Remote monitoring technologies help patient care
Australia’s current and future challenges in delivering hospital and aged care services are well documented. The Australian health and ageing sector needs to look towards medical and information technologies to support Australians to remain in their own homes for as long as possible and to avoid unnecessary hospitalisation. The provision of care that enables individuals to be treated in the home environment is far more cost effective than all other alternatives.
In the aged care sector alone, forecasts by the National Health and Hospitals Reform Commission estimate that the number of aged care places will need to double by 2030 in order to meet demand. An additional challenge is a shortage of care-givers, nurses and doctors.
The medical technology industry provides a range of home health solutions which assist in meeting the challenges of delivering care to patients and the ageing. These include devices to manage cardiac disease, diabetes and chronic obstructive pulmonary disease (COPD), as well as a range of devices that can be used to monitor patients in their homes (e.g. personal alarms, sensors, heart rate and other vital signs monitors, pressure sensors, enuresis sensors, scales, glucose monitors, blood pressure monitors, sub-acute medical products etc).
Devices may have a diagnostic application (e.g. an implantable loop recorder), assessment application (e.g. bladder diaries) or monitor symptoms associated with an undiagnosed condition (e.g. atrial fibrillation).
Increasingly the home is seen as an appropriate setting for healthcare services. There are a range of technology choices that are available to assist patients to manage medical conditions and remain independent at home (e.g. telehealth and remote monitoring). The sophistication of home health medical technologies is increasing. In the future wireless technology will enable many medical devices to be monitored from a distance, effectively assisting with ‘hospital in the home’ type care. In many cases the technological capabilities already exist. The Australian healthcare system must harness the advances in information technology that have revolutionized other industries (e.g. the mobile phone industry).
Independent living solutions have been piloted throughout Australia, with excellent outcomes. Personal alarms are a good example of a technology used by older Australians to gain faster assistance in an emergency. Remote monitoring of patients with chronic disease has been shown to reduce hospital readmissions and the number of patient bed days. Research in the United States to determine the benefits of assistive technology found that 80% of elderly individuals were able to reduce dependence on others and 50% were able to avoid entering a nursing home.
There is a large amount of evidence to show that medical and assistive technologies can significantly improve the lives of Australians. There has been a shift in chronic disease management from acute care in hospitals to home or residential care. Medical care has traditionally been provided in clinics, hospitals and residential care units. Funding of the healthcare system supports these traditional models of service delivery, for example Medicare Benefit Schedule (MBS) item numbers are provided for face-to-face consultations, chronic care is managed in hospitals or clinics and funding is provided for products (pharmaceuticals, durable medical equipment).
Access to technology is vital to the provision of ambulatory care. The Federal Government has implemented policy initiatives for telephone and video consultations. However, very little policy work has been undertaken to support broader uptake of telehealth or other assistive technologies in Australia. A small number of devices that fit under the remote monitoring umbrella are funded in an ad-hoc way. A small number of items are funded by Private Health Insurance and are listed on the Prostheses List (e.g. implantable cardiac devices). In these cases the device is funded and the monitoring capabilities tend to be a free or unfunded adjunct and paid for by the patient. Currently there is no policy that outlines how doctors and allied health professionals should be reimbursed for telehealth services.
There are a range of telehealth pilots operating in each state and territory. There is a need for comprehensive policy that pulls all of these services together, with the specific aim of ensuring Australians can access support to remain independent in their homes.
The Medical Technology Association of Australia (MTAA) has outlined cost savings to Government of $3.1 billion per year. Considerable savings can be achieved by reducing the need for residential care and residential care packages and reducing the costs associated with emergency room admissions, potentially preventable hospitalizations, flying doctors services in rural areas, patient travel and unnecessary tests and chronic disease management. In addition to direct cost savings, there are a number of indirect cost savings associated with telehealth, for example, reducing patient travel time, reducing the burden on family members and caregivers and loss of income etc.
Access to telehealth should not be limited to rural patients. It is now recognised that a large number of individuals with chronic illness live in major urban areas and can access greater levels of care via telehealth services. Restricting telehealth item numbers to ‘live’ online consultations is likely to constrain the utilisation of telehealth in Australia.
The Federal Government is introducing MBS item numbers for telehealth in July 2011. At this stage it seems likely MBS item numbers will be restricted to video consultations, and not cover other telehealth services. MTAA has recommended that MBS item numbers for telehealth include reimbursement for the assessment and monitoring of medical data collected from a patient’s home (remote monitoring).
Chief Executive Officer
Medical Technology Association of Australia
MTAA represents manufacturers and suppliers of medical technology used in the diagnosis, prevention, treatment and management of disease and disability in Australia. MTAA recommends access to innovative medical technology to decrease hospitalisations and defer residential care admission. For more information visit www.mtaa.org.au
Posted in Australian eHealth