It’s ehealth week in Australia with the annual Health Informatics Conference in Brisbane starting today, and yesterday the Australian General Practice Network Ehealth conference on Monday with a range of other events including the Nursing Informatics Association amongst others. I was asked to present to the AGPN forum on innovations in telehealth. Before me Fionna Granger from the Department of Health and Ageing spoke about their program. For those of you who don’t know Australia recently launched a $600M+ initiative to reimburse specialists and some other healthcare providers to use telehealth. It was an exciting initiative, although I have to admit it does have some limitations. But, as the say the first step is the hardest, and Australia has taken that first step, so we need to be thankful for all blessings.
Below is the script I had prepared for my AGPN presentation. As always I did change it a bit on the day, but the basic message stays the same. The innovation we need in telehealth is not in devices, but rather in models of care, education and policy. However we can’t forget the technology, and we have to avoid the temptation of picking a shining new proprietary video conferencing tool when we now that industry standard PC technology can provide us with a solution we can use today, and that can grow with us in the future.
I have been asked to talk about innovations in telehealth. I guess I am credentialed to talk about that, having spent the last 6 years at Intel, one of the world’s largest technology companies, and the last 30 years neck deep in ehealth and technology. My first foray was in 1981 when I was writing clinical applications for the Apple II at the UNSW, and I won’t bore you with the rest of my history.
There is a cliché that is being bandied around a lot now, and it says that it is not about the technology, but more about the culture, and the change management, and the people and so on. Let me start off by saying that I both agree and disagree with that statement. I disagree, because seriously, if you get the technology wrong then you are paddling upstream big time to try and get anything to work. Those of us who bought BETA video recorders will know about that. The technology is critical, and it needs to be an open platform, not a closed proprietary solution, otherwise you will be finding yourself in a few years trying to flog off devices you paid thousands for today on EBAY for a few bucks, or more likely as I have recently done, put them outside for the council clean up. Today, with the government about to hand out $6000 to doctors to get set up for telemedicine consults, you need to seriously consider your technology purchases.
Having said that, there is no shortfall of innovation in telehealth technology, and I don’t want to speak to you today about the latest and greatest gadget, because tomorrow there will be a better one. What I want to talk about is the needed innovation in telehealth, and to me that comes in three areas.
Clinical Models of Care
Telehealth is a very broad term, and I prefer the concept of Virtual Care, i.e. providing care, something we as clinicians are the experts in, to people who are not sitting in our rooms, or in the hospital bed to which we are standing next too. Delivering care when we are physically not there. We have seen that from July 1 this year there is some reimbursement around video consultations, which is a good step forward. But if all we do is replace the current system of delivering care, one person at a time to a strict calendar based on 15 minutes consultations, then we have really failed to understand the power of the technology we now have at our disposal. What we need to do is look at the way we actually deliver care and adapt it to the power of the technology solutions we now have available. Let me give you an example. Today we manage our diabetics by having them see us on a fairly regular basis, often booked weeks in advance, where we evaluate their status, determine whether we need to change their medications, ask them a few questions, and if need be refer them for some further evaluation. What if we could use the technology to track their progress automatically, looks for any relevant changes and be notified of them, respond in near real time to any issues they face, be alerted of any issues with their medications, their management or their personal status in such a way that we could provide them with the service they need when and where they need it, without necessarily having to change how we currently work. Even better, imagine if we could do this and still get paid, not have irate patients sitting in our waiting room for hours, and cut our own expenses in running our surgeries by 50%? This is the innovation we need in new clinical models of care based on continuous management of populations at risk. The chronic disease epidemic we keep hearing about, the silver tsunami of ageing. If we develop clinical models of care designed to take advantage of available technology, ranging from the phone in our pockets, to the analytical capability of supercomputers to identify trends and respond to them, we have an opportunity to improve the quality of life of our patients, manage the increasing costs of healthcare, and also make our lives better and more productive, and we may even be able to get back to working reasonable working hours.
Second is the issue of education. Telehealth, ehealth, clinical informatics, call it what you like is not taught to clinicians today well. Geek doctors like me are basically self-taught, and that means that in reality we just don’t know what we don’t know. We are well intentioned, we make the young guys at Dick Smith a fortune in commissions as we buy every new gadget that comes along to experiment with, but we do not have a structured evidence based education on how to best use this technology to deliver health outcomes. That needs to change, the same way we are taught how to use a stethoscope to listen to heart sounds we need to be educated on how to use technology to do a better job delivering and documenting healthcare.
Finally, policy. The Department of Health and Ageing has an ehealth branch, we have NEHTA, and now we have the Department of Broadband playing in healthcare. However we have very few if any medical practitioners, with the obvious exception of our good friend Mukesh and his merry band of doctors, really driving policy. We need more involvement in driving policy around reimbursement, quality standards, adoption practices and the various issues we face in the use of technology in healthcare. Be it through consultation, or I believe just empowering us to make our own decisions without the requisite red tape and paper work we continue to face, policy innovation is critical.
So to summarise, the technology is important so don’t paint yourself into a corner with limited scope solutions, open up the world of innovation by sticking to flexible solutions that can expand with your practice. To be blunt, don’t buy a dedicated proprietary piece of video conferencing technology to get your $6000, rather get an open standards high powered PC that will enable you to take advantage of the advances in software that await us. Then drive innovation by thinking differently about how you deliver care, and can do more of it virtually, get yourself the right education, and events like this are a great start, and finally let your politicians know that we really are good smart people so let us deliver the best healthcare we can with the technology without them telling us how to do it.