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Telehealth in Australia:
Emerging Trends and Challenges

     Dr Anthony Smith, Associate Professor
               Deputy Director



         Centre for Online Health
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 colleagues




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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/coh


Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Mud-map (Overview)

    Australia in context
    Examples of telemedicine in Queensland
    Measuring outcomes
    Government investment –Medicare and the NBN
    Success factors
    Collaboration




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 issues




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 Smith
Centre for Online Health, The University of Queensland, Australia
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 uptake



Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Logistical challenges

   Incorporating telehealth into mainstream practice

           Complimentary method of consultation

           Existing referral pathways – or new?

           The complete picture – FTF, outreach, telehealth




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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
Telepaediatrics in Queensland

                            General
                           paediatrics



                                              Sub-
              Home
                                            Specialist
            telehealth
                                            referrals




                         Telepaediatrics



           Indigenous
              health                       Critical care
            screening



                            Neonatal
                            intensive
                               care
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 Smith
Centre for Online Health, The University of Queensland, Australia
Telepaediatrics in Queensland

               14,350 consultations over 12 years
               2400 consultations per y

                2800
                2400
Consultations




                2000
                1600
                1200
                 800
                 400
                    0
                     2000        2002              2004             2006   2008   2010   2012


Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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): 457-460

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 abuse



Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Indigenous health screening


 Indigenous health workers
 Specialist outreach services and telehealth support

                ENT
                Dental
                Dermatology
                Ophthalmology
                Psychiatry
                Respiratory




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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):193-198

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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):193-198

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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   2011

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 hospital




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 - flexible




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Telepaediatrics – Robots

  Telepaediatric robots
  Commenced 2004
  mobile, wireless videoconference systems
     child-friendly
     direct to bedside




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Telepaediatrics – Robots
 2005 – Gladstone Hospital, no paediatrician
      daily ward rounds
      sub-specialist consultations




Smith 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 and
Telecare 2005, 11 (Suppl. 2): 81-5
Tiny Tom -
                   Townsville
  Eliza – Mt Isa
                                ROY – Gladstone




Emma - Emerald
                                 Gypsie – Gympie
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 participate
Usually informal educational opportunities

 Associate Professor Anthony Smith
 Centre for Online Health, The University of Queensland, Australia
Outcomes

         User satisfaction
         Changes in clinical practice
         Accuracy
         Patient outcomes
         Education and training (workforce development)
         Economics




CRICOS Provider No 00025B
Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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): 79-83
Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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): 79-83
Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Telepsychiatry (30 months)

                                                                                               Actual

           800,000                                                                                         Patient
                                                                                                           travel
Cost ($)




                                                                                                        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
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 Smith
Centre for Online Health, The University of Queensland, Australia
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 press

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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.shtml

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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.shtml

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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.shtml

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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.shtml

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 2010/2011




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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   0.06




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 factors




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 satellite




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
National Broadband Network (NBN)




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
National Broadband Network (NBN)

      97% coverage, satellites for the remainder
      Healthcare?
      Telehealth – not NBN dependent, but…
      Opportunities to develop new methods
      Increased reliability, transmission speed




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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): 15-19

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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): 15-19

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 settings
Gray L, Smith AC, Armfield NR, Travers C, Croll P, Caffery L. Assessment of telehealth implementations and associated
requirements (2010). Department of Health and Ageing, Australian Government. Reports available via the MBS Online
website: Telehealth Business Case Advice and Options and Telehealth Assessment Report
Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 failures


Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 Smith
Centre for Online Health, The University of Queensland, Australia
Australasian Telehealth Society (ATHS)

 Membership – individual and corporate
 www.aths.org.au
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 Smith
Centre for Online Health, The University of Queensland, Australia
Call for Papers




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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 Smith
Centre for Online Health, The University of Queensland, Australia
???
     “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 Smith
Centre for Online Health, The University of Queensland, Australia
???
     “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 Times




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
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
  required

Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Shared vision

      Ensure all patients are able to access the
     highest quality health services in the most
       efficient manner regardless of location




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia
Dr Anthony Smith

Associate Professor
Deputy Director
Centre for Online Health

Email: asmith@uq.edu.au
Web: www.uq.edu.au/coh




Associate Professor Anthony Smith
Centre for Online Health, The University of Queensland, Australia

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Telehealth in Australia - Emerging Trends and Challenges

  • 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 colleagues Associate Professor Anthony Smith Centre 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/coh Associate Professor Anthony Smith Centre 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  Collaboration Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 5.
  • 6. 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 issues Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 7. 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 Smith Centre for Online Health, The University of Queensland, Australia
  • 8. 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 uptake Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 9.
  • 10. Logistical challenges  Incorporating telehealth into mainstream practice  Complimentary method of consultation  Existing referral pathways – or new?  The complete picture – FTF, outreach, telehealth Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 11. 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
  • 12. Telepaediatrics in Queensland General paediatrics Sub- Home Specialist telehealth referrals Telepaediatrics Indigenous health Critical care screening Neonatal intensive care
  • 13. 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 Smith Centre for Online Health, The University of Queensland, Australia
  • 14. Telepaediatrics in Queensland  14,350 consultations over 12 years  2400 consultations per y 2800 2400 Consultations 2000 1600 1200 800 400 0 2000 2002 2004 2006 2008 2010 2012 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 15.
  • 16.
  • 17. 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): 457-460 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 18. 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 abuse Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 19. Indigenous health screening  Indigenous health workers  Specialist outreach services and telehealth support  ENT  Dental  Dermatology  Ophthalmology  Psychiatry  Respiratory Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 20.
  • 21. 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):193-198 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 22. 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):193-198 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 23. 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 2011 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 24. 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 hospital Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 25. 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 - flexible Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 26. Telepaediatrics – Robots  Telepaediatric robots  Commenced 2004  mobile, wireless videoconference systems  child-friendly  direct to bedside Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 27. Telepaediatrics – Robots  2005 – Gladstone Hospital, no paediatrician  daily ward rounds  sub-specialist consultations Smith 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 and Telecare 2005, 11 (Suppl. 2): 81-5
  • 28. Tiny Tom - Townsville Eliza – Mt Isa ROY – Gladstone Emma - Emerald Gypsie – Gympie
  • 29.
  • 30. 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 participate Usually informal educational opportunities Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 31.
  • 32.
  • 33.
  • 34. Outcomes  User satisfaction  Changes in clinical practice  Accuracy  Patient outcomes  Education and training (workforce development)  Economics CRICOS Provider No 00025B Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 35. 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): 79-83 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 36. Telepsychiatry 30 months – 606 consultations Method FTF – Patient FTF Outreach – Telemedicine – Patient travel ($) Visiting seen via Psychiatrist ($) videoconference ($) Total cost 514,094 299,913 230,753 Average 1073.25 494.91 380.78 Marginal 1073.25 494.91 190.01 Smith AC, Stathis S, Randell A, Best D, Ryan V, Bergwever E, Keegan F, Fraser E, Scuffham P and Wootton R. A cost-minimisation analysis of a telepaediatric mental health service for patients in rural and remote Queensland. Journal of Telemedicine and Telecare, 2007, 13 (Suppl. 3): 79-83 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 37. Telepsychiatry (30 months) Actual 800,000 Patient travel Cost ($) 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
  • 38. 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 Smith Centre for Online Health, The University of Queensland, Australia
  • 39. 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 press Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 40. 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.shtml Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 41. 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.shtml Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 42. 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.shtml Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 43. 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.shtml Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 44. 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 2010/2011 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 45. 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 0.06 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 46. 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 factors Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 47. 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 satellite Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 48. National Broadband Network (NBN) Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 49. National Broadband Network (NBN)  97% coverage, satellites for the remainder  Healthcare?  Telehealth – not NBN dependent, but…  Opportunities to develop new methods  Increased reliability, transmission speed Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 50. 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): 15-19 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 51. 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): 15-19 Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 52. 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 settings Gray L, Smith AC, Armfield NR, Travers C, Croll P, Caffery L. Assessment of telehealth implementations and associated requirements (2010). Department of Health and Ageing, Australian Government. Reports available via the MBS Online website: Telehealth Business Case Advice and Options and Telehealth Assessment Report Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 53. 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 failures Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 54. 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 Smith Centre for Online Health, The University of Queensland, Australia
  • 55. Australasian Telehealth Society (ATHS)  Membership – individual and corporate  www.aths.org.au
  • 56. 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 Smith Centre for Online Health, The University of Queensland, Australia
  • 57. Call for Papers Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 58. 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 Smith Centre for Online Health, The University of Queensland, Australia
  • 59. ??? “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 Smith Centre for Online Health, The University of Queensland, Australia
  • 60. ??? “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 Times Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 61. 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 required Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 62. Shared vision Ensure all patients are able to access the highest quality health services in the most efficient manner regardless of location Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia
  • 63. Dr Anthony Smith Associate Professor Deputy Director Centre for Online Health Email: asmith@uq.edu.au Web: www.uq.edu.au/coh Associate Professor Anthony Smith Centre for Online Health, The University of Queensland, Australia

Editor's Notes

  1. 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.
  2. 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.
  3. 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.