Industry Focus

HEALTHCARE Teleconference room Although not a new way of delivering healthcare, telehealth's potential has only just begun to be realised WORDS: TANYA RYAN-SEGGER Telehealth involves a clinical video consultation between a specialist and a patient—who may also be in the presence of a general practitioner or other prescribed health professionals. Along with this mainstream definition of telehealth there are other areas within the field such as: asynchronous store-andforward technology; vital signs patient monitoring; and preventative and educational services, including online support groups and social networking interventions. There is a growing interest in the aspects of telehealth that receive government support; however, the crux of the service is currently focused on internet-based video conferencing capabilities. What are the benefits? Although many local projects are still in their infancy, industry experts agree that telehealth's ability to improve health consultancy services outweighs any negative aspects. Associate Professor Sabe Sabesan, an oncologist at the Townsville Cancer Centre, is at the forefront of a telehealth project linking 18 remote communities in northern Queensland using a share-care model of the practice. Speaking at the Cancer Institute NSW's Innovations in Cancer Services and Care conference, Professor Sabesan said patients benefit immensely from improved access to specialists. This results in faster treatment and significant personal and financial gains from eliminating the need to travel vast distances to medical appointments. Professor Sabesan's initial findings present a compelling case for telehealth. His cost comparison shows benefits exceeded establishment costs by more than $300,000. A program in the UK presented similar findings. The Whole System 8 Industry Focus Demonstrator program—the world's largest randomised trial of telehealth and telecare—lists other potential patient, industry and cost benefits from reductions in: • mortality rates • emergency admissions • accident and emergency visits • elective admissions • bed days (in hospital) Of course, a key indicator of success is the measure of uptake. A spokesperson for the Department of Health says the Medicare telehealth program has been well received by key stakeholders. "To the end of June 2013, over 97,000 services have been provided to over 40,600 patients by nearly 8300 providers," the spokesperson confirms. Professor Anthony Maeder, President of the Australasian Telehealth Society and Professor of Health Informatics at the University of Western Sydney, agrees, noting that: "Practitioners across a range of specialties are now providing telehealth services, addressing service gaps in areas including psychiatry, dermatology and opthalmology". Impact of legislation The introduction of a number of claimable items under the MBS as of 1 July 2011 has had a positive effect on the awareness and uptake of real-time videoconferencing capabilities between remote specialists, doctors and patients. The following year, rules were amended to ensure the patient and remote specialist are at least 15km apart (with the exception of aged-care residents and patients in Aboriginal Medicinal Services). In a move to further focus the service on populations outside of major cities, on 1 January 2013 the telehealth MBS eligibility criteria was aligned with the Australian Standard Geographical Classification—Remoteness Area. Despite these amendments, most telehealth providers agree on the positive outcomes for patients. The Australian College of Rural and Remote Medicine (ACRRM) is one organisation that has supported telehealth requirements for rural GPs in the past decade. ACRRM'S Vicki Sheedy says that, along with addressing operational and workflow issues, the dilemma facing rural doctors offering telehealth is not financial, but finding the capacity to successfully manage the service. Current challenges A significant discussion remains around the topic of payment. According to Maeder, outside the Medicare Benefits Scheme (MBS) the biggest obstacle in the sector is not uptake but who pays for the services. "Telehealth's current main barrier exists around adoption policy issues—is it an extra service the patient should pay for, or is it an alternate way of doing business for which the government or a provider should absorb?" he says. Many medical professionals offer telehealth via state government-owned infrastructure models (often in hospitals) and user- or insurer-pay models. Meanwhile, general practitioners, along with some allied health professionals and specialists, can provide telehealth services under the MBS. Outside of this, many medical professionals are offering the service through state government-owned infrastructure models (often in hospitals) and user- or insurer-pay models. Technology: now and the future Notwithstanding the large state-owned infrastructure service models, many clinicians offer telehealth via web-based

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