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Broadband Enabled Rural Health Care
- 1. Pathwaystothefuture Broadband Enabled Rural Health Care Ross McKenna Portfolio Manager, Health System Infrastructure Information Strategy and Architecture National Health Board Business Unit Ministry of Health Rural Broadband Symposium 2009 Distinction Hotel, Rotorua
- 2. BroadbandEnabledRuralHealthcare 2 Key points Rural health care presents some specific challenges Broadband is one component of health service capability – and not just a means to access the internet Broadband can support bringing health services to remote communities
- 3. BroadbandEnabledRuralHealthcare 3 New Zealand’s “Rural” people Rural Urban Urban influence Remote Highly rural/remote areas (53% of land area) = 66,000 Other rural areas = 840,300 Rural with “high urban influence” = 128,000 71% European, 18% Maori Slightly older than Urban On average more children than Urban Maori over 45 – 25% Rural cf.18% Urban High Urban influence, ‘commuter belt’ areas have different work practices and higher population growth
- 4. BroadbandEnabledRuralHealthcare 4 Living the country life.. You are more likely to.. - make an ACC claim - visit outpatients or hospital - visit A&E - have neck/back disorder and less likely to.. The 66,000 in “Highly Rural” areas.. Have lower median personal income– especially for Maori ($16K versus $24K national average 4% have no phone, 51% have Internet access (2006) 4.4% have no access to a vehicle Have higher suicide risk (men) be diagnosed with asthma
- 5. BroadbandEnabledRuralHealthcare 5 Health Sector provider profile Diversity of the Health sector 19% Clinicians and 25% specialists work in more than one DHB area Wide variation in numbers of patients seen/treated per day per clinician 34% sector organisations part of a larger group 34% sole private practices 17% not-for-profit 25% GPs work from multiple locations •Strong agreement across the Sector (94% DHB & 80% Non-DHB clinicians) that improved ICT would help to enhance service delivery - but limited perception of value for money. •Generally consistent view of top 4 priority information types needed electronically Test results Medication informatio n Discharge summaries Referrals High level of technology capability in the sector •93% Clinicians have internet access and use email. •80% Clinicians like to keep up with the latest technology
- 6. BroadbandEnabledRuralHealthcare 6 What driving ICT investment in Health? 13 24 33 37 37 44 47 51 58 63 29 27 30 35 31 31 32 33 28 20 0 20 40 60 80 100% Very important Fairly important Base: All ICT Decision-makers (n=784) How important are each of the following factors to your organisation when deciding to invest in electronic systems and applications? Source: Connected Health Research 2009 Improved access to patient information Reduction in paperwork or manual processing Workflow benefits Savings and increased revenue The need for more information to support better clinical decision-making Savings in medical records transcription and storage Better networking with other groups within the Health Sector e.g. primary or secondary care Possibility of subsidised purchase of systems and applications Mandated requirements Pressure from other health care providers to link to their systems
- 7. BroadbandEnabledRuralHealthcare 7 Rural Health providers Rural clinicians treat slightly more people per day than urban clinicians (23 v 20) and support more consumers per organisation Rural Health Provider issues Technology ‘speed’ and coverage Need for good hospital discharge information (E.g. can’t pop out to the Chemist if script is needed) Access to ICT support services Isolation from peers and specialists – support, training, advice Referring patients to specialists or Hospital – patient travel 34% of rural GPs are planning to leave rural practice within five years (2006)
- 8. BroadbandEnabledRuralHealthcare 8 Addressing the rural challenges of distance, skills and workforce – examples of “emerging” BB enabled services •Emergency medicine On site triage Clinical guidance /support •Wound care •Plastic Surgery follow up •Dermatology assessment/review •Heart disease – monitoring and follow up. Ultrasound imaging •Radiology – peer review •Psychiatry •Geriatrics •Hospice care – video phones •Paediatrics
- 9. BroadbandEnabledRuralHealthcare 9 Expected benefits of UFB for Health are in deployment of: Video based services Greater sharing of electronic health information – improved access and workflow Integrated Family Health Centres Diagnostic Imaging Telecare – home based Shared systems and applications
- 10. BroadbandEnabledRuralHealthcare 10 “Ultra-fast” Broadband and Health In August 09 Cabinet agreed that to take advantage of the UFB investments for Health MoH will work on behalf on clinicians and consumers to ensure that: the priorities for the health sector are understood and that services are, as much as possible, able to be implemented in areas of high need “use of Faster Broadband and the potential for technology enabled improvements in healthcare are a part of every new Integrated Family Health Centre proposal”
- 11. BroadbandEnabledRuralHealthcare 11 Rural broadband policy Most rural hospitals and health care provider sites of significance to rural communities within one kilometre of a rural school connected under the RBI should also be connected to fibre (with funding for the fibre drop cost and any other connection costs being provided from other sources)” Determined on a case-by-case basis by taking into account: the additional cost incurred in connecting the hospital or health site the need and potential benefit to be derived from a fibre connection – particularly in terms of enabling improved primary care services the significance of the hospital or health site to the local community, and the potential benefits that would result from connecting it to fibre the availability of funds (outside of funding for the RBI) to contribute to the fibre drop and connection costs the willingness and ability of the health provider to purchase a fibre-based service.
- 12. BroadbandEnabledRuralHealthcare 12 Linking Broadband investment to health benefits Linked to the Primary Care Implementation Plan – IFHCs. IFHCs as centres supporting the community – enabling provision of services such as: videoconferencing, diagnostic imaging and home based Telecare EOI selection process informing the prioritisation for funding and roll- out of faster broadband to support. Key steps: November 2009, EOIs for participation in BSMC selected to proceed to business case. This will inform decisions around which areas require broadband in the first wave of implementation. By December 2009, proposals from potential LFC co-investors. - Indicate the regions likely to receive the first phase of funding from this initiative. - Ministry of Health will provide advice on the requirements identified from EOI process to align, where possible, any plans for fibre deployment. Early 2010, identify rural schools and therefore which hospitals and health care provider sites outside the 75 percent coverage are able to be connected.
- 13. BroadbandEnabledRuralHealthcare 13 Enabling more effective rural Healthcare – Primary Care and IFHCs Early detection Education Community Medicine Alerts Education Self care Feedback loop Monitoring Electronic consultations Support – care giver/family/whänau Home-based TelecareInternet Internet BROAD BAND Home assessments Electronic consultations Sharing health records Billing/payments Monitoring – 24/7 Support/advice Education •Consults •Tests •Referral & discharge •Systems access •Hosting DR •Share health records Hospital/DHB Peer review Consult Train Share systems & health records Diagnostic Imaging Videoconferencing Other provider sites SECONDARY PRIMARY COMMUNITY
- 14. BroadbandEnabledRuralHealthcare 14 Summary – broadband enabled rural healthcare Removing the isolation of rural health providers - Peer review - Confer/advise/guide - Education - Reduced travel to provide care Being a remote patient… - Electronic consultations - Link to secondary services - Specialists referrals - Diagnostic services – e.g. dermatology, wound care - Enabling remote outpatient clinics - A & E services - Medications Opportunities for broadband to support rural health: Supporting IFHCs as technology “hubs” Shared services; hosting/DR, billing, administration, assessment, referral High definition video; video conferencing, diagnostic imaging
Editor's Notes
- By international comparisons, the New Zealand health sector has a high level of modern technology available[i] and widespread electronic connectivity. However, the quantitative research shows only a small number (16%) of health ICT decision-makers reported ‘excellent’ value from their ICT investments. This response implies that a health user’s experience of what capability ICT typically provides does not translate well to their perception of value (cost/benefit). There appears to be a significant disconnect between the availability of ICT and its productive use in the sector. This response should also be considered in light of the view that ‘inadequate funding’ is considered a barrier to ICT investment. The fact that health ICT is considered expensive is unsurprising given the perceived low value and limited ability to fund its purchase. More than three-quarters (80%) of all clinicians reported that they liked to keep up with the latest technology and three-quarters (78%) of non-DHB clinicians rated themselves as ‘knowledgeable’ about ICT. This result is somewhat at odds with a view that ICT provides little value, but it does indicate openness to adopting ICT if the cost issues can be overcome and business benefit can be clearly identified. The research shows that at least 80% of clinicians agreed (strongly or slightly) better access to health care information could improve the way they provided health services. This belief is further supported by the view of three quarters (74%) of ICT decision-makers, who agreed that improving their organisations use of ICT was a priority. There was general agreement on the top four clinical priorities: diagnostic test results, referrals, discharge summaries and medication information These priorities are not necessarily ranked in this order when broken down to represent ‘sending’ and ‘accessing’ priorities. These differences are generally due to variations in the role and function of the organisations involved, e.g. some GP practices provide blood testing services. There are significant differences between the ‘sending’ figures for DHB and non-DHB clinicians, which could be attributed to Hospital clinicians needing to assess and diagnose patients without the benefit of easy access to their treatment background. Clinicians consistently agreed (67 to 77%) that accessing diagnostic test results was a top priority. The aged-care, DHB clinician and GP segments had the highest levels of interest in accessing this type of information electronically.. A strong interest in accessing other test information relating to a patient creates a greater demand than supply interest in the pathology/ laboratory segment. Clinicians across the board had a high interest in accessing patient referrals (53% to 71%), particularly secondary providers, including DHB clinicians (71%) and specialists (61%) DHB clinicians again see the importance of both accessing (74%) and sending (67%), or ‘sharing’, discharge summaries. Aged care clinicians also rated both sending (71%) and receiving (76%) as important, and were the most likely to have agreed that sending discharge summaries is important. More than half of GPs (65%) want to access discharge summaries, and a significant number say they want to be able to send them (29%). American research suggests this priority reflects the impact that delayed or incomplete discharge communications can have on the safety and quality of follow-up care management. All clinicians had a very high interest in accessing patient medication information. Between 68% and 77% of clinicians agreed that accessing was a priority.
- There is wide agreement that improving the interoperability and integration of health provider systems and databases has the potential to create significant flow-on benefits for the health sector. These benefits include improved access to health services, increased quality of care, and reduced costs. Limited support or direction from other areas of the health sector also emerged as a barrier to accessing information electronically (refer to chart 4). Clinicians agreed that DHBs, other health care providers, and the Ministry of Health had not provided support to the level required. Most non-DHB clinicians (94%) who identified lack of support from the Ministry said lack of support from DHBs was also a barrier. There was a feeling that the Ministry of Health needed to provide better advice and follow up on national initiatives and requirements such as privacy and security and that DHBs could do more to work cooperatively with providers to, for example, support the use of accredited ICT products or services. Just under half of non-DHB clinicians (49%) and DHB clinicians (42%) agreed insufficient support from other health providers was a barrier to accessing information electronically. DHB clinicians were also more concerned about lack of management support (54%) compared with non-DHB clinicians (39%). Given the nature of the health marketplace and diversity of the health sector, there are considerable barriers which ICT vendors and health providers must overcome to capitalise on the opportunities enabled by ICT. The sharing of electronic information is currently dependent on the interoperability and integration of the various systems and databases used to store health care information by different provider organisations, including primary and secondary, public and independent. The need to involve vendors, health agencies and clinical groups in agreeing common approaches to interoperability has led to the increasing membership of organisations focussed on finding common solutions to these issues, such as Integrating the Healthcare Enterprise[i] which has more than 250 member organisations worldwide. The research suggests that the greatest potential for ICT problem solving in the health sector is in improving the capability for specific types of health providers to electronically access and exchange: Diagnostic tests results Patient referrals Discharge summaries Medication information. Both the qualitative and quantitative research show that health providers believed improving capability in these key areas will require leadership from the Ministry of Health and DHBs to drive a co-ordinated approach to addressing system incompatibility issues. The research also implies that if additional costs are involved in improving system interoperability then funds need to be made available – additional to capitation or fee-for-service types of payments. Even with funding available, the implementation of health ICT to facilitate health information ‘liquidity’ will take time. The research shows there is a substantial time delay between health provider organisations making the decision to change and actually implementing the necessary changes. In addition to the implementation of the new ICT capability, updated process and procedures to utilise the additional capability are required and must be integrated into each organisation involved. The health sector also wants more guidance and support on how to appropriately deal with patient-identifiable information if the flow of electronic health information is to be improved significantly. The research indicates the issue is not so much the lack of legislation or regulation, but the need for a wider understanding on what is appropriate to share and what controls should be applied. The research shows there is significant scope and an overall willingness from health providers to implement health ICT initiatives to improve information exchange in the sector. Clinicians and ICT decisions-makers surveyed showed a belief that improving electronic information flows presented significant potential to support better quality of health care to New Zealanders. There was general agreement on the barriers that need to be overcome and that the benefits are significant. Making the priority areas of information available when and where they are needed will require a co-ordinated approach across the health sector involving funders, providers, vendors, decision-makers and clinicians. Involving clinicians in the planning of health care and enabling them to make decisions at the closest point of contact with the patient are important Government priorities