Time to focus on the national telehealth strategy
Telehealth has huge potential to improve the quality and safety of healthcare whilst also improving its cost effectiveness. Numerous studies have shown that when well implemented it provides an effective tool for better healthcare delivery.
However, its potential has been constrained in Australia by a number of barriers imposed by regulatory, reimbursement and cultural restrictions. As a result Australian clinicians, patients and payers have not been able to take advantage of the potential benefits it can provide.
It is my belief that one of the main reasons for this is the lack of a cohesive and coherent national strategy on the development and implementation of telehealth in Australia. To date it has been entwined as a subset of a number of strategy discussions, but its full potential cannot be reached until it is recognised as the substantive tool for healthcare transformation that it is. We need to provide the required technical, clinical, cultural and financial research and development to allow it to flourish.
National telehealth strategy
In late 2012, the Australasian Telehealth Society (ATHS) held a workshop at its annual conference in Sydney to gather feedback from members of the healthcare and technology community on “national strategic directions in telehealth”. I was privileged to co-chair that meeting with Professor Colin Carati from Flinders University. From that workshop we developed a white paper, which is available at the ATHS website at www.aths.org.au.www.aths.org.au
For the purpose of the paper we used the definition of telehealth as “enabling healthcare services and related processes delivered over distance, using information and communication technologies”. This was designed to not be too prescriptive so as to allow for innovation in the development of telehealth solutions as the technology improved.
The vision was for a transformative change in healthcare delivery to meet the challenges of a rapidly ageing population, financial and workforce constraints, and the expectation of high quality healthcare delivered in a timely manner for the Australian population.
Focus and implementation
Three broad themes developed from the discussion. The first was a focus on national priority groups and to target initially key groups identified in the National Health Reform Agenda who have to most to gain from telehealth as they provide the bulk of the burden of healthcare needs today. This includes the aged, those who are poorly mobile and disabled, and those in outer metropolitan rural and remote locations.
These sectors already have significant financial support from various levels of government and private payers, so there in no need for extra funding, but rather the making available of funding that is currently spent in these sectors to providers who use telehealth without the current restrictions.
An example is the exclusion of general practice services from the current reimbursement model. We are in agreement with the RACGP that primary care should be eligible for telehealth reimbursement as it is the most likely to interact with the various priority groups.
The second priority area was the application of ‘fit for purpose’ models – to develop technical, business and financial models that support clinical change that are sustainable and scalable, and work across multiple providers, funders and jurisdictions as required to deliver the requisite high quality care to the patient.
Such systems are deemed to be ‘fit for purpose’ for patient-centred healthcare with outcomes that are clinically relevant at an individual as well as at a population level. The goal is to embed telehealth as a valuable tool within the healthcare delivery system, and not have it as a sidelined research project of interest only to the technologists.
The third focus is to optimise the locus for implementation. The current healthcare system is fragmented and driven by many ‘masters’ which makes change, including the implementation of telehealth, complex. However, the bulk of healthcare is delivered locally, and with a patient-centred model of healthcare delivery the focus should be on delivering relevant services and inherent value at a relatively local level, and aggregating this up to a national level.
Recent reforms including the development of the Medicare Locals as a locus for better primary care is an opportunity to also localise the delivery of telehealth services to enable sufficient scale for good implementation models, whilst avoiding the unnecessary overhead of large-scale national programs. This will also foster innovation as the various groups develop models suitable for their loci of implementation that can be built upon by other groups.
Across all these themes a need for research and innovation was required to develop evidence-based models that were effective and sustainable. It was deemed essential that this research move on from the small pilot phase that has characterised telehealth research in Australia to larger scale projects with entrenched evaluation mechanisms that would inform the national debate.
Discussion to action
Now is the time for robust discussion about the National Strategy for Telehealth for Australia. However, we need to move rapidly from discussion to action. This is not a ‘set in concrete’ strategy, but rather a framework for the development of a new set of tools to be used in the delivery of healthcare. The goals are improved quality, safety and cost effectiveness of healthcare delivery for all Australians.
Technology can play an important role in delivering on those goals, but it needs to be embraced by the healthcare community as an enabling tool, not a threatening diversion from mainstream healthcare delivery. To do this requires collaboration across the gamut of stakeholders, healthcare providers, technology providers, regulators, funders and most importantly patients. They all need the opportunity to develop sustainable and scalable models of care that utilise the technology to enhance healthcare delivery.
There will be stumbles along the way, as there has been for all medical innovation over the centuries. However, if we keep our focus on the goal, ensure collaboration across all parties, and maintain an open frank and robust discussion along the way Australia has the opportunity to become a world leader in telehealth.
This can provide not only healthcare benefits to all Australians, but also potentially a lucrative export market for Australian healthcare and technology providers into the Asia Pacific region and the rest of the world.
About the author
Dr George Margelis
MBBS M.Optom GCEBus
National Committee Member, Australiasian Telehealth Society
Dr George Margelis is a medical doctor and health informatician. He was recently appointed Adjunct Associate Professor at the TeleHealth Research & Innovation Laboratory (THRIL) at the University of Western Sydney.
Posted in Australian eHealth