Healthdirect Australia will use the open source WebRTC standards for real time video, audio and data communication as part of plans to implement video consultations for the nurse-led health advice line and after-hours GP helpline (AGPH), as well as the Pregnancy, Birth and Baby counselling service.
The federal government announced last month that it planned to introduce video consultations for several of the national helplines managed by Healthdirect Australia as part of its update to the national digital economy strategy.
Healthdirect Australia is jointly funded by the Commonwealth and the states and territories to procure and manage health information and advice lines, along with developing the National Health Services Directory (NHSD).
Healthdirect Australia CIO Anton Donker said the focus was on aspects of video enablement that are most important to services, to combining services and to consumer interactions, rather than the technology.
“Healthdirect Australia has been undertaking a significant program of work to include video consultation as an additional option for consumers to access services, alongside other channels such as the telephone and online,” Professor Donker said.
“This has included research and evaluation surrounding consumer and technology readiness and the approach required to support access to services at a broad system level, in both planned and unplanned settings. The aim has been to achieve outcomes in line with consumer expectations, using the devices available to them, and at a cost in line with telephony.”
He said WebRTC was one of a range of technologies the organisation had been looking at to facilitate video calls from consumers to the clinicians manning the helplines.
“The reason for that is that we are looking at how to do telehealth in homes and ad hoc settings, how to combine services, and how people move between services,” he said. “RTC is not quite yet a mature technology but we can see the direction it is going.”
He said Healthdirect Australia took the view that it was not so much a matter of particular technologies being used, but at looking what is emerging and what is possible, so health services can plan on that basis.
“They can now look at the things that matter, which is how you look at services, not what you are doing with technology.
“You are after what works for services and what works for people in their homes and their settings, not just for the consumers but also to make it easy to use for practitioners in their settings. What we are trying to do is seed some of that thinking.”
Healthdirect gave a demonstration of the AGPH service being accessed via video consultation at the Health Informatics Conference (HIC) in Adelaide last week.
The demonstration highlighted the potential of WebRTC for healthcare, including how easy it was for multi-party video conferences to be conducted, which would enable interpreters to assist non-English speakers during a consultation.
Chris Ryan, managing director of video consulting specialist Attend Anywhere, which provides project management to Healthdirect Australia, said WebRTC was a draft web standard that enables users to deal with real time audio, video and data communications in the web browser in the same way we share images or videos today.
Open APIs make it easy for developers to implement WebRTC in their own applications, he said.
“So what you have is highly scalable, free, secure, resilient, very high quality, real time video and data communications between web browsers that can include multiple parties in the same call,” he said. “The only cost consideration is internet usage, which would fall within most household internet plans.”
Mr Ryan said WebRTC will increasingly be adopted by consumers using everyday applications and they will want to use it to access healthcare.
“One reason WebRTC will be so powerful for telehealth is that healthcare is consumer-driven. In the physical world it is consumers who initiate the care – they choose to go to a GP or a hospital and they choose the transport method to get there. They will want to do that with telehealth as well.
“The point is that consumers own the transport capability or technology, not the health system. Telehealth models need to reflect current enablement models but do things faster, cheaper, better.
“From a provider perspective, enabling secure video consulting access to their service via their web site will be as easy as embedding a YouTube video.”
The Healthdirect Australia video consulting capability works in the same way as a consumer physically arriving at a medical centre reception. The consumer either has an appointment or they take a number and wait for the next available clinician in the waiting room.
In the Healthdirect video setting, the consumers enter via a secure portal on a website and are given their own personal, virtual waiting room.
“It’s the same as sitting in the practice waiting room, just without seeing the person next to you,” Mr Ryan said. “The portal can also be used to schedule appointments, create case conferencing video rooms and manage the queues.”
WebRTC is able to be used in conjunction with the existing telecommunications-based systems used by many health services, including the Cisco-owned Tandberg and Polycom systems most commonly used in hospitals.
“As with physical transport, there are different video technologies suited to different circumstances,” Mr Ryan said.
“Most hospital to hospital video communications use telecommunications standards-based video conferencing equipment and that works very well within managed networks.
“It is difficult to apply this approach outside of these environments, however, where consumer technologies make much more sense. Of the tens of thousands of consultations that have claimed the MBS telehealth items since June 2010, 82 per cent have used Skype, despite its limitations, and a large proportion of the rest has been technologies such as Apple's FaceTime, despite its proprietary nature.
“Both of these approaches are valid and in the majority of cases the two worlds don’t overlap. The challenge is where the worlds do intersect, and WebRTC is going to make that much easier.”
Mr Ryan said WebRTC promises all the benefits of existing proprietary consumer technologies without the downsides and with far greater upsides, such as consumers not needing to download special-purpose software or create a user account.
“WebRTC also offers significantly enhanced flexibility, functionality, security, quality and interoperability – all you will need is a modern web browser.”
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