Benefits of Telehealth in Australia - Research Paper Example

Telehealth/Telemedicine Name Course Lecturer Date Executive summary Telehealth/telemedicine has developed rapidly in Australia from year 2000. This has been necessitated by the recent innovations in technology and health services. Consequently, this has lead to provision of medical services in new ways bringing them closer to people and in a more refined way. Telehealth/telemedicine has benefited various agencies in Australia such as patients and their families, the government, health professionals and the society at large. Telehealth has reduced the amount of time taken to take care of patients. This technology has facilitated the provision of health services. On the other hand, there are limitations on the use and applications of telehealth/telemedicine services, this report discuss these limitations in details. There is also a comparison of the state of these services in Australia to the international level. The report provides recommendations on how to adopt and implement telehealth/telemedicine in Australia. The report concludes that there are things needed to improve the state of this telehealth to make more beneficial to all Australians and to be used by many people as possible. Table of Contents Executive summary ii Table of Contents iii Introduction 1 Benefits of telehealth/telemedicine 2 Patients and their families 2 Providers (doctors, specialists, nurses) 2 The government 3 Society 3 Limitations of telehealth/telemedicine 4 Requirements for effective delivery of telehealth/telemedicine services 5 Technology requirements 5 Training requirements for telehealth 7 Router 8 Switch 8 Patient Presenter 8 Multi-point Teleconferencing 9 Interactive video or television 9 Integrated Services Digital Network (ISDN) 9 iii) Other requirements for effective delivery of telemedicine services includes 9 Reviewing jurisdiction restrictions 9 Provision of Telehealth support costs 10 C) Create an effective and convenient work environment 10 d) Telemedicine should be mainstreamed into the standard care process 11 e) Making full time coordinator(s) available 11 Australian situation and the international context 11 Recommendations for adoption of telehealth/telemedicine in Australia 13 Conclusions 16 References 16 Introduction Maheu & Allen (2002) defines telehealth as the delivery of related health services at a distance; this is in line with the assertions of (Clough, 1999).  This is challenging the importance and necessity of physical presence in health care circumstances; this is also due to the recent telehealth applications advancement. The use of telehealth in Australia, as (Magjarevic, 2003) illustrates, is expanding rapidly with telemedicine projects increasing considerably from year 2000. This report evaluates telehealth/telemedicine in Australia context. The report addresses the benefits and limitations of telehealth to patients and their families, providers (doctors, specialists, and nurses), the government and society. The report sought to address the requirements for effective delivery of telehealth/telemedicine. In addition, the report compares and contrasts the Australia situation with the international context and provides recommendations on the adoption of telehealth/telemedicine in Australia. Benefits of telehealth/telemedicine Patients and their families There are a number of benefits of telehealth/telemedicine to the patients and their families in Australia as (Dillon, 2003) points out. Telehealth/telemedicine eases access of specialty medical services to patients more so to patients in rural areas. Telehealth makes it possible for patient carers to fully participate. Telehealth/telemedicine increases access of health services education opportunities for the public. It also provides for real time second opinions for patients. The health services provided by telehealth/telemedicine are very cheap as compared to other health services providers in the country. This makes the patients to afford the services with ease and receive quality services altogether. The quicker consultations by telehealth considerably reduce time for investigations, treatment and diagnosis to the patient. Telehealth decreases the number of cancelled appointments as a result of weather or travel conditions. This is made possible by the fact that it permits patients to reside in their area rather than travel long distances to seek the services. Providers (doctors, specialists, nurses) Telehealth/telemedicine increases the scope of available services more so in their facilities in rural primary care. It also improves the continuity of care providing experience and expertise to the providers of the services as (Pain et al 2007) notes. The health provider decrease professional isolation of the providers. Rural practitioners in remote areas are able to have access to health care providers. By using current technology, it allows for video and digital storage of consultations for offline reviews and for teaching as (Hui et al 2001) found out. Professional health care providers get educational opportunities like physiotherapy and nursing. It gives permission to family physicians, caregivers and professionals to be present during consultations so that they can improve their skills in care and treatment of patients. Health providers provide teaching and learning opportunities to physicians present in specialty consultations thereby leading to more breadth of experience. The government It increases opportunities for education for the staff physicians and this helps the patients from travelling from one authority to another seeking for medical attention. This increases staff efficiency and productivity as it reduces the travel time for the health care providers. It also reduces the overall training expenses for the government of the health professionals; it increases the exposure to experts and specialists. It helps in maintaining the role of the primary health care institution within regional boundaries. Society There is increased impact on patient care, the society lives in free with no worries of infections. The provision of health services gives the members of the society insight on how to care for the society members; this is because telehealth providers involve them in consultations (Lim et al. 2000). They are given information and training on how to take care of patients. This benefits the society at large. It also makes it possible to manage and control ongoing care to patients. The society benefits from home telehealth services and this helps patients who prefer to live at home rather than in hospital settings. Limitations of telehealth/telemedicine Demiris (2004) explaints that there is a breakdown in health care professionals and patients relationship. This is brought by communication breakdown due to poor master of the telemedicine technology and poor interpersonal skills. This inhibits disclosure of information from patient to health care providers thereby limiting consultations and poor treatment. The inability to perform a whole consultation as a result of patients reduced confidence in health care professionals and technical difficulties are limitations of telehealth/telemedicine. Demiris (2004) continue to assert that health care professional’s perception of telemedicine has potential bad effects on using telemedicine/telehealth. The continued inadequate regulation of telecommunication and poor infrastructure pose a challenge and it’s a limitation in use of telehealth. Regulation of protocols and policies in use of telehealth is still not well regulated thereby limiting the level of application of telehealth/telemedicine as (Miller, 2007) states. Legal status of telemedicine between and within states causes uncertainties which result in potential medical malpractice liability; this is a limitation in use of telehealth.  Maheu et al (2001) asserts that there is conflict because of confidentiality due to increased unauthorized access to the records of t patients. Stanberry (2006) demonstrate the complications of managing and implementing change in healthcare institutions and highlighted to major barriers associated to using the telemedicine. He pointed out the lack of evidence and quantification of cost effectiveness and telemedicine efficiency applications, differences in culture and linguistic among the patients and health care professionals.  He continues to point out that there are no explicit standards in the use of telemedicine, possible increased workload and insufficient knowledge of telehealth. Hjelm (2006) asserted that many of these limitations could be included in assessment of clinical risks as specific criteria for evaluation in consideration in using telehealth.   Most health professionals are not familiar with telemedicine and this prompts for further research for efficiency and competency of the whole system and staff.  This is further necessitated by the opinion that there is scant evidence on its reliability for therapeutic and or diagnostic interventions. This would address the limitations of telehealth in the whole country and all stakeholders should take relevant actions in ensuring that these improvements are made for the sole purpose of making telehealth efficient and effective. Requirements for effective delivery of telehealth/telemedicine services There are a number of requirements for effective delivery of telehealth/telemedicine services. These requirements are such as education, communication, training, equipments, human resources, technology and stakeholders support as (Lim, 2000) states. These requirements have a defining effect on the quality and level of telehealth/telemedicine services offered in health institutions by health professionals. Technology requirements This provides and identifies major opportunities to better understand and for collaboration on the interaction of telehealth/telemedicine services and health information technology. This helps in the application of telehealth/telemedicine services on local, regions, state levels and national levels. It defines the interdependency of health information technology and telehealth/telemedicine. In addition, it gives a clear ways of leveraging the community’s experiences on telehealth/telemedicine in areas of mutual benefit with technology initiatives. Technological requirements in telehealth/telemedicine are very important as they provide a systematic approach to provision of telehealth. Use of technology such as machine level communication infrastructures lays groundwork for creation of clinical decisions and electronic records support systems. Realization of this technology is vital in growth and standardization in applications of telehealth/telemedicine. The federal government has taken an initiative of speeding up the use of health technology systems. Application of information technology in telehealth/telemedicine links health records by means of interoperable system that ensures there is total privacy of patients and practitioners; it connects providers, patients and payers. Use of information technology results in fewer mistakes, lower costs, less hassle and the most important better health leading to a healthy nation. The government have formulated and partly acquired health technology systems and infrastructures that considerably better telehealth/telemedicine, promoting and coordinating the use of these electronic interoperable health systems and other related health technology initiatives remains the duty of the government. Technology ensures availability, standardized and secure solutions for accessing medical attention.  Information technology can be applied  in many departments and forms in health institutions, however, there are four major areas in which technology is be applied in telehealth/telemedicine, these are   Consumer/patient empowerment   Chronic care   Bio-surveillance and   Electronic records (health) Craig (2006) notes that health institutions and government have put expanded efforts which reflect a serious commitment in integration of health technology programs and initiatives. Adoption of health technology to fulfill technology requirements needs policies, standards and procedures which are only possible when there is health organizations to over the formulation and implementation of the policies, standards and procedures. This enables systematic approaches to innovations and developments which are accomplished by a variety of technology standardization and technical bodies. Telehealth/telemedicine is the main beneficially of this applications and efforts.  Technology is even more important in dissemination and record of information in the process of provision of clinical services in rural areas where the participants (patients) are located at different locations. They aid in communication and eliminate the need for travel to access these telehealth/telemedicine services. Technology also plays a major role in consumer outreach, education and other applications where information technologies and electronic communication support health care services. Training requirements for telehealth There are various ways used in training both patients and health practitioners in telehealth care provision. Router This is a device that provides a crossing point between two networks or that connects sub-networks in a single organization (Rajagopalan et al 2003). It directs network traffic between many localities and it can find the best route between any two locations. For instance, PCs or H.323 video conferencing devices shows the routers where the destination device is sited and the routers get the superlative way to get the data to that far-off point. Switch According to (Down 2001), switch is an electrical device used mostly in video conferencing whereby it chooses the channel of video transmission. Sometimes it is referred as an intelligent hub because it is programmed to routes traffic on a particular port to particular destinations. Hub ports supply the same data to every device. Patient Presenter This is a device that needs the distant provider to carry out an exam of a patient from miles away. It needs a trained person to operate it at the instigating site in order for it to present the patient, control the cameras and carry out every hand on duties to effectively complete the exam (Tang 2005). For instance, a neurological diagnostic exam normally needs a nurse skilled of testing a patient’s reflexes as well as other manipulative activities. In some cases, like interview based clinical discussions such as Telemental Health or Nutrition Services, a licensed practitioner like RN or LPN, may not be essential, and a non-licensed carer such as support staff, could present telepresenting purposes. Multi-point Teleconferencing According to Chang (2002), this is an interactive electronic communiqué between many users at either two or more locations which assists in voice, video or information transmission systems such as graphics audio, computer as well as video systems. This multi-point teleconferencing needs a MCU or a connection device to connect multiple locations into one videoconferencing. Interactive video or television This is analogous that has video conferencing technologies that permits for two way, synchronous, audio signals and interactive video for the sake of conveying telehealth/telemedicine or distant training services. Acronyms always refer it as ITV, VTC or IATV video conference (Wootton 2006). Integrated Services Digital Network (ISDN) This is an ordinary dial –up programmer channel for teleconferencing. The charges for ISDN accumulate at some contracted rates which are then billed to the location of the placing call, because the services are used on demand by dialling another ISDN based device. The service is regarded as analogous for using the dialling characters that are connected with a long distance telephone call. The originator of the call pays the bill and ISDN allows associations up to 128Kbps (LaMonte et al 2003). iii) Other requirements for effective delivery of telemedicine services includes Reviewing jurisdiction restrictions Licensing is a major area of concern in regard to telehealth (Landgreen 2001). For instance, psychologists ought to be registered in order to work with patients from another state. This makes it difficult to offer services to clients who have retired to another state. According to Wootton et al., 2003 most clients prefer to take their ongoing therapy with the current provider, instead of finding a new provider and begin a new relationship. Current various laws do not provide adequate guidance considering that most states still continue to follow policies that were devised before technology allowed interaction of provider and client from different state. Thus, analysts have argued that coming up with better and more feasible system will enhance delivery of telehealth services (Paing et al. 2009). Provision of Telehealth support costs This can be done by creating a long term financial plan in any state. Even when financial considerations may not be the principal objective in telemedicine programs in a state, they remain critical. A solid financial justification ensures success and effective delivery of telehealth services. Making clear financial goals both for the short and long term, will drive reaching the telehealth goals (Wootton et al. 2003). C) Create an effective and convenient work environment Jennett et al., 2003 observes that telehealth must be available and accessible where it is required. This means that, for effective delivery of this service, equipment must be readily available where care is to be provided as well as near to the consulting physician. The sending room ought to be an environment that is similar to a usual patient exam room. Thus, it should be able to address the unique requirements of telemedicine like layout and lighting without interrupting the already existing healthcare process. Receiving room on the other hand ought to be near the consulting physician workplace and well equip similar to a typical work environment (Herrick 2007). d) Telemedicine should be mainstreamed into the standard care process Mainstreaming is supposed to be an objective of any manner of telemedicine program implementation. Delivering care through telemedicine should be similar to delivering care without it. As Loane and Wootton, 2002 observes, high utilization is realized only if telemedicine is made part the regular normal care process. This involves simplified measurements, scheduling, documentation, and billing systems and protocols. Details counts in healthcare. For this reason, standard protocols in regard to equipment use, as well as for examination and documentation, must be written for each and every medical specialty. The protocols ought to follow the standard employed in non-telemedicine in the most way possible. As a result, this structure gives greater comfort for providers and more constant clinical results are realized. e) Making full time coordinator(s) available For telemedicine implementation, personal requirements must not be under-estimated. Scholars have argued that telemedicine has focused much on the technology, rather than the coordinators resulting to minimal achievements. Full time coordinators engaged in day to day support, operations, and serve the users. These personnel schedule sessions, address issues, encourage users and ensure everything is working well. The coordinator therefore, should have commitment, skill and passion (Darkins et al. 2008). Australian situation and the international context The Australian teleHealth initiative was launched in 2011 under the National Digital Economy Strategy. This was a vision that targeted a National Broadband Network as the country moves towards a digital economy in the year 2020. Electronic technologies for communications are the ones that have been employed in this kind of strategy aimed at improving the people’s welfare. The Australian teleHealth initiative ensures that people in rural and remote areas are capable of receiving services from medical specialists. There are different components of TeleHealth in Australia. They have a technical aspect, clinical usage aspect as well as health servicse context (Australian Nursing Federation 2013). The technical aspect consists of the use of software along with hardware mechanisms in achieving a videoconferencing function. The clinical usage aspect includes the support given to clinical processes as well as considerations that are appropriate in the same case. The third are health services context where videoconferencing is utilized with the closely related requirements being put in their proper place. The context of the services is physical, profession and even of the business environment (Australian College of Rural and Remote Medicine 2013). At the same time, Australian TeleHealth is guided by principles that are envisaged in the basic standards governing the professional conduct provided in the health care profession. The principles are aimed at the protection of the patients who receive the TeleHealth services. Despite the growing intensity of the use of TeleHealth services, Australia has come late in the field and more development is underway to ensure that the services are well utilized and at the same time effective (Australian College of Rural and Remote Medicine 2013). The Australian organization of the TeleHealth services envisages different field such as telenursing, teletriage, on-line video consultation, among others. The services are considered in a cluster, such that it is hard to identify any of the defined TeleHealth services by itself while discussing the nature of TeleHealth in Australia. Terminologically, it is worth noting that these services are different but considered under one (Australian Nursing Federation 2013). Still according Bywood et al (2013), the main target of the Telehealth services is the rural population as well as the remote areas as compared to other countries where TeleHealth Services are given to the entire nation’s population; whether in the urban areas or rural areas. America, Germany, and Netherlands are examples of countries where TeleHealth services are given indiscriminately to the entire population. Australia faces the challenge of resources and time for the services compared to other countries where the services are more effective or not at all existent. However, this cannot be termed much a challenge considering the time when the services were introduced in Australia. It therefore stands as an example of the countries that have moved faster in embracing this form of technology and services in such a short time, that is, since 2011. To this due, it is notable that Australia has moved some steps in these forms of services to enhance health services. Economically, these services have been maintained and more needs to be invested before it becomes well placed in the international field. Still, enhance computer literacy will be an added advantage to this growth. Recommendations for adoption of telehealth/telemedicine in Australia Darkins & Cary (2000) explains that telehealth market developments have been siloed and sporadic rather than ubiquitous in Australia. A good example of this is the institutional telehealth which comprise the hospitals and public agencies, it has been stable though stagnant, and the developments have been limited to pilots which are based on proprietary device technologies and management system which is siloed. The consumer telehealth has lagged behind as well in spite of the explosion of innovations, many of them are proprietary which have data stored in users phones or either uploaded in web portal of the vendor as chew points out. With this concern, telehealth landscape must be improved from the current state of siloed proprietary model to client oriented, technology based, open principles service platforms models in order to eliminate the need for heavy investments to the end users (doctors, caretakers, patients) as emphasized by Lim et al (2000). Lack of clear regulations and policies is proving to be a handle as the absence of defined procedures hinders implementation of telehealth and telemedicine and ensuring the health practitioners perform their jobs efficiently and the comfort of the patients is safeguarded. This can be overcome by aligning telehealth with overall health care goals. This would ensure that health institutions align their goals in line with those of federal government and all hospitals, health organizations and agencies. Full implementation of telehealth policies and regulations would lead to developed markets, lead to clinical efficiency, cost benefits and more importantly high satisfaction of the patients. Joint public – private investment plays a major role in push for adoption of telehealth. This would be even more rampant if policy, procedure and regulation policies were solved at government level. Joint public private support would ensure that that implementation of telehealth do not die down as there would be enough resources in human expertise and funds for implementation (Lim et al. 2000). Government recognition of telehealth as the future of health care helps in putting the essential requirements for success in sustained and concrete support. In essence, public - private partnership in adoption of telehealth would be rampant and realized up to the last stage of implementation. The Australian government should embark on this initiative. The government should formulate would boost its use among the citizens. To improve telehealth, sharing of information must be equally improved by improving access to information and learning with peers. This would make it more widely used. Balance of power changes between clinician and patient which are brought about by technology, this sets the bar high which is good. Besides, having solutions which integrate easily with everyday life and demand led solutions would be successful. Adopting telehealth/telemedicine without training patients would realize little success, in this regard, it is very important to train them (Chang 2002). This requires big investment in time and funds as telehealth needs one-to-one nursing time. This would eventually be realized for the long term. Education and health disciplines must be addressed in order to overcome lack of pedagogical and professional progress representation for the health workers concerned with telehealth applications. Conclusions This report points out that there are noteworthy break in research around the evidence supported on practices in telehealth that may have significant implications for Australia as (McClellan, 2008) advises. Telehealth training should be joined with students and practitioners practices every day and must be linked to practice opportunities to retain competence. 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