Australian Telehealth Conference
29 August 2012
Medicine and healthcare regularly make the news with the latest breakthroughs.
The momentum, change and innovation captures the public’s attention.
Today, it is the new and unprecedented direction of telehealth that transforms the health service delivery landscape.
We are at the beginning of a new era, where quality healthcare is no longer limited by geography, distance or mobility.
It is an era where digital technology can deliver the right healthcare to the right people, at the right time.
It is an era of incredible breakthroughs.
We all know Australia faces significant, long-term challenges in the area of health service delivery.
A rapidly ageing population, the rise of chronic diseases, and an ageing health workforce all combine to rapidly intensify the pressure on our healthcare system.
Already, more than two-thirds of current health expenditure relates to treatment of chronic diseases.
This is only going to grow.
The costs from diabetes alone is predicted to increase by a staggering 436 per cent by 2033.
Costs from type 2 diabetes will increase by 520 per cent.
By 2050, real health spending on those aged over 65 years is expected to increase seven-fold.
Those aged over 85 years will increase twelve-fold. [i]
Clearly these demands on the healthcare sector present real challenges for us all.
We need to ensure that we have a health system that can respond to the pressures.
And one that can also adapt to the changing health needs of the population.
Digital innovation is a way of meeting these challenges.
Online innovation will allow us to develop new, more efficient approaches to delivering high-quality healthcare.
The National Broadband Network (NBN) is the platform that will drive innovation in Australian healthcare.
Its superfast download and, critically, upload speeds will transform how we do things.
High-speed, high-capacity broadband to the home makes it possible to provide quality telehealth services to all Australians.
Telehealth applications require reliable connections, high-definition videoconferencing, and the ability to transfer large files quickly.
High-definition videoconferencing is much more demanding of broadband connections than traditional applications such as internet browsing or one-way, ‘YouTube’-style video.
The NBN provides highly stable connections that are very reliable in terms of the speed and capacity they provide.
Currently, standard definition videoconferencing is within reach of only the best DSL and mobile connections.
Research by Monash University and the Alfred Hospital has compared telehealth delivered by ADSL to that by the NBN.
Led by Professor John Wilson, it identified a number of problems with ADSL that impaired diagnostic confidence and impeded clinical rapport.[ii]
In contrast, NBN fibre is robust, reliable and supports applications that need assured internet performance and high-speeds and capacity.
People living in the areas outside the fibre footprint will also benefit from improved telehealth services.
They will be able to access next-generation fixed-wireless and satellite services better than services currently available in many urban locations.
The initial upload speeds of one megabit per second provide sufficient bandwidth to deliver standard definition video.
I’m going to take this opportunity to give you a brief update on where the NBN is at.
This is not always clear from what you might read or hear in the media.
The good news is that the NBN is well and truly underway.
By the end of this year, work on fibre for 758,000 homes and businesses around the country will be underway or complete.
By the middle of 2015, work will have begun or be completed for 3.5 million homes and businesses.
Construction contracts are in place for every state and territory.
We have 30,000 premises passed by fibre – that is, ready for connection. And we are finding that demand is stronger than we were expecting.
Across the first eight release sites around the country, the average take-up rate is 20 per cent.
In Kiama, just south of Sydney, take-up in just over twelve months is an extraordinary 40 per cent.
In Willunga, in South Australia, it is 38 per cent, also over twelve months.
International telco executives are simply amazed when they hear about this level of take-up in such a short period of time.
In rural and remote areas we are also making good progress.
The Interim Satellite Service is seeing strong demand.
There are over 13,500 customers connected since it was launched in July last year, with hundreds more connected each week.
This service has been particularly well received with 82 per cent of customers saying they are happy with it.
This service will be upgraded in 2015 when our two dedicated, state-of-the-art NBN satellites are launched.
Contracts for the construction of these satellites have been signed and work is underway at a facility in California.
We are building our fixed wireless network on the outskirts of country towns.
There are nearly 200 active customers around Ballarat, Armidale and Tamworth online.
The fixed-wireless service will by 2015 cover hundreds of thousands of homes and businesses in rural areas.
On the retail side of things, we are already seeing vibrant competition for NBN services.
Entry level services are very affordable, starting at $29.95 per month from one retailer, with many packages being offered between $30 and $50 per month.
Because this does not include line rental, which many of us must pay from Telstra, this can represent a significant saving for many consumers who are using copper based ADSL.
So what we are seeing is the market and Australians embracing the NBN.
What this means for you is that Australians are increasingly going to have access to the broadband that will allow you to deliver the services we are here to explore today.
In Australia, Access Economics has put the potential benefits of NBN-enabled telehealth at between $2 and $4 billion each year.[iii]
The government is supporting a number of initiatives to test how high-speed broadband can transform health service delivery.
This audience is well aware of these.
Two trials are underway to demonstrate the opportunities to provide telehealth services using the NBN.
One is a diabetes trial in Townsville that you will hear more about a bit later from those involved in implementing it.
The others in Armidale and Kiama are for people with chronic disease, and a youth mental health service.
These trials will provide the information we need on the impacts, outcomes and opportunities of in-home telehealth services.
They will inform how Australia’s health and aged-care systems can best harness the NBN to deliver services to the home.
The Departments of Health and Ageing, and Veterans’ Affairs, are funding a number of other NBN-enabled telehealth initiatives.
The NBN-enabled Telehealth Pilots Program is using the NBN to deliver innovative in-home telehealth services.
These services will target older Australians, people living with cancer and those requiring palliative care.
There has been very strong interest in the program and the successful applicants will be announced soon.
The Australian Government has also co-funded telehealth projects with state and territory governments through the Digital Regions Initiative.
I have over the last month visited two of these.
The Health eTowns project is designed to improve the delivery of health and education services to people in 47 remote towns in the Northern Territory.
IP Patient Monitors are now enabling telehealth services at emergency rooms and resuscitation areas in regional hospitals and 17 towns.
In 2011-12, more than 2200 video calls, including teleconsultations, were made.
In South Australia, the SA Digital Telehealth Network project has already implemented over 100 videoconferencing units across the state.
The network is improving mental healthcare throughout South Australia, including indigenous communities in the APY Lands.
In just one month, a total of 655 video conference calls were recorded.
We heard from one of the mental health patients at the launch who said of the service:
“The quality and clarity of both image and sound is like being in the same room with my psychiatrist.
“It is much more convenient - no tyranny of distance or time constraints, no large petrol cost or parking costs and I can be seen quickly and regularly and stay local.”
This service is a great example of how telehealth can be used to meet the needs of the patients.
The challenge for the future is how to make telehealth services sustainable and part of everyday healthcare delivery.
The new MBS items are an incentive.
But a number of other factors will need to be considered in order to make telehealth sustainable long-term.
- developing appropriate clinical standards;
- considering patient safety requirements across a range of telehealth services, and;
- convincing medical practitioners and practice managers of the financial and workflow benefits.
Current telehealth trials will provide us with the data we need to implement ongoing telehealth initiatives.
This is, as I said, a completely new era.
The NBN allows us to revolutionise heath service delivery across the country.
It allows us to meet current demands on our healthcare system as well as the challenges of the future.
The government is working to ensure we maximise its capabilities.
I look forward to your insights on the opportunities new digital technologies offer for delivering innovative and effective health services.
[i] Australia to 2050: Future Challenges Report p.51
[ii] Potential telehealth benefits of high-speed broadband, Monash University, The Alfred Hospital and Deloitte Consulting, August 2011: http://www.dbcde.gov.au/digital_economy/benefits_of_digital_economy_from_nbn
[iii] Economics, ‘Telehealth for Aged Care’ 2010: http://www.dbcde.gov.au/__data/assets/pdf_file/0014/131900/Telehealth-for-aged-care.pdf