Telehealth

Through the UVA Center for Telehealth, the organization will also develop training courses for healthcare providers that help them identify and treat chronic diseases.

With an evolving healthcare tech environment and changing consumer needs, Australia has to rethink the way it approaches telehealth and remote care, a major healthcare conference has heard. Speaking during a panel session at the recent AFR Healthcare Summit, Royal Australian College of General Practitioners (RACGP) President Dr Harry Nespolon said the way remote healthcare and telehealth is offered has changed little since the 1960s. “Doctors still need to see patients in front of them to dispense care. It hasn’t changed much over the last 50 years. I used to work for the AMA [Australian Medical Association] and my boss once said, ‘fish and chips shops today have more technology than most GPs’. There is still some truth in that,” he said. NSW Health Secretary Elizabeth Koff addressed the need for industry, governments and patients to grasp the concept of new-age telehealth and remote care as virtual care delivery models see traditional provider-patient interactions evolve. “Not everyone universally understands what we’re trying to achieve with telehealth. It’s not just about providing face-to-face communication in an effectively and timely manner in rural and remote Australia,” she said. “It’s also about data and information exchange that we can do in a systematic way to enhance patient care.” According to Silver Chain CEO Dale Fisher, consumers are ready and asking for changes to how remote care is offered, but there are some setbacks. “Consumers are directing the future of care and are asking for changes to how remote care is offered. The policies exist, but there needs to be funding flow from governments to support those policies,” she said. “The funding needs to flow into innovative programs that consumers are asking for. Digital disruption and innovation has already happened. What we haven’t done as a health system is adapt and take advantage of the digital revolution.” Nespolon agreed, adding that general practice needs to be freed from its current regulatory and financial constraints and that’s something that needs to be worked towards. “Medicare and Medibank were set up as face-to-face systems and they still are face-to-face systems. Over the years, successive governments have credibly tried to resist the idea of breaking that nexus. That is about to change and both the potential governments are interested in delivering on what consumers want, which is the ability to access their healthcare in a variety of ways depending on their needs.” [Read more: We need to get the digital basics right and quickly: Tim Kelsey | The promise of NBN is not being delivered in the bush: RFDS CEO] Royal Flying Doctor Service of Australia (RFDS) CEO Dr Martin Laverty said telehealth is part of the organisation’s DNA, but part of the challenge it faces is that the latest technologies don’t work without proper broadband coverage. “If the pipe doesn’t deliver broadband into remote areas, the devices aren’t going to work. The promise of recent times, for high-speed broadband into the bush is not yet clinically-grade reliable. And until this happens, we’re going to be held back in our next investment.” SECURING THE NUTS AND BOLTS IN HEALTHCARE Koff said having an agile system in place would enable interoperability, allowing care at a local district level or hospital level be fully integrated with primary care and other services. “The issue around digital enablement and being agile is something health is not known for. And that’s something we struggle with at a system manager level. Whilst we’re keen to have the architecture right, we need interoperability so it can be integrated,” she said. According to Laverty, some of the challenges of telehealth will be eradicated with the next layers of development in broadband delivery. “The problem has not been solved with the existing satellite and mobile reach of broadband connectivity. That's the difference between consumer and clinical grade. We haven't achieved clinical grade, even if we've got patchy consumer-grade broadband access across remote areas today.” Fisher said in the lead-up to a working virtual hospital system, industry needs to be designing innovative programs in partnership with other organisations. “Rather than worrying about where the money comes from, we need to invest in our organisations to bring siloed parts of our operations together to demonstrate that there is a new way of doing things to deliver good care,” she said. Nespolon concluded the session by saying that a barrier isn’t necessarily technology, but rather, people. “You can’t force technology on to people. It’s whether people want to use it and how they use it. For example, electronic health records have the potential to do great things, but hasn’t taken people all the way through. A more gentler approach is necessary in getting this message across,” he said. [Read more: What are the barriers to widespread telehealth adoption? | The Australian health system “will fail” if the pace of change is not met: KPMG] Carelink Managing Director Craig Porte, who spoke at a separate session during the summit, said there is still a heavy reliance in traditional delivery models of care in rural areas of Australia, resulting in an unequal distribution of benefits. “Interoperability, unreliable internet, a lack of offline solutions and investments are only some of the problems in remote Australia. There are plenty of amazing technologies that work out there, but for true remote care, they all need to be connected,” he said. “Face-to-face care is still necessary in rural and remote Australia. Interoperability – offline and online systems working together seamlessly –  is key. AI will play a role going forward too; simple things like driverless cars will be essential in delivering remote care. Mobile solutions delivering care to the home will also need to become more mainstream. “But we have to keep in mind that technology is only an enabler in keeping people in their communities. Our challenge, as an industry, is to take the next leap in delivering true remote care.”

The market size of blockchain technology in healthcare is set to grow from US$6.9 million in 2018 to US$1.6 billion by 2025, supported by advancements in digitised healthcare systems and an increasing risk of counterfeit drugs, according to new research. Australia has been one of the countries to lead the way in the use of the technology as the International Organisation for Standardisation (ISO) approved the Australian blockchain standards development proposal submitted by Standards Australia in 2016. This led to a boom in consumer-focused blockchain projects soon after. In the lead up to 2025 the report, by market research and strategy consulting firm Global Market Insights, expects the use of blockchain to grow by 65.6 per cent globally. With the increasing number of healthcare organisations adopting Electronic Health Records (EHRs), leading to advancements in digitising healthcare systems, the report said there is a demand for blockchain to safeguard data. In addition, as healthcare data breaches costs around US$380 per patient record, the use of blockchain is also expected to help healthcare organisations save these costs in the event of a breach. “Around 40 per cent of healthcare data records consist of several misleading information and errors. Many of the healthcare facilities are still dependent on old and outdated systems for keeping patient records,” the report identified. “The growing digitisation in healthcare systems has also resulted in high demand for interoperability. The application of blockchain such as eliminating fraud, reducing delays from paperwork, improving inventory management, minimising courier costs, increasing consumer and partner trust and identifying issues more rapidly will help boost industry growth in future.” SOLVING OTHER PROBLEMS The increasing risk of counterfeit drugs is expected to spur the growth of blockchain technology in healthcare. In the last few years, there has been a rise in the number of counterfeit drugs globally, killing an estimated one million people, according to the report. “According to the World Health Organization (WHO), around 10 per cent of the medicines across the globe are counterfeit. Also, as per the Organization for Economic Co-operation and Development (OECD), the counterfeit pharmaceutical industry amounts up to US$200 billion,” the report addressed. Blockchain is expected to solve this challenge as it has several application in securing vast data, decentralisation, immutable record-keeping and by tracking drug movements. The report said blockchain will turn the “high annual losses” from counterfeit drugs on their heads, helping healthcare save “billions of dollars” and drive business growth in the forthcoming years. [Read more: Is blockchain feasible for the healthcare sector? | Artificial intelligence and blockchain: an easy pill to swallow] The amount of risk involved and unpredictability of clinical trials is another driver for implementing blockchain in healthcare, according to the report. “Blockchain in clinical trials use distributed computer network platform that helps databases to be secure and safe from infringements and hackers. The safe and secure platform of blockchain will help store and process valuable information of clinical trials resulting in smooth workflow thereby, influencing the market growth positively,” it indicated. In addition, the report found that the growing application of the Internet of Things (IoT) in healthcare will result in huge demand and adoption rate of blockchain technology. “Most of the leading players are using blockchain and IoT to improve patient results and optimise internal operations. Several benefits such as real-time information and location of digital X-ray equipment in healthcare facilities will augment the blockchain demand across the globe,” the report stated. “Increase in use of IoT for clinical services and clinical settings will boost the business growth in the forthcoming years.” However, the lack of skilled workforce will be one the major factors responsible for impeding the growth of blockchain technology in healthcare market in the near future. “Limited number of people with blockchain technology knowledge and lack of blockchain training, programs and courses will result in sluggish business growth,” it reported. A Deloitte survey of Australia’s regulators, incumbents, government, and technology community found that 90 per cent of people still don’t understand how use cases around blockchain will work. TIBCO Global CTO Nelson Petracek recently told HITNA that Australia still has a long way to go to realise its full potential. “Countries like Estonia are setting the bar with an increasing number of national services opting to use blockchain to carry out transactions. However, the technology remains in comparative infancy in Australia,” he said previously. “The relatively slow uptake of the technology is further fueled by the recent declaration from the Australian Government’s Digital Transformation Agency (DTA) that, while the technology has potential, it still requires compelling evidence that blockchain can deliver better value for government services. “In addition to concerns about the security of digital records, many Australians are also frustrated by the cost of private healthcare, the time it takes to process claims, and the changeability of their insurance cover,” he added. Tiani GmbH Italy IT Security Architect Dr Massimilliano Masi also spoke about how blockchain is not fit for purpose for healthcare IT. He said blockchain could be good in facilitating monetisation and payments, but it has not reached the maturity levels to tackle interoperability within the healthcare sector. “Interoperability is key in establishing sustainable health IT services and is not achieved by only using standards. But many blockchain projects do not tackle interoperability, enabling vendor lock-in. The cryptography of blockchain remains tamperproof, leaving IT security still vulnerable,” he said previously. “The problem with vendor lock-in is that when a customer is dependent on a vendor for products, it is unable to use another vendor without substantial switching costs and risks, resulting in no component continuum.”

A backlogged queue of eye center patients, most for diabetic screenings, dropped from 14,000 to 3,000 within a year of implementation of the technology.

The tablets pair with disease specific Bluetooth biometric devices, allowing patients to take their blood pressure, weight and heart rate.

NBN Co needs to do more in the delivery of broadband services to the bush, especially as broadband shortfalls still massively limit the care rural patients receive, according to the Royal Flying Doctor Service of Australia CEO Dr Martin Laverty. Laverty told HITNA that whilst NBN Co and other platforms have broadband access in the bush and serve some areas, they “simply don't serve everywhere”. “The perception is that, because we've got NBN, it works everywhere. You can’t just tie two tin cans together with a bit of string. Even satellite connections to the NBN are not yet reliable enough for our clinicians to have confidence in supervising patients or supervising other clinicians in the field from a base location,” he said. As the Royal Flying Doctor Service of Australia (RFDS) provides emergency and primary health care services for those living in rural, remote and regional areas of Australia, Laverty said a clinical-grade reliability of broadband is necessary for the organisation to properly utilise telehealth around the nation. RFDS currently uses broadband where available in country Australia for delivering telehealth, managing patient records and keeping medical teams in contact with patients, hospitals, and back-to-base operations. “There’s a difference between consumer and clinical-grade. For Netflix, for example, if it’s interrupted, it's inconvenient. But if a surgical procedure is interrupted, it's life or death. We haven't achieved clinical-grade, even if we've got patchy consumer-grade broadband access across remote areas today,” Laverty said. “In remote Australia, it's not even possible to have a fully functional electronic medical record (EMR) when you don't have a fully functional broadband system. “We’ve got a Band-aid around our EMR at present. We download records, we fly them out to location and manage them there. They're manually uploaded when we get back because that’s when we get access to broadband and cloud systems. If the pipe doesn't work between city and bush, you don't have information flowing through it, therefore, you don't have a functional EMR,” he said. In 2017, RFDS and NBN Co inked a partnership to have 300 of its remote area clinics and 24 RFDS bases, which previously had limited internet connectivity, benefit from broadband supplied by Sky Muster satellites. In addition, 14 remote RFDS clinics were expected to use telehealth services as a result of this partnership, allowing patients to video conference with RFDS’ clinicians. However, the demand for remote services is high, with an RFDS report identifying that one in six remote patients are waiting at least two days to see a doctor for urgent medical care. “We’re a healthcare organisation, not a broadband provider. We just want it to work. We don't have the tech expertise to be specific about what we need. We just know it doesn't work today, and we're looking to the suppliers to deliver it soon,” Laverty said. [Read more: Federal Government Budget sweetener to boost Flying Doctors services and new mental health outreach | EMRs and the Royal Flying Doctor Service – how the iconic institution approaches innovation] According to Laverty, the next layers of development in broadband delivery will solve the clinical-grade reliability challenge that currently exists with the existing satellite and mobile reach of broadband connectivity. “We're heading in that direction and when NBN gets there, it changes the dynamic, particularly as artificial intelligence is likely to jump ahead and make telehealth even more customer-responsive. But you've got to have the nuts and bolts in place – the broadband has got to work before you can even think about a greater reliance on telehealth,” he said. “With the last few hundred miles' connectivity issue, we’ll be able to deliver the pipe into remote areas. The worst thing we could do would be to invest in the hardware or the training of clinicians and patients and for the pipe to continue to be too thin or incomplete because we wouldn't be delivering the point-of-care health outcomes.” Laverty also said that only with NBN efficiencies and upgrades is the RFDS able to deliver on some of its future goals. “When the pipe is fixed, we'll add more to [our services]. We've had a telehealth infrastructure that has evolved over 90 years, and it's going to continue to evolve as the capacity of broadband doing more is proven,” he said. “Our barrier to future expansion is broadband reliability in remote areas at a clinical-grade level. And when it gets to that level, we will have less reliance on telephone. And as we shift to broadband, we're able to put more share of diagnostic information from patient to clinician, making RFDS more reliable. “Today, we can't do that because we can't trust broadband to be at this efficient bandwidth 24 hours a day. When it gets to that, we will invest more and be able to deliver more,” he added. An NBN Co spokesperson told HITNA that the company is "committed to regional and remote Australia and helping to ensure the NBN network enables social and economic prosperity" in these regions. "Our team is currently working with retailers to launch a new business-grade satellite service, which will be available later this year. The service is designed for businesses with complex networking requirements including wide-area network connections to multiple locations and those requiring more broadband data, higher speeds and business-grade service levels," the spokesperson said. 

Telehealth helps providers deliver better child care and treatment, says Cloe Benz, senior physiotherapist at Sydney Children's Hospitals Network.

Australian homes currently have an average of 17 connected devices, including smartphones, tablets, watches, TVs, wearable devices and even connected fridges. And with Schneider Electric Smart Home Spaces Director Ben Green predicting that this number is going to rise to 37 connected devices per household by 2021, the potential of these devices is huge. While the majority of these devices are currently used for safety – such as security systems, energy monitoring or comfort management like blinds, lighting and heating – we are slowly seeing a rise in connected health devices enter the home, either as direct clinical tools such as blood pressure cuffs, or secondary use devices that collect data and provide better insights into a patient’s activities and needs. In addition, the proliferating number of mobile health apps in the market supports future potential. In 2017 alone, there were more than 325,000 mobile health apps available, with that number set to rise. Patients use these mobile health apps to understand and manage their health needs, be it for their general wellness or managing specific diseases, or for operational purposes such as managing their health insurance or provider specific services. Clinicians are also increasingly looking to use these applications to support clinical care delivery or general work process efficiencies. As such, it’s becoming an increasingly crowded marketplace to attract and retain the attention of potential customers and investors. The commercial players who have long been exposed to the market forces of changing consumer demands and expectations understand the value of strong design. To stand out, as well as deliver a great product or service and a smooth experience for users requires commitment and use of design. THE CHALLENGE Many health organisations and senior leaders within healthcare still think of design as the ‘colouring-in’ department – a nice to have if they’ve got some extra money. Yet it’s prevalent, in an increasingly competitive commercial space, that the organisations that prioritise and include design from the outset emerge as the leaders. In Australia, when speaking to stakeholders across the sector, sentiments that the healthcare industry struggles to translate health and medical research output into commercially viable, scalable and usable solutions still exist. There are, of course, some brilliant exceptions. Companies such as Blamey Saunders, ResMed, Attend Anywhere, DoseMe and Seer Medical have led the way. While we have seen the emergence of many incubators and startup hubs, only one, ANDHealth, has developed specific programs that enable digital health innovators to create commercially scalable, successful companies on a global level. Collaborative research centres (CRCs), innovation hubs and accelerators have also been a core part of the innovation landscape in Australia, as they partner industry with academia to encourage the translation of research into commercially viable, scalable solutions. But even then, the role of design in enabling innovation is yet to be fully realised. Many research grant recipients face challenges when trying to incorporate design into the planning and development of their activities. In many cases, the grant stipulates that funds cannot be spent on design or commercial advice and support services. This leads to poorly designed and difficult to use products and services being developed and used in trials or other research initiatives. This may create a number of risks not only for the insights generated by the trial, but also in the ability to translate the research into market ready solutions. Many are also aware of the 1:10:100 rule in terms of costs escalating – that $1 spent on prevention will save $10 on correction and $100 on failure costs. This applies to the chain in healthcare. As one moves along the stream of events, from design to delivery, the cost of errors escalate and failure costs becomes greater. BENEFITS AND WHAT'S REQUIRED TO SUCCEED? Design can and should be a key part of fuelling the future innovation economy, from ideation and research, all the way through to implementation and growth. There is significant evidence supporting the investment of good usability and design. Some benefits include: increased sales, a decrease in user error, task times and training times, and reduced development, maintenance and support costs. Research pilots can achieve success in the open market, but these institutions will often need to seek investment, gain customers and provide a usable, efficient and effective solution for the end user. For this, design is essential. The World Economic Forum, in its Future of Jobs Report, identified creativity as one of the top three skills workers will need in 2020. Creativity was ranked number 10 on the list in 2015. As such, with the avalanche of new products, new technologies and new ways of working, the healthcare industry is going to have to become more creative in order to benefit from these changes.   To explore this area of discussion further, digital health strategy, design and innovation agency, codesain, will be hosting a panel as part of the Sydney Design Festival on March 5 at the George Institute in Sydney from 4pm to 7pm.   Rachel de Sain is the CEO and lead advisor of codesain and was previously the Executive General Manager of Innovation and Development at the Australian Digital Health Agency.

(Sponsored) Healthcare organizations are turning to video streaming to communicate better with patients and caregivers.