The Federal Government must focus on providing suitable broadband connectivity and technical capability to general practitioners and other healthcare providers in order to ensure the success of telehealth services in rural Australia, health professionals have warned.
The scheme, first announced by Prime Minister Julia Gillard during the 2010 federal election, offers $402.2 million in government funding over four years to provide Medicare rebates for some 495,000 online consultations to patients in rural, remote and outer metropolitan areas. The funding will also provide financial incentives and training to health professionals to encourage take-up of the scheme, and $50 million in funding to provide online triage and basic medical advice through videoconferencing.
In a discussion paper released in November last year, the Department of Health and Ageing identified financial incentives and procurement models as some of the obstacles to be addressed ahead of implementation.
However, in responses to the discussion paper, several health associations have warned of the need for high capacity broadband in order to provide telehealth services.
National Health Rural Alliance (NHRA) chairman, Jenny May, told Computerworld Australia that connectivity remained “very patchy” and inconsistent between regional practices.
“Some GPs are extremely IT-literate and have a very high level of connectivity and existing broadband and some of our rural and remote areas are already using an internet-based health record and putting in video conferencing and that sort of thing,” she said. “In other places the level of IT knowledge and capability is low.”
Bill Heddles, president of the Australian Association of Consultant Physicians, agreed that IT capability remained low among the practices of colleagues in the field.
“I’ve had a number of colleagues ask what we do in our practice because we’re very close to being fully electronic... There’s a fair bit of telephone discussion going on, and text messaging and so on, but in terms of formal online consultants with GPs, we haven’t got ourselves set up to do that.”
Online consultations for psychiatric care are already valid for rebates under the existing Medicare scheme.
Video conferencing and telehealth services between regional and urban centres have already undergone trials in several areas, with Victoria’s Loddon Mallee Rural Health Alliance extending its initial $5.2 million trial to all 16 regional hospitals in the area. NSW Health will also conduct a $4 million trial of telehealth monitoring units and video conferencing systems among critical care patients in the NBN-connected sites of Armidale and Kiama Downs this year.
“We know high speed broadband will be the foundation of future productivity, growth and international competitiveness,” federal communications minister, Stephen Conroy, said at the trial’s announcement. “It will revolutionise the way health services can be delivered to people in their homes.”
The Victorian trial showed video conferencing would not require a dedicated link, but bandwidth of at least 20 megabits per second (Mbps) was desirable to ensure continued connectivity. However, in rural and remote areas, such connectivity would be difficult to obtain, even once the National Broadband Network has been built.
“Are we going to get an affordable broadband system that is universal enough to provide video conferencing to smaller places,” NHRA’s May said.
Lack of connectivity could be solved through the financial incentives the government plans to provide to practitioners as part of the scheme. The current proposed incentives, introduced in the discussion paper and supported by those Computerworld Australia talked to, would involve a one-off payment to the health facility to help establish required IT systems, which are separated from the Medicare rebates paid to individual professionals as online consultations are held.
The Royal Australian College of General Practitioners (RACGP), which noted the lack of technical capability among GPs in a submission to the government on the suitability of the government’s e-health records, reaffirmed its measure of caution in its response to the government’s telehealth paper.
“Rural and remote areas stand to benefit most from telehealth consultations yet they are likely to have the poorest infrastructure, resources, and capacity for successful adoption of this service option,” the association’s report reads.
It also recommended establishing a procurement framework for those participating in telehealth services including minimum technical and interoperability standards in order to prevent “exploitation by information technology vendors and suppliers”.
May said a successful telehealth scheme would require careful integration with existing face-to-face and other consultation methods. However, she said existing uses of telehealth proved its worth.
“It’s happening, it’s not systematic currently and that’s because of some of the barriers,” she said.
It remains unclear whether the department will publicly release all stakeholder submissions on the discussion paper. Computerworld Australia contacted the department for comment, but did not receive a reply at the time of writing.
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