Various systems -- collectively known as "telemedicine", in which patients consult doctors remotely using systems such as real-time video links -- are already available for such long-distance consultations.
But experts from a Queensland centre that has been pioneering the use of telemedicine have warned uptake of the technology to date has been marred by poor planning and a greater interest in buying hardware than in teaching staff how to use it, or making it easy for them to do so.
As a result, machinery once bought tended to sit under-used while doctors continued to use traditional referrals -- underwritten by taxpayer-funded schemes that reimbursed patients for part of their travel costs.
In Queensland, that scheme costs an estimated $30 million per year. An analysis has showed that telemedicine schemes could bring a cost saving of at least 37 per cent.
In a paper published last week in the Medical Journal of Australia, Anthony Smith and Leonard Gray said the uptake of telemedicine had been "disappointingly slow" in light of its benefits, which included an "enormous potential to improve equity of access to health services in a cost-effective manner".
The paper noted there had been "numerous examples of telemedicine failures around the world where large telemedicine networks have been constructed, but under-utilised" and it was essential to integrate such services more seamlessly.
"Telemedicine services should be easily accessible, present no hindrance to the clinician, and should complement conventional outpatient services," the authors concluded in the paper (2009;190:15-19).
"Clinical processes may need to be re-engineered to ensure effective engagement of clinicians and efficient use of equipment."
Gray, a senior research fellow at the Centre for Online Health at the University of Queensland, told Weekend Health that the centre, based on the site of the Royal Children's Hospital in Brisbane, had been running its own paediatric telemedicine service for almost 10 years, and had provided about 7000 consultations.
Satellite centres had been set up in towns such as Mackay and Hervey Bay, equipped with the necessary audio-visual and other communications equipment. Doctors in rural Queensland could ring a 1800 number to speak to a convenor of the telemedicine service, who would make contact with a relevant staff specialist at the hospital.
While some cases could be dealt with in an email or phone call from the specialist, other problems were more complex and for these a booking could be made for communication facilities. The convenor could also help sort through any technical questions.
The system meant the patients could attend the studio-type facility in the smaller town nearer their home, such as Mackay, obviating the need to travel 1100km to Brisbane. Of 140 cases involving children with a suspected heart defect who were referred to the service, only three required to seek treatment in Brisbane. As well as speech and sound, the system was set up to allow other information, such as scans and real-time ultrasound, to be transmitted as well, Smith said. "State hospital systems are spending a lot of money on telemedicine already, but that money is spent on infrastructure -- it's not spent on co-ordinators who make it happen," he said.
Smith said telemedicine's benefits included the building of expertise in local communities. "It also ... provides an excellent opportunity for training and professional support, and may be a useful for recruitment and retention of clinicians in regional and remote areas," he said. "Also, the environmental benefits related to reduced travel should be taken into consideration."
However, he said other existing barriers -- such as the current ineligibility of telemedicine consulations for Medicare rebates -- needed to be addressed. New services should be both integrated with existing outreach services, and thoroughly evaluated to provide the evidence of their cost-effectiveness.
Peter Brooks, executive dean of health sciences at the University of Queensland, said the barriers to greater uptake of telemedicine included the "lack of understanding and acceptance by the health professions and governments" about the potential for telehealth.
"That is why I set up the Centre for Online Health some nine years ago, to do research in these areas and communicate the findings," Professor Brooks said. "Governments need to look at how these new technologies can help and then play a co-ordinating or facilitatory role, encouraging partnerships between universities and health departments -- but most of all ensuring that these services are funded properly with the creation of new Medicare rebates. We (also) need to educate the profession and importantly patients about opportunities that exist to make their lives easier and more connected -- particularly in rural and remote Australia."
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Autor(en)/Author(s): Adam Cresswell
Quelle/Source: The Australian, 17.01.2009
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