Queensland holds inquiry into telehealth services

A Queensland parliamentary committee is holding an inquiry into the telehealth services managed by Queensland Health with a view to ensuring telehealth services are, in the words of the inquiry's chair, “on the right track”.

The terms of reference of the inquiry include examining the implementation of the telehealth service by the Department of Health and Hospital and Health Services in trials, pilot and other sites, as well as the new Rural Telehealth Service that was announced in the state government's blueprint for better healthcare in Queensland in February last year.

It will examine the factors that support successful implementation of telehealth services and identify any barriers to successful implementation, and consider factors such as quality of patient care; access to health services, particularly in rural and remote locations; and the value for money of the delivery of telehealth services.

The committee intends to visit some rural and regional telehealth sites and hold public hearings in Brisbane and other locations. It invited submissions on telehealth from interested parties, which are available on the inquiry's website.

In its submission, the Australian College of Rural and Remote Medicine (ACRRM), which has developed a number of telehealth resources over the years and co-ordinates the well-regarded Telederm service, informed the inquiry that it is a requirement for ACRRM fellows to use technology to optimise the provision of care and access to care to patients in rural and remote areas.

This includes using telehealth as well as clinical information systems, shared electronic records, secure messaging, clinical decision support systems and point of care testing.

ACRRM argued that telehealth arrangements should complement existing specialist services, build on rural workforce and referral patterns to avoid further service fragmentation, and address practicalities of coordination, scheduling and support from the patient’s perspective to improve their continuity of care.

“The recent, much welcomed, substantial investment in telehealth by Queensland Health, supported by their comprehensive approach and commitment to a whole of health sector approach (private and public) is welcomed by ACRRM,” it said.

“ACRRM is represented on the governance committee for the new telehealth arrangements, which provides a forum for such discussion. ACRRM is keen to continue to work with Queensland Health to assist in the development of a range of professional support arrangements that ACRRM can provide by leveraging the resources that we have already developed.”

It also said it believed that new, targeted resources and training will be required to optimise outcomes for rural and remote patients.

In its submission, the University of Queensland's Centre for Online Health pointed out existing capabilities in telehealth in Queensland. CoH hosts the National Health and Medical Research Council's Centre of Research Excellence for Telehealth, established last year, which looks at home-based care, aged care, small rural hospitals and indigenous health and considers technology modalities, change management and health economics in each of these themes.

The CoH urged the inquiry to look beyond just video conferencing as the only technology for telehealth, even though it is the most tangible form. Store and forward and telemonitoring are other technologies that need to be harnessed, it said.

A strong research program was needed to support telehealth provision, it said, and sustainable funding models were required in order to achieve the many stated benefits of telehealth, including reduced costs as well as improved access to care.

It made five recommendations to the inquiry:

  • sustained investment is required in technical infrastructure, administrative support, business development, demonstrations and evaluation to fully exploit the benefits of telehealth for Queensland
  • the recently implemented funding arrangements to facilitate telehealth within Queensland Health need to be sustained for a sufficient period to explore its efficacy
  • investment in telehealth should be expanded beyond video conferencing to other modalities such as store and forward and remote monitoring
  • adjustments to activity-based funding arrangements should be considered to encourage system change and remove perverse incentives
  • and a formal relationship between the Centre for Online Health and the Queensland government, which it says has the potential to place Queensland in a position of great strength in telehealth development worldwide.

The Australasian Telehealth Society (ATHS) emphasised in its submission that telehealth was not simply about technology but about service development.

Often erroneously described as just video conferencing, ATHS argued that simply expanding the current Queensland Health videoconference network, which is predominantly used for educational and administrative meetings, was not enough.

“If telehealth development is treated as an IT project, the end result is the 'dust cover effect', whereby unused video conferencing machines are found in cupboards, or not found at all,” it said.

“It is important to recognise the difference between a videoconference network and a clinical telehealth service. A funded health department strategy designed to increase telehealth usage and to promote integration into the health service, needs to focus on clinical service development, and to a much lesser extent, the videoconferencing infrastructure.”

It also urged the inquiry to consider the role of home telehealth in the future of telehealth in Queensland, saying it has been found to reduce mortality, hospital admissions and ED attendances.

Assistive technologies service provider LifeTec said there was enough evidence for the benefits of telehealth from national and international experience, and policy now needed to move on from funding pilot projects to funding the development of a robust telehealth framework.

“This new framework should not only invest in new services, but also existing ones that have demonstrated successful telehealth service delivery models and outcomes,” it said.

Having provided telehealth services in both rural and metropolitan areas, LifeTec said it had become apparent that having the right processes and user awareness was more important than the actual hardware.

However, one major barrier that remains is the quality of broadband services. “Current connectivity is inconsistent and unreliable, which leads to break downs in communication,” it said. “This inconsistency in connection can also detract from client adoption and support of telehealth services.

“A more extensive and prompt rollout of the National Broadband Network could alleviate this issue significantly.”

Telstra proposed the development of a public/private partnership in the provision of telehealth services in Queensland which would use existing Telstra networks, infrastructure and customer bases to allow a significant scaling of telehealth services.

Telstra said it was partnering with the Northern Territory government to build a secure telehealth platform to connect public and non-government providers to ensure integrated patient care, particularly in indigenous communities.

Its public/private partnership proposal for Queensland includes offering Telstra's existing networks and infrastructure along with its ability to manage service support and billing.

Telstra also foresees the ability to interact with other jurisdictions, with a view to building a national telehealth platform or, as Telstra calls it, a “national telehealth connection service”, which would allow providers both public and private to connect within and between jurisdictions to allow telehealth to be an accessible model of care for everyone.

Technology company CSC also outlined a model that Queensland Health could look at, involving a fully managed service. This would include a service centre would be responsible for all non-clinical activity including arranging home visits, first point of contact for all issues and navigating service directories, as well as assisting in cross organisational scheduling.

CSC's model would provide everything from help in identifying suitable patients, centralised logistics and equipment provision, care monitoring, wellness calls and technical support.

A public hearing will be held at Parliament House in Brisbane next Wednesday, with further public hearings around the state planned.

Posted in Australian eHealth

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