Its been another really interesting day in Melbourne. Rather than write up each session in turn, I’ll focus on my three key takeaway messages which I’ll call Leadership, Terminology, and Scope.
A consistent plea has been for those attending to designate ourselves as leaders in health service delivery reform and assume a collective mission to drive a telehealth-led sea change for the future.
But I’m not convinced that a pack of committed disciples, however large, can achieve this. There are some major hurdles.
One speaker crystallised the dichotomy for me. In one breath he called for telehealth to be addressed not in isolation, but as a beachhead for sweeping change across every element of health service delivery. Then a few minutes later he urged that anything the government or others did to guide or enforce standardisation should be a “very light touch.”
That’s the dilemma. We all understand the drive for change – the status quo is unsustainable. But to achieve the sea change required needs more than a bunch of devotees each leading in directions that are vaguely similar. It will require one person or entity with vision, authority and knowledge to lead from the front, being prepared to drive the changes through even if not every element is absolutely optimal at the outset.The alternative may be counter-productive anarchy.
Imagine a large orchestra performing to a cast of millions. Midway through the first item the conductor falls ill and cannot continue. The word goes out to the orchestra that they are to decide amongst themselves which numbers to play and how to play them for the rest of the evening. They must keep the show going while they decide. Each section of the orchestra naturally wants to focus on the numbers that best fit its instruments. There are varying views on keys, tempo, and the transitions between numbers. Nobody is in charge. The result – in the absence of clear leadership and direction they continue playing their opening number for the rest of the night - not quite the outcome the audience might have wished for!
So it might be with health.
So who is best placed to take the lead? Those who hold the purse strings, I say - governments, DHBs, PHOs and the like. As the sector comes to recognise that the payment structure is being progressively retuned to reward those who deploy innovative communication tools, change will follow.
Its nice when change can happen through evolving consensus, but its sometimes unrealistic. In this case decisive leadership is needed. Otherwise the same old health tune will haunt us all for a lifetime.
Last weekend speaking to the Rural GP Network conference in Wellington, I floated the idea that the word “telehealth” is anachronistic and is holding back the changes we all want to see. Being a derivative of “telecommunications” it is yesterday’s word – a boring 19th or 20th century term being used to explain an exciting 21st century vision. It’s not working.
This came to me a few weeks ago. I watched the reaction of the citizens of Matakana Island as I tried to explain “telehealth” to them. Their eyes glazed over. But when I went on to talk about the “video doctor service” or “video consultations” they got it instantly.
Today, on impulse in one of the question sessions, I raised the notion again. It was well received. Not only did several people agree with me in the break, but the conference chair supported the idea in his closing summary.
ICT-enabled banking services have many manifestations – ATM machines, Internet banking, call centres and EFTPOS. We don’t group them all under a single term like “telebanking”. Similarly we should break down telehealth into video consultations, video education, remote monitoring, ambient assisted care and the rest. “Telehealth” as a descriptor has had its day.
Finally, I realised today what a huge range of video doctor and remote monitoring initiatives are alive and kicking in Australia. Just about every subset of medicine is the subject of a trial, implementation or (dare I say) pilot somewhere in this country. I have a lot of notes and when I have time will compile a list.
Australia is better positioned than I realised even yesterday. At some stage these will all meld together into a movement of real value.Whatever we are going to call them, health services enabled by communication technologies are poised to make big strides in the coming years. They had better. The survival of good quality health care depends on them.