Telehealth Beyond Videoconferencing Laurie Wilson Honorary Fellow, CSIRO Computational Informatics Adjunct Professor, University of Western Sydney Honorary Secretary, Australasian Telehealth Society

CSIRO COMPUTATIONAL INFORMATICS

Outline

• Telehealth Today • Potential restricted

• Lagging behind other ICT applications

• Potential Evolution • CSIRO study

• Models for telehealth evolution

• Examples • Telehealth to the patient

• Multisite high-care teams

• The need for a national strategy

Telehealth is booming!

0

5000

10000

15000

20000

25000

30000

Telehealth Medicare

Claims

But technology is slow to change

• To most users, telehealth=videoconference

• Consultation rather than service delivery

• Not at point of care

• Restricted data access

• Telephone with pictures

Telepresence & mobile media

•Healthcare (as usual!) slow to adopt new technologies •But telehealth must change to achieve its potential

Health systems are in crisis Can telehealth play a role?

http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/report-redbook/$File/HRT_report3.pdf

Health budget as percent of

total expenditure

Bandwidth will cease to be a barrier

Image: NBNCo

Only the most remote users may be limited by •Latency •Bandwidth •Symmetry

Even truncated NBN will free healthcare from bandwidth limitations

CSIRO Study

• How can we “future-proof” infrastructure such as the NBN?

• How will telehealth evolve over the lifetime of such infrastructure?

• Can telehealth evolve to meet the challenges?

• Literature search • Telehealth literature

• Computer Supported Cooperative Work (CSCW) literature

• CSIRO Broadband Pilots

• Interviews with panel of thought leaders

Analysis

Telehealth literature

CSCW literature

CeNTIE pilots

Expert panel

Analyse for trends

Analyse for trends

Analyse for trends

Analyse for trends

Meta-analyse for trends

Conclusions

Research questions

Patient centricity

Universal access

Networked caregivers

Ubiquity

Quality of service

Adaptability

eHealth integration

Smarts

Care models

Future trends

Technology Clinical applications

Aged & chronic

Point of care critical

Mental

Wellness & prevention

Care models → Patient centricity

• Both a driver and beneficiary of telehealth evolution • Key technologies

• Home-based systems

• Mobile applications

• Personal health records

• Implies ubiquity of access • Also includes such issues as

• Human factors/culture and

• Process change

• Policy/regulation

• Business model, funding

• Implementation and sustainability

• Legal/liability issues.

Personalised

information

Interactive

technology

Personal health

record

GP

CSIRO NBN Telehealth Trial

6 Sites • Townsville • Penrith • Greater Western Sydney • Canberra and ACT • Ballarat and the Grampians • Launceston / Northern Tasmania

• Number of patients at each site • 25 Test Patients • 50 Control Patients

• Total • 150 Test patients • 300 Control Patients

• Trial Design • Case Matched controls • Before-After-Control-Impact (BACI)

High-end & point-of-care systems Evidence base

ViCCU - Emergency

ECHONET – Intensive care

RIDES – Paediatric post-surgery

Three advanced telehealth systems trialled in the CSIRO CeNTIE program

LS Wilson, DR Stevenson & PC Cregan, Telehealth on Advanced Networks, Telemedicine & eHealth 16, pp 69-79 (2010).

Care models

Technology Clinical

applications

Telehealth evolution

Complexity

Simple, low bandwidth

Multichannel, broadband

Tertiary referral hospitals

Primary care

Home & mobile

Early systems

Future advanced systems

?

Current advanced systems

Current advanced systems

Publication

J.Li and L.S.Wilson. Telehealth trends and the challenge for infrastructure. Telemedicine and eHealth, 19, pp 772-779 (2013).

Challenges for telehealth 1

• Achieve economies of scale • Beyond pilots

• Facilitate structural and changes in healthcare delivery

• Make best use of technology • Telepresence – as good as being there

• Multimedia

– Multicamera

– Images

– Sounds

– Touch

– Data, vital signs

• Integrate with eHealth

• Wider range of clinical applications

• Bandwidth no longer a problem

Challenges for telehealth 2

• Human factors • Ease of use

• Process change

• Integration into workflow

• Point of care => patient not tech focus

• Economics • What is the value of telehealth?

• Business models for telehealth implementation, esp home-based

• Cost-benefit

Need for a National Strategy

• Advocated by HISA and more recently, Australasian Telehealth Society.

• High level guidance of process change

• More patient centred delivery of healthcare

• Removal of social and organisational barriers

• Achieve economies of scale

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•Only organisation specifically addressing the needs of the Australian and New Zealand Telehealth communities •Over 300 members •Has run four internationally-recognised national and international conferences •A forum for all those involved in telehealth •Actively promoting telehealth with Government and other decision-makers

www.aths.org.au