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Breaking down the barriers to scale in telehealth


Making telehealth so easy to use that it requires no training, is business as usual in institutions, and a diagnostic tool completely separate from health provision, are among approaches needed to ramp up its widespread availability, a recent health event has heard.

A panel of five experts discussed how to break down the barriers and bring telehealth to scale across the country at the Australian Telehealth Conference in Sydney last week.

The technology needs to be so simple that no training or change management is required, said Dr James Freeman, a GP and the founder of GP2U Telehealth.

“Think about Gmail. How did you learn Gmail? Were you change managed or did you just pick it up and start using it? It needs to be that easy,” Dr Freeman told delegates.

He said mobile apps on smart devices were the perfect technology because the camera, speakers, and microphone were all  switched on and the user could not unplug them.

“Technology-wise, it has to be that easy. If it is harder, you’re talking change management and you are talking ‘not going to happen.’”

Similarly, Chris Ryan, Healthdirect Australia’s video consulting program director, said telehealth needed to be easy, use existing and ubiquitous technology, be available as a web-delivered service, and support healthcare workflows.

Social video calling workflows, such as Skype, Google Hangouts or Facetime, didn’t work beyond low scale because a service cannot be a contact with all the people they might want to see. Business workflows require pre-planning rather than just turning up as patients do in the real world.

Use smart people to lead change

In large institutions, telehealth has to be business as usual, said Associate Professor Andrew Kornberg, director of RCH Global at the Royal Children’s Hospital, Melbourne, where telehealth has been integrated widely.

“One log on. One way. Everyone knows how to do it. If you have multiple ways in an institution you will fail,” Associate Professor Kornberg told delegates.

He said as change happened from above and below in institutions, a successful telehealth implementation needed executive backing to get the money, plus savvy staff.

“You have to use all those smart people in your institution to work out what is the best way forward for the care for their patients, because if you don’t do that and you impose upon them a program of how you do it, I can tell you that senior medical staff will push back and you will not succeed.”

He said they offered grants to people in the hospital to show a novel way of using telehealth, from which grew the hospital in the home program and sleep medicine telehealth programs.

Dr Tori Wade, a GP, psychologist, senior research fellow with the Discipline of General Practice at The University of Adelaide, and clinical director of the Adelaide Unicare e-Health and Telehealth Unit, previewed a model being developed for change management for large scale telehealth.

“It is a model based on the premise that you have a small group of enthusiasts but no budget to do the change management with,” Dr Wade told delegates.

The enthusiasts’ role is to create a community of practice to build telehealth and get it accepted, then market it to clinicians, patients and leadership showing the benefits, how it aligned with existing policies and solved any existing problems, she said.

A tool for diagnosis only

Paul Frijters, Professor of Health Economics University of Queensland, said in the long run, he would like to see telehealth become a diagnosis tool completely separate from health provision, which could then led to a contract for which several health providers could bid.

“I expect lots of things to disrupt this market in the coming years. For instance, I expect a private market to emerge, which could do things that government agencies or funded agencies cannot,” Professor Frijters said.

He said in China there were telehealth rooms with doctors giving diagnoses to people phoning in from far away. While that set up did not exist in Australia, in principle it was possible to do a deal with highly-educated doctors in Bombay, for example, to allow them to be the professional diagnosers of patients anywhere in Australia.

“At the moment, the barrier to that is the law; we are not allowed to give medical advice to Australia from abroad. But there is nothing to stop Australians from dialling into to a Bombay telehealth service and getting an opinion from outside for a little amount of money about what is wrong.

“I expect that kind of disruptive technology to emerge and start to drive a lot of the more innovative pilots of telehealth,” Professor Frijters said.

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