The second tranche of the so called “Health Care Homes” (HCHs) trial started enrolling and providing services yesterday (1st December 2017) in Australia according to Australia’s Department of Health.
HCHs are existing General Practices (GPs) or Aboriginal Community Controlled Health Services providing a more systematic, coordinated care for people with chronic conditions such as diabetes, heart disease and respiratory problems. Patients who have been assessed as eligible can choose to enrol on the programme at a HCH and a care plan is then developed covering care to be received from their GP/ Aboriginal health worker and nurses at the GP practice as well as specialists and allied health workers.
Australia has seen a rise in chronic diseases with 50% of the population now having at least one chronic illness and 25% having at least two. The Australian Government believes that the GP led Primary Care system does not deal well with chronic diseases where patients often need services from multiple professionals working in different parts of the healthcare system. The HCH model is expected to reduce the confusion, delays and costs by using a team based coordinated delivery of care.
A key element of the HCH model is that the patient and all members of the care team (within the HCH and outside) have access to the care plan. A minimum requirement for software tools for creating and sharing the care plan have been defined and several companies have already produced software for this purpose. There has been some criticism of the way the software tools market has developed and the lack of independent guidance on choosing such software.
On the whole this trial is of interest not just to Australia but also to all other countries since chronic disease care is a key issue around the world. HCH model is considered consistent with the models used in the UK and New Zealand.
The stage one trial is due to run until November 2019 and has around 200 HCHs, of which the first tranche of 22 started in October 2017.
A brochure on the HCH produced by the Australian Dept of Health is available here.
While telehealth is still being tested in pilot projects in primary care in Australia it is beginning to be business as usual in secondary care, particularly for out patient services in rural areas and emergency care in regional areas, according to a review of this year’s Australian Telehealth Conference (ATC 2017) which concluded on Saturday. The article in Pulse+IT, puts the difficulty of getting telehealth into primary care down to the funding model in Australia.
The much admired Australian health care service is a mixture of public and private health care with, broadly speaking, the publicly (Medicare) funded hospitals providing a universal free service and the primary care being provided by a Medicare subsidised private practice service.
Until July 2014 telehealth services received incentives under the Telehealth Financial Incentives Programme. This programme was instrumental in introducing many telehealth trials through which the medical community learned the benefits and difficulties of telehealth first hand. Although these incentives have stopped, providers still receive higher Medicare benefits for approved telehealth services listed in the Medicare Benefits Schedule (such as video consultations between specialists and patients in telehealth eligible areas). However restrictions in eligibility for Medicare Benefits for telehealth usage have been shown to reduce the potential use of telehealth facilities (see our earlier item Should Australia review restrictions on use of telemedicine?).
Topics discussed at the conference included Telestroke, Innovations (Augmented Reality, AI), delivery models and virtual care. Many of the presentations given at the ATC 2017 are available at the ATC website here.
Research carried out in Australia shows that a hospital with telemedicine facilities for outpatient consultations was using those facilities for only one in seven potential appointments. The retrospective study of outpatient appointments at Princess Alexandra Hospital in Brisbane showed that in a 12-month period 2.5% of outpatient consultations were carried out by telemedicine. Although 17.5% of the appointments were potentially viable via telemedicine, a policy of permitting telemedicine only for rural residents meant that, as the majority of the viable telemedicine consultations were with metropolitan residents they were carried out as hospital visits.
This raises the question whether expansion of the use of telemedicine for hospital consultations in Australia should now be reviewed. Currently there is a geographic requirement that the patient’s location must be outside of an Australian Standard Geographic Classification Remoteness Area 1 (a city) for a telemedicine consultation to be eligible for Medicare Benefits.
The research has been published in the Royal Society of Medicine publication Journal of Telemedicine and Telecare. The author, Monica Taylor, also presented the findings at Successes and Failures in Telemedicine 2016 in New Zealand where she was awarded the best paper award.
Intensive Care Units treat the most sick people in a hospital and requires round-the-clock staffing by doctors and nurses. 24-hour staffing, however, means shift working and an inevitable night shift. To make it fair on all staff the shifts are usually rotated so any doctor or nurse would do a period on one shift and then move to the next shift.
It is not surprising that the more senior staff manage to have less night work than newer, less experienced ones. On the other hand night shifts may have attractions such as extra pay and this may be more important to the lower paid less experienced staff than to the higher paid senior ones. Also, the cost of staffing nights with less experienced staff may prove cheaper for the hospital. Nevertheless, the patients’ needs are no less important at night than during the day. Another aspect of night-time care is the possibility that a doctor or nurse may not be as alert at night as they would be in the day-time.
Looking at these downsides of night-time ICU care staffing, an hospital in the US has come up with a novel idea – move the doctors and nurses to a zone where it is day-time when it is night-time at the hospital and use telehealth to connect them. This is counter intuitive and has its own drawbacks.
Georgia’s largest healthcare provider Emory Healthcare is sending some ICU doctors and nurses to Sydney, Australia, for tours of six to nine weeks at a time, in a trial to staff ICU at night with health staff in a daylight zone using telehealth. The six month trial in collaboration with Philips and Australia’s Maquarie Health has been underway for 3 months.
The reason this is counter-intuitive is that telehealth was invented to overcome the problems associated with healthcare professionals and patients not being at the same location and here the two are being artificially removed to two ends of the world. While telehealth is a good solution to the diagnosis and treatment from afar, most professionals are likey to agree that it is inferior to being face to face with the patient. So it will be good to see the conclusions reached by this trial on how any drawbacks of distance balances out with having more alert doctors and nurses.
See also mHealth Intelligence article here.
- Telehealth has been confirmed as the way forward for sustainably treating the leading chronic diseases in Australia says a report published following a scientific study. The study, which analysed the effects of monitoring a mixed group of patients with chronic conditions using home-based telehealth equipment, concludes that use of home-based telehealth will not only reduce the hospital admissions but will also reduce the length of stay when admitted. The analysis of the data from the trial has shown that for chronically ill patients, an annual expenditure of AU$2,760 could generate a saving of between AU$16,383 and AU$19,263 representing a rate of return on investment of between 4.9 and 6. This is equivalent to a saving of AU$3 billion a year, says the report.
The Australian study, carried out by the Commonwealth Scientific and Industrial Research Organisation (CSIRO) is reminiscent of UK’s Whole System Demonstrator (WSD), the world’s largest randomised control trial of telehealth. Although the Australian study is much smaller with a total of 287 participants over 5 sites (covering the 5 States) compared with over 6,000 in the WSD, the principles are similar. Due to the smaller sample sizes and the need to have patients connected to the National Broadband Network (NBN) the selection of patients was not random but other techniques were used to obtain statistically significant results. Patients selected had unplanned acute hospital admissions indicationg one or more of Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease, Hypertensive Diseases, Congestive Heart Failure, Diabetes and Asthma.
The TeleMedCare Systems Clinical Monitoring Unit (CMU) was used as the home-based unit although not all features offered by the device were utilised in this study. The CMU system deployed in this study was developed in Australia, registered with TGA (Therapeutic Goods Administration) and has been extensively used and tested in previous trials.
Typically patients would have some or all vital signs measurements scheduled at a convenient time, typically in the morning. These measurements were blood pressure, pulse oximetry to measure arterial blood oxygen saturation, ECG (single channel), lung capacity, body temperature, body weight and blood glucose concentration. In addition to scheduled times, patients could take their vital signs at any time. A full suite of clinical questionnaires was also available.
The full report Home Monitoring of Chronic Diseases for Aged Care is available to download here.
A study has concluded that most of the benefit from the National Broadband Network in Australia comes from two sources, telehealth and teleworking. Economic Benefit of the National Broadband Network (NBN) is a report partially summarising a study by the Centre for Energy Efficient Telecommunications (CEET) at the University of Melbourne. The study analyses the potential economic impact of Australia’s NBN.
Assuming that eventual access speeds will reach 10-25 Mbps, the model used by CEET predicts long-term GDP increase of 1.8% and a 2% increase in real-term household consumption. Of six categories of services considered, cloud computing, e-commerce, online higher education, telehealth, teleworking and entertainment, it is telehealth and teleworking that have come up as the services that will generate the most benefit from the NBN.
The average annual household benefit is estimated to be around $3,800 by 2020. Recognising the significant investment being made in broadband in Australia, the paper attempts to describe how the NBN will influence the national economy through the adoption of new services and new ways of working.
The short summary report is in easily accessible language and well presented and is available here.
An Australian health insurance underwriter has announced that it is offering a telemedicine service for its traveling and expatriate policyholders, according to today’s Insurance Business.
Accident and Health International (AHI) is offering access to Australian-trained emergency physicians via video, phone call, email or text 24 hours a day for these customers.
The service is being offered through Docto, which describes itself as “Australia’s first on-line telemedicine hospital”. CEO of AHI, Peter Banks, is reported to have said “the policy holder simply clicks a button on the AHI App or the Docto website and they can see a doctor from the comfort of their home or hotel room. Often when you are travelling in an unfamiliar place, it is the simple questions you want answers to. They can simply text, email, video or voice call AHI’s TeleHealth for an immediate answer.”
Dr John Field, founder of Docto, offers another scenario: “it is preventing a mother from having to go to a foreign hospital in the middle of the night with sick kids. She can press a button and see a doctor in real time, without leaving the house.” Docto website claims that its “Emergency Department” is staffed 24-hours a day by fully trained Australian Emergency Physicians. Access to medical specialist covering a wide range of areas are arranged via Telemedicine consultations on the next business day.
If the traveler requires repatriation back to Australia that is arranged via Dynamiq, a global emergency management company.
HCF, the oldest of the “Big Four” Australian health funds, has bought a 15% stake in telemedicine online doctor service startup GP2U. GP2U provide systems which helps to make remote consultations via video conferencing possible.
According to yesterday’s press release HCF will run a pilot to “ensure the service is scaled to the wider HCF membership as smoothly as possible”. In addition to providing the video conferencing platform, GP2U also provides a prescription service that sends prescriptions directly from the GP office to pharmacy once the GP approves it. GP2U has agreements with three Australian pharmacy chains, Terry White Chemist, Chempro and Priceline.
HCF is a not-for-profit organisation founded 80 years ago and provides health cover for 1.5 million Australians and has a turnover in excess of AUD 2 billion. GP2U is very fortunate that such a large fund has taken a serious interest in it
has released a smartphone app for the safety of ‘lone workers’ including community health nurses who, in Australia, may be traveling and working in isolation or at night. MyCareTrack is accessed by a lone worker with an individual ID, and provides check-in, check-out capability, activity reporting, GPS tracking and SOS emergency alerts. It leverages Tunstall’s existing 24-hour response centers for automatic check-up calls and SOS. We wonder if this will be marketed in other countries as, for instance, the US has many areas which are as isolated as Australia for health workers. Pulse + IT (Australia)
Tunstall Healthcare in Australia is adding an unusual (for telehealth) market with the National Home Doctor Service (NHDS), which provides after-hours home visits for urgent, episodic care. The NHDS’ 600 doctors provide one million patient visits in home, including calls on those living in residential aged care (assisted living), older adults and those with disabilities. Home visits (US=house calls) have the aim of reducing ED/ER visits which may require ambulance calls. NHDS coordinates records with the patient’s regular GP. Tunstall’s role is to provide on-call care consultants who coordinate NHDS services; they also match NHDS with the needs of current Tunstall clients. Australian Ageing Agenda Technology Review. Tunstall Australia release.
The demand for telemedicine services in south western Queensland is reported to have tripled from 8 consultations a month to about 35-40 following the appointment of coordinators who show patients how to use the service. The Queensland Government media statement issued last week quotes the coordinator at Charleville Hospital as saying 99% of people prefer the service to traveling to see a specialist face to face.
The video link service connects doctors with patients from 2 rural hospitals and one district hospital in south west Queensland. These are relatively small hospitals with 24 to 39 beds and use Flying Doctors to provide some of the facilities such as surgery. Alternative for patients, say in Charleville, could be a 7 hr 620 km drive to Toowoomba or a 8 1/2 hour 750km drive to Brisbane to see a specialist for a 10 minute appointment.
Telstra Health has splashed out $100 million buying up other telehealth companies, it was revealed at a recent conference. Bronwyn Pike, former Minister of Health in Victoria and now Community Care Lead at Telstra Health, addressing the 13th National Rural Health Conference held in Darwin from May 24th to 27th, described how Telstra Health wants to transform rural health in Australia.
“Increasing demand, rising costs and more people with chronic illness are among the challenges Australia’s health care industry is facing. Working harder can only go so far — we need to reimagine what the future could look like”, Pike wrote in her abstract.
“Helping users to do more for themselves has been a key feature of almost every other industry change of the last decade. Banking is a perfect example — where once every single interaction required your physical presence in front of a teller, now you can manage almost every aspect of your banking needs securely online.
“Health is caught in a model that is inconvenient for patients and labour intensive for health care providers. We need to tailor the model to suit the health industry and capitalise on the benefits connection can provide. Those living in rural and remote communities without regular access to all levels of care stand to benefit enormously if we can unlock the potential of ehealth”
A familiar debate raged at the Connect Expo Future Health Summit in Melbourne this week [TTA 15 Apr]. Is lack of digital health adoption due to lack of political push, as Lyn Davies, managing director at Tunstall Healthcare, maintained? Australia continues to back the Personally Controlled EHR (PCEHR) to the tune of AU$1.1 billion so far, yet it is still not integrated into the healthcare system. Are clinicians allergic to technology qua technology projects, and need to be approached differently to adopt digital health, as Donna Markham, advisor to chief executive affairs at Monash Health, said? Is it people–the patients– not seeing any benefit to things like PCEHR, a lack of demand filtering down to the practice level, per Toby Hall, Group CEO of St Vincent’s Health Australia? There is a certain comfort in the issues not being much different in a smaller, centralized health system (as the US is not–and as we’ve learned from ISfTeH, in Germany telehealth adoption is low). What seems to be missing is a perspective on what individuals are doing with their own health management and tracking outside the system. TechRepublic Hat tip to David Trainor of Belfast’s Sentireal on David Doherty’s mHealth LinkedIn group (signup required).
Breaking from our HIMSS coverage, Australia takes its turn in technology mega-events with the Connect Expo
next week, 21-22 April, in Melbourne. It features one expo and 11 conferences, including the Future Health Summit
covering telehealth, big data, analytics, wearables and robotics. Featured are speakers Tim Kelsey from NHS England and Dr George Margelis. Reports indicate that sponsor Tunstall
will be debuting its mymobile
telehealth app, which ties into their Integrated Care Platform, and the myCareTrack
app, a mobile safety solution meant for lone workers, including health professionals on in-home patient care visits. The Tunstall website in its release also has presentation times
. Pulse+IT (Australasia)
(Returning to the US, we note that Tunstall was absent from HIMSS, and will also be from ATA2015 where they have been a major sponsor in the past. And we wonder how things are developing with mHealth platform designer Tactio
.) Hat tip to Guy Dewsbury via Twitter
Capita Healthcare Decisions is forming a partnership with Medibank, an Australian insurance and healthcare company, according to a press release issued by Capita. One of the areas highlighted in the announcement is that Capita will provide its TeleGuide product which Medibank has customised to the Australian market.
Capita, with 68,000 staff, is a UK company providing process management and professional support services in the UK, Europe, South Africa and India and has a checkered history with UK Government health service contracts.
In Nov 2008 Capita won the contract to run UK’s NHS Choices website which provides information on medical conditions, treatments and services to UK patients on behalf of the UK Department of Health. The Cabinet Office then refused to renew the £60m 3-year NHS Choices contract with Capita in 2013. (more…)
Following our report earlier in the month on Telstra’s success in winning the Western Australia telehealth contract, Telstra announced the acquisition of UK based Dr Foster last week. Telstra has now announced that they are acquiring Medibank’s Anywhere Healthcare platform, further expanding its Telstra Health arm.
Since 2013 Telstra has had exclusive access to Dr Foster in Australia and supplies Dr Foster products to several health services in Australia.
Anywhere Healthcare is a middleman platform with specialists signed up to provide remote consultations and GPs signed up to use the services of those specialists. When a face-to-face consultation is considered not appropriate the GP can arrange for a remote consultation via Anywhere Healthcare. Typically, this has been used to date for patients in nursing homes.
The current Anywhere Healthcare directory lists 30 specialists covering 17 specialties and it is reported that there are 1600 GPs signed up to the service. Telstra have stated that they expect to expand the service, particularly into rural patient consultations.