Meeting Tomorrow’s Health Care Needs Today

eHealth and Telehealth

The number of Australians living in rural areas varies with the state, with some residing in areas considered “remote” and “very remote.” The Land Down Under is unique not only for its culture and vast, varying landscape, but for the fact that it has become one of the most urbanised countries in the world, with 69 per cent of the population residing in major cities, according to 2011 figures from the Australian Institute of Family Studies. For the health care profession, this presents a host of challenges, from working with persons in densely packed urban centres to accommodating the needs of clients in remote, sometimes almost inaccessible remote areas with extremely low population densities, with 1.5 per cent of the population residing in remote areas, and 0.8 per cent in very remote areas.

According to the Australian Bureau of Statistics (2010), 324,000 Australians live in remote areas, with another 174,000 living in very remote areas. In between the extremes of major cities and very remote areas are those living in inner regional areas (14 per cent of the population), and another 14 per cent in outer regional areas – and when it comes to health care, the needs of all must be served.

All Australians stand to benefit from improved access to the latest technologies, such as eHealth and Telehealth which, if properly administered and maintained, have tremendous potential to streamline the health care needs of the entire 22,620,600-strong population.

Streamlining Health Care

In short, eHealth is an amalgamation of modern electronic communication and information technology which helps to greatly streamline access in the health care sector. Seen by many in the health care profession as a means of saving time and money, eHealth can afford professionals the ability to access personal health information (with permission) when needed. Many seemingly routine activities, such as blood draws, X-rays and other scans, prescriptions, referrals to other doctors, hospital discharge reports and more are generated daily, many of them still on paper. Seen as a means to improved paper-based health management, it is estimated that eHealth will not only greatly improve the safety and quality of Australia’s health care, but save money. As of last July, all Australians were able to choose to register for their own electronic health record.

Along with eHealth there is Telehealth, which brings with it a host of benefits for those living outside of major metropolitan centres. In rural areas, where populations are often dispersed compared to densely packed cities, medical professionals such as general practitioners can be spread out across greater distances than in cities. With Telehealth, Australians are able to connect to general practitioners and specialists via video conferencing, in real time. Medical professionals can be located in a major metropolitan centre, and can bridge literally hundreds of miles through technology to reach out and share opinions with other doctors and specialists located in rural areas.

Benefits of eHealth and Telehealth

The potential advantages of eHealth and Telehealth to both rural health care consumers and the broader medical profession are immense, and these benefits extend well beyond the traditional hospital model, all the way to aged care facilities. With many of us living longer, legions of seniors are remaining at home as long as they are able; as a result, they are often considerably older and more frail when the decision is made to move into an aged care facility, and health needs are often greater. Some providers, like Estia Health Pty Ltd (see Healthcare in Focus Dec 2012), are actively engaged in training, recruitment of new staff, and investigating technologies to make the lives of residents and staff healthier and happier today, and in the years to come.

Serving the needs of residents in Victoria, Estia Health recently signed up for Video Telehealth, which remains new and innovative to the nation’s aged care providers. For staff and residents at Estia, the service offers countless advantages, particularly when it comes to bed-ridden residents. In the past, staff were required to ensure elderly persons who needed to see a specialist, such as a dermatologist, were safely transported from the facility to the hospital, with the staff member waiting while the examination or medical tests took place, then returning to Estia with the resident. During that time, the staff member was unable to assist other seniors since he or she was busy accompanying the resident to and from hospital, which often took hours. For the senior, especially those with difficultly walking, the entire experience was often gruelling and left them feeling exhausted.

“With Telehealth, it is done with Skypeing two specialists who are on standby who are part of the clinical rounds for the day, and it’s effortless – they just talk with their GP at the bedside, and the next steps are arranged,” says Ruvani de Silva, Executive Director of Nursing at Estia Health. “The person in bed remains comfortable, and it is done remotely.” Video Telehealth greatly reduces the need for appointments, waiting times, handling of the patient, and saves staffing and transportation costs, all without wearing-out residents. “We’re probably the first complete company to sign on,” she says, “meaning every one of our facilities is signed up with Medicare and with participating general practitioners to go ahead and do this with every facility.” The organisation is also investigating a similar model for dentistry, which will allow dentists to conduct examinations prior to invasive treatments being required, making the experience much more efficient and far less traumatic.

Along with Video Telehealth, Estia is a leader in implementing intelligent, practical, and cost-effective means of making the lives of all its residents easier and more pleasurable. Instead of transporting seniors to hospitals for X-rays, they will soon have visiting radiographers come directly to them on-site, saving staff time and sparing residents the discomfort of being transported many kilometres to a hospital for imaging that only takes a few minutes.

“Estia Health offers choice at every turn, because what we’re trying to promote is life quality on a daily basis,” explains Ms de Silva. “The clinical care is a given, but [residents’] life quality program is very open-ended, and we give as much as we can give them… The key to this is trying to maintain their feeling of belonging in the community while they are a little bit secluded from it.”

For rural and remote hospitals, another challenge they face is attracting and retaining staff. Some, like Benalla Health – located about two hours from Melbourne – offer scholarships which are open to clinical and non-clinical staff, so employees can continue to grow and develop their skills within the organisation. With an average age of 49 for nursing staff, Benalla, like many other rural health care providers, needs to remain competitive when it comes to recruiting and working with the staff they already have, and must make the prospect of working outside of a city centre as attractive as possible whilst providing a range of hospital services, community health, and aged care.

“We focus on trying to develop our staff, provide them with education opportunities and professional development opportunities, so that Benalla Health is an attractive place to want to come and work,” says Andrew Freeman, Chief Executive Officer.

With roots going back to the 1990s, the concept of eHealth is viewed as being used by developed countries to provide high-quality, patient-centred care. In Europe, eHealth – while still in development – has almost all stations across the European Union implementing, or about to implement, forms of national electronic health records which will make patient information available to those in health care. “Public health informatics employs a wide variety of tools and techniques to reach its goal of preventive health, a practice that telemedicine similarly attains,” said C Pettruccelli, in Telemedicine and rural health care. Telemedicine, like informatics, applies advancements in health technologies to the health care setting. Using such innovations and technologies improves clinical quality, particularly in rural areas.”

While eHealth and Telehealth will undoubtedly benefit the lives of tens of millions of Australian patients and those working in the health care profession, the very nature of supplying these services to rural areas presents a number of challenges, many of them centred on technology. Although broadband services are gradually becoming more widely available, progress is slow in some very remote areas of the nation, making connections unreliable. By some estimates, 10 per cent of small Australian towns – the same towns that often have just one local general practitioner – do not yet have the infrastructure needed for high-speed Internet connections; likewise, even consistent supplies of electricity, needed to power technology, are not always reliable. Discussion is crucial with small-town doctors to determine need, especially in remote areas where residents do not have the same access to health care services as persons living in Melbourne or Sydney, and often have worse health as a result.

While eHealth and Telehealth will undoubtedly assist health care professionals in sharing information and caring for patients, all levels of government along with general practitioners, specialists, rural aged care providers, technology experts, and others need to dialogue and co-ordinate their efforts to make certain all pieces of eHealth fit together seamlessly to provide Australians the health care they deserve not only today, but years into the future.

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October 17, 2017, 9:09 AM AEDT

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