Good uptake for telehealth in western NSW

The federal government's $15.7 million telehealth support program comes to a close this weekend, and while it is far too early to evaluate whether it has achieved its aims or not, for one Medicare Local area, the program has seen a good rate of uptake of telehealth provision.

Western NSW Medicare Local (WML) was one of six MLs that received extra funding under the program, which aimed to assist in the adoption of telehealth into everyday practice, with a focus on rural, remote and outer-metropolitan areas.

Twenty-eight new projects were funded under the program in total, in addition to ongoing funding provided to the RACGP and the Australian College of Rural and Remote Medicine (ACRRM). A number of telehealth support officers (TSOs) were funded through the Australian Medicare Local Alliance (AMLA), with six MLs receiving extra funding: Inner East Melbourne , Goldfields Midwest in WA, Perth North, Macedon Ranges and North-West Melbourne, Townsville Mackay, and WML.

WML used part of the funding to put on four telehealth support staff, two in Bathurst and two in Dubbo. Their roles were varied, with one TSO concentrating on aged care facilities and the others on helping general practices in this large region to get on board.

While a number of GPs were using telehealth already, it is estimated that up to 65 per cent of general practices in the region are now offering telehealth services to patients, the majority of them using Skype as the technology of choice, Bathurst-based TSO AJ Jack said.

The region is not as poorly serviced by specialists as some others in regional Australia, with good hospitals at Orange and Dubbo, but it is dotted with many small towns that don't often see a visiting specialist and where distance in particular is a problem.

Since the telehealth support program started, many of those smaller towns have taken up telehealth in good numbers, Mr Jack said.

“We came up with the concept of a telehealth town,” he said. “We said that if more than 50 per cent of practices in any town were offering telehealth, we would designate them as a telehealth town, and pretty much almost every town falls into that category.”

Not every practice has taken it up, but Mr Jack said there was a good amount that do. “Oddly enough, it's the larger towns that are slower on the uptake. Bathurst is okay, in Dubbo there are still quite a number of practices that haven't taken it on and Orange is about half and half, but the smaller towns are loving it.”

Dubbo and Orange in particular are well serviced by specialists and GPs there often don't send their patients long distances, Mr Jack said, but for outlying towns – the Medicare Local catchment stretches from Bathurst up to Coonabarabran and Coonamble in the north-east, west to Nyngan and Condoblin and south to Cowra – it was proving a very popular program.

For residential aged care, Mr Jack said the technology was a bit slower to take off. “There's no real use in going out to aged care facilities and saying you can do this if the GPs weren't willing to go along with it and to refer aged care residents to specialists,” he said.

“We had to make sure we had a big cohort of GPs on board, so there was a bit of a delay in getting aged care up and running. However, one of the good things for aged care is that they are not subject to the 15km rule, so one of the first telehealth consults that I helped out at an aged care facility was at Orange and was with a dermatologist who was also in Orange.

“The aged care facility found it really beneficial because in terms of getting that resident to the specialist, needing a vehicle, needing an escort, all of that, even to get them to the other side of town, you are probably looking at about three hours from go to whoa.”

The majority of GPs offering telehealth are using Skype, with Mr Jack estimating that up to 90 per cent in his region doing so. He puts the reason down to Skype's ubiquity and the fact that the name Skype has pretty much become synonymous with video conferencing.

“A reasonable number of people would already have used the product at home, Skyping with their kids overseas or distant relatives, so it's not a huge leap,” he said. “It's relatively easy to use.”

The quality of broadband is not a major issue in most of the area, as all of the major centres are well services, but there were one or two places that it was not possible because the internet was so bad, he said.

“One of the good things is that the rules for claiming the MBS item basically say that you don't have to have the entire consultation by video, so if you do start off the video consult and then it drops out, you can carry on just on the telephone, and that is still a valid consultation,” he said.

“For those places that do have slow internet, we are saying that is not necessarily a barrier. In clinical terms, if you get past that point where the specialist has seen what they want to see, and in a lot of cases it is just follow up and talking head stuff, if you get to that point and the video goes flaky, that's fine, just carry on on the telephone and it's still valid.”

Mr Jack is a firm advocate for removing the separate telehealth item numbers and allowing video consults to be billed just like a face-to-face consultation. The RACGP has put its backing behind the idea and the federal government recently announced that the Department of Health and Ageing would review the possibility and make recommendations later this year.

“Because there are incentives in place at the moment, as long as they remain a separate MBS item to activate them, then you will need a separate MBS item,” Mr Jack said. “By the time they run out this time next year, at that point I'd just say get rid of all of the MBS telehealth items because you don't need them any more, and a consult is a consult whether it is face to face, on the telephone or in a video conference. As long as it's clinically appropriate to do it, then do it.”

He is also an advocate for new, web-based video conferencing technologies like WebRTC, which many believe will revolutionise the provision of telehealth. WebRTC is a standard being supported and worked on by Google and Mozilla, who are currently trying to get Microsoft and Apple on board as well.

Mr Jack, who has worked in IT for over 15 years, including some time in health IT working with the NSW Department of Health, believes that WebRTC as an open source standard will be revolutionary. It will also help to overcome the reticence of public hospital IT departments to allow their staff to conduct video conferences with GPs or anyone not using their internal video conferencing technology.

WebRTC will allow video conferencing to become truly ubiquitous, he said. “As Microsoft and Apple get on board with the standard, and even if they don't, that's not important, because even if there were two standards, the worst that you would have to do is install two different browsers.

“I've got Internet Explorer, Chrome, Safari, Firefox and Opera. If hospitals believe that Skype is the work of the devil and they couldn't possibly allow it on their systems – even after you point out that it is owned by Microsoft, which every other piece of software on your system is made by – if you can do it through Internet Explorer, then the hospital IT staff have no excuse.

“So many people get daunted by the technology, but it’s actually the easiest part of telehealth. Getting it to fit into the workflow of your practice is what requires extra thought. Traditionally the patient organises the appointment with the specialist. Under telehealth, this is done by the GP practice to ensure all parties are available at the same time.

“The most common feedback I get from practices which take up telehealth is ‘This is so easy, why weren’t we doing it earlier’.”

As funding runs out for TSOs, WML has kept on some of its telehealth staff, with one moving over to help with its eHealth program and another being funded to continue the work with aged care facilities. One other TSO has decided to become an independent consultant installing video conferencing.

And even though the town of Orange was slower than most to take up telehealth, it was recently announced that the Orange Day Surgery Centre will operate a regular genetic oncology clinic by telehealth, allowing patients to see specialists at Sydney Cancer Genetics, based at the Sydney Adventist Hospital in the suburb of Wahroonga.

WML announced that future clinics may also be set up in Bathurst and Mudgee, and patients outside these areas can be seen via telehealth at their local GP or in their own homes.

Posted in Australian eHealth


0 # Ewen McPhee 2013-06-29 16:01
It's naive to think that telehealth is just a clinical consultation - this fails to recognise the significant administrative and scheduling work behind the scenes. Sure it must appear seamless at the clinicians level but practices that do this well have a significant background workload and infrastructure that must be funded and standard rebates won't cut it. Second point is you must be able to measure telehealth - I can seeks of discrete items as an opportunity to Rory the system. Third comment - standards based systems that allow cross platform communication are critical - hanging our hat on one more system is problematic, it has to work with secure portals and I know some web based systems struggle with this

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