The Australian Telehealth Society’s annual conference “Successes and Failures in Telehealth” has become a must-go for me. By building the term “failures” in they encourage speakers to depart from the standard focus on positive chest-thumping and reflect candidly on the things that have gone wrong. There are plenty of these in this highly-innovative, future-oriented, yet fraught journey bringing 21st century communications technology into this conservative health sector.
This year's conference in Brisbane 12/13 November lived up to expectations.So here’s my take from these past 2 days.
Telehealth is no longer new. However, it remains immature, with a weak evidence base. There’s an increasing number of people, including the 199 at the Conference, working on Telehealth implementations in Australasia, in a diverse range of settings. Some implementations have a geographic base such as an outback community, while others focus on a specific type of patient or sub-set of medicine such as paediatrics, geriatrics or diabetes.
Yet despite this diversity the challenges are remarkably similar - how to make the technology simple enough not to be a barrier to busy clinicians, how to overcome low bandwidth, how to schedule consultations efficiently and deal with time overruns, and how to get doubters across the line. And the biggie - how to grow Telehealth use to a sustainable scale where the economic and health benefits can be measured and the viability proven.
Researchers are everywhere. Students, academics and PHD candidates are all over telehealth, frantically looking for elements to study as they join the practitioners in seeking that elusive evidential proof that a Telehealth project somewhere has actually delivered sustainable benefits. One academic was honest enough to acknowledge that such is the pace of progress, by the time most telehealth research has been completed it is irrelevant.
That’s not to demean the researchers, nor their work. However, it illustrates the frustration many feel that a technological opportunity that the visionaries see as so important with vast potential, is proving so difficult to embed sustainably into work practices and to support with a robust evidential base.Perhaps we need less research, and more marketing of telehealth. Practitioners must get out of our own Telehealth scrum and spread the word externally. We should aim to ensure that no conference, planning session or policy process where the future of health is under discussion is ever without a reminder of its enabling potential.
A marketing strategy must also engage consumers. Telehealth is not just about isolated communities, but about any consumer, wherever we might live, being able to take delivery of appropriate health services any time, any place - just as we routinely do with Internet banking or to arrange our travel. As one speaker noted, there is ample research about the drivers for clinicians to embrace telehealth, but little on the drivers for consumers. One exception is work by Queensland University’s Trevor Russell. This examined predictors of which cohorts of consumers are most likely to embrace Telehealth. The finding was that it had everything to do with their IT literacy but almost nothing to do with their health status, access to transport or location. Interestingly almost every consumer Trevor Russell surveyed perceived that a telehealth appointment should cost them he same as or less than face-to-face, regardless of the underlying cost or the saving in travel.
Australia’s Medicare subsidies need to be updated to recognise better the legitimacy of a telehealth consultation. It seems there are some codes that can be used for claims, but for administrative reasons a lot of Telehealth consults do not result in a Medicare claim even if they qualify. I wonder where New Zealand is at with recognising telehealth in remuneration?
Tele geriatrics came in for a good deal of attention. The aging population and the high needs of this group make it a prime candidate for telehealth, whether the patient is in aged residential care, in the community or elsewhere. Speaker Victoria Wade described primary care for aged residential care facilities as “fundamentally broken”. Assessments of patients newly admitted to aged residential care can take many weeks when family are required to transport the patient to a specialist, but a video assessment can be done inside a week.
Hearing services came under scrutiny. Teleaudiology is being trialled in Queensland for children - (undiagnosed hearing loss in childhood has been shown to lead to poor educational and employment outcomes, and substance abuse) and for senior citizens (hearing services in Australia are in crisis and 80% of older people who need hearing aids don’t get them.)
I got a timely reminder from one speaker of the importance of the telehealth “go to person” – not necessarily an IT specialist, but somebody with the mix of technology aptitude, patience, availability, approachability and communication skills to be on hand for uses at each site. This is highly relevant to my current work in the Pacific.
I've blogged sepatately about an excellent presentation from the Queensland Department of Health.
In all, an excellent experience, thought provoking and well worth the time. Count me in for November 2016 in Auckland.