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Prof. Colin Carati, Flinders University - Impact of the NBN on eHealth in Australia
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Prof. Colin Carati, Flinders University - Impact of the NBN on eHealth in Australia

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Professor Colin Carati, Executive Director (ICT Strategy and Integration), CIO: Office of the Pro Vice-Chancellor (Information Services) and Associate Head of ICT: Faculty of Health Sciences, Flinders …

Professor Colin Carati, Executive Director (ICT Strategy and Integration), CIO: Office of the Pro Vice-Chancellor (Information Services) and Associate Head of ICT: Faculty of Health Sciences, Flinders University presented "Impact of the NBN on eHealth in Australia" at Connected Australia 2013.

This conference is designed to help organisiations harness the opportunities that super-fast broadband will create, and explores the future impact of the NBN through the healthcare, education and consumer industries.

For more information, please visit the conference website: http://www.connectedaustralia.com.au/2013

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  • 1. Impact of the NBN on eHealth in Australia Colin Carati
  • 2. e-Health is ….. ‘the combined use of electronic communication and information technology in the health sector’ (WHO) • electronic health records • digital information flow in healthcare • telehealth, remote monitoring and videoconferencing • “participatory” health
  • 3. NBN will accelerate development of eHealth …… ……. and shift the focus of healthcare from institutions and healthcare sites into the community ……. but how ?
  • 4. 1. observations so far 2. challenges along the way 3. next steps ?
  • 5. national ehealth strategies and programs • National eHealth Strategy 2009 • NEHTA - PCeHR, eFoundations including standards, interoperability, security and access, health identifiers and clinical terminology • National Digital Economy Strategy 2011 (updated 2013) - Health and Ageing Goal • Medicare Benefit Scheme Online – payments for certain Telehealth consultations • NBN enabled ehealth / TeleHealth projects state and territory ehealth strategies and programs commercial sector / private practitioner developments
  • 6. National eHealth Strategy 2009 “….E-Health is the means of ensuring that the right health information is provided to the right person at the right place and time in a secure, electronic form for the purpose of optimising the quality and efficiency of health care delivery ….. E-Health should be viewed as both the essential infrastructure underpinning information exchange between all participants in the Australian health care system and as a key enabler and driver of improved health outcomes for all Australians. “
  • 7. could something like the NBN enhance healthcare through ehealth ? • evidence from international and national trials • evidence from “NBN – enabled” trials in Australia • evidence from jurisdictional (State / Territory) trials and programs • evidence from professional uptake / commercial development
  • 8. do you need the NBN for ehealth ? health ‘networks’ OK at institutional level, but poor reach into the broader community • NBN improves community level access, including to the home, • allows greater proportion of healthcare to be pushed out into community settings • NBN improves rural and remote access (via wider rural and remote distribution and satellite and wireless services)
  • 9. do you need that much bandwidth ? depends on what you are trying to achieve • some eHealth solutions can operate on existing technology (ADSL, 3 or 4G) • BUT ….. increasing the bandwidth improves the service and permits more to be done
  • 10. Palliative care / rehab / aging at home • health status monitored at home via questionnaires on iPad – deterioration triggers alerts • rehab / activity levels monitored in home • videoconferencing – regular and ‘on demand’ • capacity to bring in carers, specialists and GPs (case conferencing)
  • 11. relatively low cost, low bandwidth (up to 1 mb/s) solutions can be very effective, but …. • poor quality and reliability of service (increasing bandwidth reduces contention) • useful upload speeds become important, especially for videoconferencing • successful service leads to requests for more options and increased scope leading to demands for more bandwidth !!
  • 12. bandwidth requirements escalate with multi-residential dwellings video, video , video = bandwidth, bandwidth, bandwidth http://www.telemedcare.com.au more comprehensive home monitoring increases bandwidth requirements with increasingly instrumented homes eg in dementia care
  • 13. video is becoming more prevalent visual cues are critical to human communication, and to health care • visual assessment • establishes a more direct and deeper relationship - even silences have meaning • provides a sense of the environment • stronger commitment to actions
  • 14. reproduced with permission from Chris Ryan, Attend Anywhere
  • 15. reproduced with permission from Chris Ryan, Attend Anywhere
  • 16. so, …. • current evidence is that ehealth does enhance healthcare, and has great potential • NBN will improve community access, especially to the home, and push healthcare towards primary care • bandwidth demands are likely to increase
  • 17. 2. challenges along the way – its not as easy as it looks !! • NBN rollout schedule • mainly organisational, rather than technical • digital literacy
  • 18. fragmentation • different approaches taken by institutions, private practitioners and commercial suppliers • growth has been ‘organic’ and opportunistic – “pilotitis” • trials ‘bolted on’ rather than through reengineering work practices
  • 19. despite good evidence for value of telehealth, uptake has been slow ….. because it involves complex change management, new models of care and new business models “Telehealth is a good example of a complex innovation; it changes – – – – the way in which health care providers work. referral patterns, clinical pathways and the patient journey. professional roles: who does what aspects of the clinical work. the type, frequency and nature of communication between health care providers.” [and the recipients and community] V Wade, How to Make TeleHealth Work http://www.e-unicare.com.au/
  • 20. interoperability and security • jurisdictional networks secure within States / Territories but not always well connected with other states, private practice, community, businesses, homes • security / privacy not always adequately addressed • operational standards are still being addressed
  • 21. digital literacy and the digital divide • implementation of eHealth requires – upskilling of health care professionals – upskilling of many healthcare recipients, especially elderly and vulnerable – making things simple – access to affordable technology • the digital divide is reducing, but how will digital literacy / access affect health care ?
  • 22. 3. next steps ?
  • 23. “ADVANCING AUSTRALIA AS A DIGITAL ECONOMY 2013” HEALTH AND AGED CARE (Labour Govt, 2013) Action 16. Consider the expansion of the Medicare Benefits Schedule for telehealth items - costs and benefits to be reviewed in 2013 ? Action 17. Evaluate outcomes from telehealth trials and develop action plans to address key challenges - during 2014-15, the Government will evaluate the current telehealth trials, share trial findings and lessons with the healthcare community, and use the findings to develop action plans to address key telehealth issues. Action 18. Implement video consultations for the after-hours GP Helpline and the Pregnancy, Birth and Baby Helpline – phased in over 2013 Action 19. Support increased use of digital platforms to provide aged care services The Government will introduce a range of reforms such as: > revision of relevant aged care program guidelines to recognise and encourage the use of innovative and digital delivery options for the provision of aged care services > expansion of the Community Visitors Scheme into home care including through the use of technology > launch the My Aged Care website to provide coordinated information for aged care services.
  • 24. www.aths.org.au KS1: focus on national priority groups KS2: apply ‘fit for purpose’ models KS3: optimise the locus of implementation
  • 25. KS1: focus on national priority groups • aged care • poorly mobile / disabled • outer metropolitan, rural and remote
  • 26. KS2: apply ‘fit for purpose’ models develop technical, business and financial models that support clinical change by • being sustainable and scalable • working across multiple providers / funders / jurisdictions • being demonstrably ‘fit for purpose’.
  • 27. KS3: optimise the locus of implementation by focussing on; • appropriate vehicle for encouraging primary / team based implementation (State based services, Medicare Locals ?) • clinical pathways and use cases for specific health care disciplines. • identifying demand, enablers and barriers for uptake by consumers.
  • 28. conclusions - leveraging the NBN : • will accelerate development of e-Health • will shift the focus of healthcare from institutions towards primary care and into the community • will be improved by nationally coordinated strategies and implementation • requires sound business models and careful change management
  • 29. National eHealth Strategy 2009 The World Health Organisation defines E-Health as ‘the combined use of electronic communication and information technology in the health sector.’ ….. ….E-Health is the means of ensuring that the right health information is provided to the right person at the right place and time in a secure, electronic form for the purpose of optimising the quality and efficiency of health care delivery ….. E-Health should be viewed as both the essential infrastructure underpinning information exchange between all participants in the Australian health care system and as a key enabler and driver of improved health outcomes for all Australians.
  • 30. Telehealth in the Home: Palliative Care, Aged Care and Clinical Rehabilitation in SA Michael Kidd, Maria Crotty, Jen Tieman,, Kate Swetenham, Alan Taylor, Colin Carati, Craig Whitehead, David Currow, Dr Sarah Mahoney, Tom Symonds Funded by the Australian Government under the National Broadband Network (NBN) Enabled Telehealth Pilots Program’
  • 31. Project Partners: Flinders University South Australian Local Health Networks (Palliative Care, Aged Care and Rehabilitation), Country Health SA Southern GP groups, ACH
  • 32. Three clinical streams • Palliative care: Integration of online tools, remote monitoring, information and resources and regular online communication to support homebased patients and their carers. • Aged: Video conferencing to support clinical care in RACF. • Rehabilitation in the elderly: Introduction of e-rehab including online tools, information provision and communication to support home-based rehabilitation services for the elderly, including people recovering from stroke or fractures.
  • 33. National eHealth Strategy 2009 “National broadband services – A key foundation of the national health information highway will be access to national broadband services that provide connectivity between all Australian care providers. ……… ……. As part of this process, there should be a focus on ensuring that national communications infrastructure will be fit for E-Health use and is priced in a manner that does not discourage the sharing of health information across geographic and health sector boundaries.”

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