FTF appointments Telepaediatrics 2100 1800 1500 Consultations 1200 900 600 300 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 19. Telepaediatrics - Surgery Rapidly expanding Routine clinics with all paediatric surgeons 6 clinics per month, up to 2 hours each multi-site appointments Pre-admission, reviews and education Referrals:  Direct to QTS via 1800 number  Patients triaged at the RCH OPD according to postcode  Appointments held at nearest regional hospitalAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 20. Telepaediatrics – Home support Video links to families at home Palliative care, oncology Support from medical, nursing and allied health staff Logitech video – via broadband connection Laptops and PCs - flexibleAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 21. Telepaediatrics – Robots  Telepaediatric robots  Commenced 2004  mobile, wireless videoconference systems  child-friendly  direct to bedsideAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 22. Telepaediatrics – Robots 2005 – Gladstone Hospital, no paediatrician  daily ward rounds  sub-specialist consultationsSmith AC, Coulthard M, Clark R, Armfield N, Taylor S, Goffe R, Mottarelly I, Youngberry K, Isles A and Wootton R.Wireless telemedicine for the delivery of specialist paediatric services to the bedside. Journal of Telemedicine andTelecare 2005, 11 (Suppl. 2): 81-5
    • 23. Tiny Tom - Townsville Eliza – Mt Isa ROY – GladstoneEmma - Emerald Gypsie – Gympie
    • 24. Neonatal ward rounds Often full care team attend  Medical  Nursing  Allied Health  Social work Mackay Base Hospital ICN, Townsville Hospital Round led by neonatologist Family members may participateUsually informal educational opportunities Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
    • 25. Outcomes  User satisfaction  Changes in clinical practice  Accuracy  Patient outcomes  Education and training (workforce development)  EconomicsCRICOS Provider No 00025BAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 26. Cost minimisation analysis  Child and adolescent psychiatry services  e-CYMHS  30 month period  Costs of providing telepaediatrics - video  Costs of providing outreach – visiting psychiatrist  Potential costs if patients travel to the RCH Smith AC, Stathis S, Randell A, Best D, Ryan V, Bergwever E, Keegan F, Fraser E, Scuffham P and Wootton R. A cost-minimisation analysis of a telepaediatric mental health service for patients in rural and remote Queensland. Journal of Telemedicine and Telecare, 2007, 13 (Suppl. 3): 79-83Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 27. Telepsychiatry 30 months – 606 consultations Method FTF – Patient FTF Outreach – Telemedicine – Patient travel ($) Visiting seen via Psychiatrist ($) videoconference ($) Total cost 514,094 299,913 230,753 Average 1073.25 494.91 380.78 Marginal 1073.25 494.91 190.01 Smith AC, Stathis S, Randell A, Best D, Ryan V, Bergwever E, Keegan F, Fraser E, Scuffham P and Wootton R. A cost-minimisation analysis of a telepaediatric mental health service for patients in rural and remote Queensland. Journal of Telemedicine and Telecare, 2007, 13 (Suppl. 3): 79-83Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 28. Telepsychiatry (30 months) Actual 800,000 Patient travelCost ($) Visiting 400,000 Psychiatrist Telemedicine 0 0 100 200 300 400 500 600 700 Consultations Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
    • 29. Developments in Australia  Medicare items for online consultations recently introduced in July 2011 General practice Broad range of health specialties Focus on video consultations  $620m+ invested by Commonwealth Government Financial incentives – 1st consultation, loadings Funding for training, support Promising sign for telehealth in Australia...Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 30. Telehealth uptake  New MBS telehealth items - what is the prognosis?  Likely uptake, long-term trends?  Learn from experience (successes and failures)  Telepsychiatry in Australia* Commonly reported, telehealth friendly MBS items for telepsychiatry - introduced early 2003 * Smith AC, Armfield NR, Croll J and LC Gray. Medicare. Journal of Telemedicine and Telecare, 2012, in pressAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 31. Methods  Review of MBS activity* for psychiatry services Reports via Medicare Australia* July 2002 – June 2011 FTF and VC items compared  Activity reports included: Services delivered – number of consultations Benefits paid – Medicare costs * http://www.medicareaustralia.gov.au/statistics/mbs_item.shtmlAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 32. Telepsychiatry MBS items  MBS items (for VC) introduced in 2003 Consult time FTF VC <15 min 300 353 >15 min and < 30 min 302 355 >30 min and < 45 min 304 356 >45 min and < 75 min 306 357 >75 min 308 358 Ref: http://www.medicareaustralia.gov.au/statistics/mbs_item.shtmlAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 33. Telepsychiatry MBS items  Registered services (July 2002 – June 2011) Consult time FTF VC <15 min 300 371,501 353 1644 >15 min and < 30 min 302 2,372,696 355 2710 >30 min and < 45 min 304 4,319,122 356 1623 >45 min and < 75 min 306 6,389,628 357 1966 >75 min 308 358,386 358 60 Total 13,811,333 8003 Ref: http://www.medicareaustralia.gov.au/statistics/mbs_item.shtmlAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 34. Telepsychiatry MBS items  Benefits paid (July 2002 – June 2011) Consult time FTF VC <15 min 300 $12,501,152 353 $73,611 >15 min and < 30 min 302 $158,144,708 355 $246,630 >30 min and < 45 min 304 $440,522,059 356 $221,258 >45 min and < 75 min 306 $941,480,922 357 $380,118 >75 min 308 $59,479,219 358 $12,873 Total $1,612,128,061 $934,489 Ref: http://www.medicareaustralia.gov.au/statistics/mbs_item.shtmlAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 35. Results  Benefits paid (July 2002 – June 2011) Total MBS Expenditure VC related services (%) $200,000,000 1 $190,000,000 Total MBS costs ($) Proportion (%) $180,000,000 $170,000,000 $160,000,000 $150,000,000 0 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010 2010/2011Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 36. Summary  MBS Activity (July 2002 – June 2011)  14 million services (psychiatry consultations)  $1.6 billion MBS funded psychiatry services FTF VC % Services 13,811,333 8003 0.06 Benefits $1,612,128,061 $934,489 0.06Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 37. Findings  Despite item numbers being available for telepsychiatry since 2003, uptake has been very slow  Considering reported telehealth success in psychiatry – results may be surprising?  Telehealth success factorsAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 38. National Broadband Network (NBN)  Construction from 2009 (10 year plan) – NBN Co.  Replacing existing copper network  High speed broadband for all Australian households  Government investment – approx. $37b  Fibre, wireless and satelliteAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 39. National Broadband Network (NBN)Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 40. National Broadband Network (NBN)  97% coverage, satellites for the remainder  Healthcare?  Telehealth – not NBN dependent, but…  Opportunities to develop new methods  Increased reliability, transmission speedAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 41. Critical factors  Funding  Clinical services (clinicians)  Infrastructure, equip and telecommunications  Administrative and clinical systems Smith AC and Gray LC. Telemedicine across the ages. The Medical Journal of Australia. 2009, 190 (1): 15-19Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 42. Telehealth checklist  Funding  Careful design – clinical requirements  Organisational support – willingness to change  Re-engineering conventional referral processes  Complementary (with outreach, patient travel)  Incentives – comparable (or better) than FTF  Clinician support (near and far)  Electronic records Smith AC and Gray LC. Telemedicine across the ages. The Medical Journal of Australia. 2009, 190 (1): 15-19Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 43. Change management Telehealth implies a change in practice Rethinking how services are delivered (e.g. specialists consultations face-to-face vs. online) This may take considerable time and the results are unpredictable Needs organisational support for success – across a wide range of settingsGray L, Smith AC, Armfield NR, Travers C, Croll P, Caffery L. Assessment of telehealth implementations and associatedrequirements (2010). Department of Health and Ageing, Australian Government. Reports available via the MBS Onlinewebsite: Telehealth Business Case Advice and Options and Telehealth Assessment ReportAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 44. Practical tips  Develop new services systematically  Start small and gradually develop  New applications:  Feasibility, technical, user satisfaction  Clinical efficacy – comparable to FTF  Economic evaluation – patient, health service, society  Learn from experience – successes and failuresAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 45. Collaboration  Established in 2008  Bringing together a community which is currently fragmented and does not have a single forum for sharing of issues.  Researchers, telehealth practitioners, clinicians, managers and industry partners together in a unique interdisciplinary grouping.Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 46. Australasian Telehealth Society (ATHS) Membership – individual and corporate www.aths.org.au
    • 47. Australasian Telehealth Society (ATHS)  Executive  President – Prof Anthony Maeder (NSW)  Vice President – Jackie Plunkett, NT  Secretary – Laurie Wilson (NSW)  Treasurer – Prof Colin Carati (SA)  Committee  Dr David Allen, Telehealth Solutions (NSW)  Mr Simon Hayden, Vivid Solutions (NZ)  Prof Yogesan (Yogi) Kanagasingam, CSIRO (WA)  Ms Pat Kerr, New Zealand Telehealth Forum (NZ)  Dr George Margelis, Care Innovations (NSW)  A/Prof Anthony Smith, The University of Queensland (QLD)Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 48. Call for PapersAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 49. Global Telehealth  Call for papers -  Submission of Full and Short Papers: Friday 28 July 2012  Notification of acceptance to authors: Friday 25 August 2012  Camera-ready copy for proceedings: Friday 8 September 2012  Author & Early-bird registration deadline: Friday 8 September 2012 WEBSITE: www.aths.org.au/GT2012/Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 50. ??? “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner.”Associate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 51. ??? “That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and the practitioner.” 1834, London TimesAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 52. Conclusions Commonwealth (Medicare) funding for telehealth is welcomed in Australia, but long-term strategies need to be adopted to ensure steady uptake A whole of system approach is essential for the successful integration of telehealth Telehealth requires health services to be re- engineered to maximise the opportunities – change is requiredAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 53. Shared vision Ensure all patients are able to access the highest quality health services in the most efficient manner regardless of locationAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia
    • 54. Dr Anthony SmithAssociate ProfessorDeputy DirectorCentre for Online HealthEmail: asmith@uq.edu.auWeb: www.uq.edu.au/cohAssociate Professor Anthony SmithCentre for Online Health, The University of Queensland, Australia

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