Broadband for Health€¦ · 62% of participants were connecting to broadband for the first time. This represents a significant improvement from the situation in 20031 when: • 9%

Broadband for Health

Prepared for

Department of Health and Ageing

Evaluation Report

25 June 2009

Broadband for Health Evaluation Evaluation Report

ISBN: 978-1-74241-059-3 Online ISBN: 978-1-74241-060-9 © 2009, Commonwealth of Australia This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part of this report may be reproduced by any process without prior written permission from the Commonwealth. All requests and inquiries concerning reproduction and rights should be addressed to the Commonwealth Copyright Administration, Attorney-General’s Department, Robert Garran Offices, National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca This report contains information and images prepared with the assistance of Communio Pty Ltd for and on behalf of the Commonwealth Department of Health and Ageing. While the information contained in this report has been formulated with all due care and is considered to be true and correct as at the date of publication, the Commonwealth does not warrant or represent that this report is free from errors or omission, or that it is complete or exhaustive. This report is made available on the understanding that the Commonwealth and its employees and agents shall have no liability (including but not limited to liability by reason of negligence) to the users of this report for any loss, damage, cost or expense whether direct, indirect, consequential or special, incurred by or arising by reason of any person using or relying on the report whether caused by any error, omission or misrepresentation in the report or otherwise. Users of this report will be responsible for making their own assessment of the information contained in this report. The Commonwealth does not accept any legal liability or responsibility for the accuracy, currency, reliability and correctness of any information provided by third parties which has been included in this report.

Prepared by Communio Page 2 of 48 25 June 2009


Table of contents

Table of contents................................................................................................................. 1

Executive Summary ............................................................................................................ 4

Recommendations............................................................................................................. 11

Document details .............................................................................................................. 12

Terms and Acronyms........................................................................................................ 13

Description of the Program............................................................................................... 14

Security ............................................................................................................................. 19

Governance ....................................................................................................................... 21

Administration .................................................................................................................. 22

Marketing.......................................................................................................................... 23

Case Study ........................................................................................................................ 27

Findings: Community Pharmacy Program........................................................................ 28

Findings – General Practices ............................................................................................ 30

Barriers and challenges ..................................................................................................... 34

Lessons learned................................................................................................................. 35

Future eHealth Programs .................................................................................................. 37

Attachment 1: Broadband Definitions ............................................................................. 39

Attachment 2: Eligibility Criteria ..................................................................................... 40

Attachment 3: Value Added Services ............................................................................... 42

Attachment 4: RRMA Classifications .............................................................................. 43

Attachment 5: The Security Awareness and Conformance Report .................................. 44

Attachment 6 – Role of State Based Implementation Officers......................................... 46

Attachment 7 – Qualified Service Providers .................................................................... 47

Attachment 8 – Qualified Service Providers by Practices ................................................ 48



Executive Summary

Broadband for Health Program

The Broadband for Health Program (BFHP) was established to build capacity in the health sector for secure, functional and equitable participation in eHealth. It aimed to allow eligible health care organisations - general practices, Aboriginal Community Controlled Health Services (ACCHS), the Royal Flying Doctor Service (RFDS) and community pharmacies - to take advantage of the potential benefits of broadband technologies. The BFHP operated between 1 July 2004 and 31 December 2007 and provided incentive payments to eligible healthcare providers to assist them to purchase BFHP qualified services for connection, or upgrade to, business grade secure broadband.

Overall Achievements

The program has been successful in driving demand for, and take-up of, business grade broadband among eligible healthcare providers. It achieved significant penetration in all targeted provider groups and across rural and remote locations. Success was measured by both the number of organisations who participated in the program and the number of participants connecting to broadband for the first time. To demonstrate this success at the conclusion of the program a business grade broadband connection had been taken up by: • 66% of eligible practices • 96% of eligible pharmacies • 100% of RFDS; and • 88% of ACCHS. 62% of participants were connecting to broadband for the first time. This represents a significant improvement from the situation in 20031 when: • 9% of medical practices surveyed had no internet connection • 32% of practice managers surveyed had broadband connection • 72% of medical practices surveyed thought daily government transactions

could be made simpler with the use of technology • 40% of pharmacies had broadband connections2.

Continued on next page

1 Survey conducted in 2003 through the Australian General Practice Network (AGPN). Data was collected from 654 practices in 40 Divisions of General Practice nationwide. 2 Information provided by the Pharmacy Guild January 2009 on a survey they had conducted prior to the BFHP


http://www.adgp.com.au/site/index.cfm


Executive Summary, Continued

Overall Achievements

Health care is an information-intensive industry, with information transactions occurring extensively on a daily basis. The ability to securely and efficiently store and exchange appropriate information, store dynamic messaging, visual imagery, or voice, is highly dependent upon the capacity of the underlying communications infrastructure3. The program created the foundation for the take-up of eHealth opportunities by providing a minimum communication platform. This will enable ongoing improvements in communication, data storage and access, all of which are critical to operational efficiency and patient safety. In addition to take-up the overall understanding of information technology security requirements were significantly enhanced through the use of the Security Assessment and Conformance Report which is now an industry standard4. The achievements of the program in encouraging take-up amongst eligible healthcare providers, and its penetration in rural and remote areas is outlined below.

General Practitioners

A total of 4618 practices, representing a total of 66% of all eligible practices (including general practices, after hours practices, ACCHS and RFDS) took advantage of the program. As a result of the BFHP practices are moving to utilise other technologies (on line pathology and radiology, and electronic messaging). These technologies support efficiencies in communication and provide an opportunity to improve health service delivery and known factors in reducing adverse events5. Many incentive recipients subsequently have participated in the Managed Health Network Grants program which built on the BFHP.


3 Australian Government Department of Health and Ageing eHealth Implementation Group Response to Broadband Connect and Clever Networks discussion paper 18/01/06 4 Security Guidelines for General Practitioners (February 2005) and Pharmacy Connectivity Incentive Program Startup Security Allowance 2008- 2010 5 Australian Health Ministers Conference. 2008 National EHealth Strategy pg 3 and 23 and Bhasale A., Alice L,. et al Analysing potential harm in Australian general practice: an incident-monitoring study MJA 1998; 169: 73-76




Pharmacies The BFHP was a significant driver in connecting pharmacies to broadband

with 96% of the 4975 eligible community pharmacies taking up the incentive. Prior to the introduction of the BFHP only 40% of pharmacies were connected to the internet and about half of these were connected to dial-up modes6 The increase in broadband take-up by pharmacies has led to the success of a number of other programs. Participation in PBS Online, the online claiming system for the Pharmaceutical Benefits Scheme, was enhanced as a result of increased broadband connectivity. The program has assisted pharmacies to improve workflow, increase their efficiency and reduce administration burdens and costs through higher participation in PBS Online which allows pharmacies to submit and receive more timely payments from Medicare Australia7.


6Information provided by the Pharmacy Guild Australia on a survey they conducted of pharmacies prior to the commencement of BFHP 7 Information provided by the Pharmacy Guild January 2009




Rural and Remote

Of eligible general practices, 80% of remote and 61% of rural practices took up the incentives. The penetration across rural and remote locations was higher than metropolitan areas where 57% of eligible practices took up the incentives. 88% of eligible ACCHS have received an incentive under the program. This has contributed to participation and adoption of other programs and systems including, Patient Information Recall Systems (PIRS), the Managed Health Networks Grants Program and the HealthConnect, Northern Territory Program8. 100% of eligible Royal Flying Doctor Services participated in the BFHP.

Program Administration

The Department was highly committed to the success of the program reflected in a high level of promotional activity and liaison with industry groups and peak bodies. The Department took a responsive approach to ensuring evolving challenges were addressed to maximise the potential outcomes of the program including: addressing exceptional circumstances claims, working with small providers to ensure the program met their needs, introducing subsidy renewals, working with Demand Aggregate Brokers, adjusting incentive levels and “troubleshooting” as required.

Program Challenges

Overall no significant barriers were experienced in the roll-out and take-up of the BFHP. As with all national change programs, however, BFHP was not without its challenges. These predominantly related to the technology environment and administrative issues. These are not considered to have significantly impacted on the objectives and outcomes of BFHP and provide useful lessons for the Department in the design and implementation of future programs.


8 National Strategic Framework for Aboriginal and Torres Strait Islander Health. Progress against jurisdictional implementation plans. Report to the Australian Health Ministers’ Conference




Program Challenges (continued)

Technology In an environment of rapidly changing technology and despite the best efforts to define business grade broadband for health (particularly taking into account rural and remote issues), technology relating to speed and security, outstripped the definition during the life of the program. It demonstrated the difficulties in developing definitions in a manner that keeps pace with the rapid evolution of technology. Consequently when setting definitions at a point in time for a 2-3 year program, it is is advisable that a review period be incorporated, or that there is a requirement for recipients / providers to abide by improvements in industry level standards as they evolve. Administration The initial manual system used for the administration of the incentive payments was unable to cope with the volume of incentive applications. This caused some angst amongst stakeholders until an electronic system was implemented at which time the timeframe for processing payments significantly improved. When designing and timing the implementation of such programs, sufficient lead time should be allocated to ensure the appropriate administrative arrangements are in place. Where potential delays are identified it is important to ensure stakeholders are adequately informed in order to minimise stakeholder unrest. The management of delays can be resource intensive and detract from the purpose of the program. Internet Service Providers Some Qualified Service Providers failed to efficiently provide participants with a Statement of Supply as required under their Service Provider Procedural Requirements. This limited the participants’ ability to apply for the incentive payment. The Department and Medicare Australia addressed these issues with the Qualified Service Providers involved. This did, however, consume significant resources and created concern for all parties. Remote Area Services Initially very remote services faced difficulty accessing the program due to geographic, service availability and business volume issues. The Department identified these barriers early in the program’s implementation and provided substantial incentives towards take-up of appropriate technologies, including wireless and satellite. This enabled virtually any eligible healthcare provider in any location to connect to and utilise the program.





Lessons Learned

The following lessons can be drawn from the BFHP: • Incentive payments can be instrumental in achieving change when

they are set at an appropriate level. • Promoting collaboration between key players can have positive flow

on effects as service providers become more familiar with the needs of particular segment sectors.

• Communication throughout a program’s life needs to be simple, consistent and repeated regularly.

• The involvement of peak agencies is a useful strategy in providing ongoing support and promotion to stakeholders.

• High level involvement of the Department in cross sectoral processes is essential in addressing the needs of, and streamlining services / incentives for, healthcare providers.

• Demand aggregation is an appropriate model for sustainable connectivity in regional areas. This involves ‘pooling’ together the demand for connectivity in rural or remote areas in order to make service connection more cost-effective. This has the impact of encouraging virtual amalgamation of some business processes (such as IT support and access to information management tools). In order to achieve this the Health sector needs to continue to look beyond its own services.

• Flexibility and responsiveness in program implementation is important in engaging with stakeholders and to improve the ‘user friendliness’ of the program over its life.

• Early establishment of evaluation criteria ensures appropriate data collection through the life of a program.





Conclusion The degree of take-up in this program is testament to its success. The

Government’s objective of assisting individual business units across the health sector to establish the building block to progress participation in eHealth has been well served by the program. The program has been effective in increasing the use of business grade broadband among healthcare providers. The program assisted in offsetting the costs of computerisation and increasing connectivity. The take-up of secure, business grade broadband through the program has laid a solid foundation for other initiatives such as secure electronic messaging and projects under the Managed Health Network Grants Program. The overall administration of the program was efficient and effective, albeit noting there were challenges. The extent to which the program improved relationships and understanding of need between general practices, pharmacies, the Royal Flying Doctor Service, Aboriginal Controlled Community Health Services and Internet Service Providers is difficult to quantify. It has, however assisted both healthcare provider organisations and Internet Service Providers identify new business requirements and opportunities which will enable them to move forward with a collaborative approach to eHealth.



Recommendations

Recommendations For future programs it is recommended that the following be considered:

• Allowance for sufficient lead time to develop efficient administrative systems to support the program.

• Standards/definitions should incorporate the capacity to respond to potential technological advances during the life of the program.

• Organisations should be adequately supported to effect implementation on behalf of the Government.

• A system such as one based on capped levels per RRMA classification, is preferable in that it accommodates market change while still providing flexibility to meet provider requirements (see page 40).

• A pre and post evaluation tool such as the Security Awareness and Conformance Report (SACR) is useful in quantifying change brought about by such programs.

• Administrative arrangements should take into account the potential for varied levels of processing requirements during the life of the program.

• A standardised reporting template should be developed for Departmental use to ensure monitoring and tracking records are consistent over time and easily interpreted regardless of personnel changes.



Document details

Purpose of this Document

This report was commissioned by the Australian Government Department of Health and Ageing (the Department) to evaluate the Broadband for Health Program (BFHP). The evaluation of this program allows the opportunity to learn from its successes and challenges and to inform future work.

Preparation This document has been prepared by:

• Christine Farraway, Project Manager/Consultant, Communio • Cathie O’Neill, Executive Manager, Communio

The evaluation has been informed by documents provided by the Department, interviews with Departmental staff, representatives of the Pharmacy Guild of Australia and the Australian General Practice Network.



Terms and Acronyms

Abbreviations The following terms and acronyms are used throughout this document. Term Definition ACCHS Aboriginal Community Controlled Health Service ADSL Asynchronous Digital Subscriber Line AGPN Australian General Practice Network BFHP / the program

Broadband for Health program

BFHP WG Broadband for Health program Working Group DoHA / the Department

Australian Government Department of Health and Ageing

DSL Digital Subscriber Line eHealth The electronic management of health information to deliver safer, more

efficient, better quality healthcare GP General Practitioner IM Information Management ISP Internet Service Provider IT Information Technology LAN Local Area Network NACCHO National Aboriginal Community Controlled Health Organisation NBSIG National Broadband Strategy Implementation Group OATSIH Office of Aboriginal and Torres Strait Islander Health PBS Pharmaceutical Benefits Scheme PIRS Patient Information Recall System Qualified Service A Qualified Service was a broadband service approved by DoHA as

meeting Broadband for Health requirements. Qualified Service Provider (QSP)

A Qualified Service Provider was a supplier of Broadband which was assessed by the Australian Government Department of Health and Ageing to become a provider of Qualified Services.

RACGP Royal Australian College of General Practitioners RFDS Royal Flying Doctor Service RRMA Rural, Remote, Metropolitan Area Classification system – see Attachment

5 for details SACR Security Awareness & Conformance Report SBIO State Based Implementation Officer SEHR Shared Electronic Health Record UIN Unique Identification Number VoIP Voice over Internet Protocol VPN Virtual Private Network WAN Wide Area Network



Description of the Program

Introduction Broadband is considered a key enabler and change agent for secure, functional,

and equitable participation in eHealth activities. The Broadband for Health Program (BFHP) sought to build this capacity in the health sector. It allowed eligible health care organisations (Attachment 2 – Eligibility Criteria) to take full advantage of the potential benefits of broadband technologies (Attachment 1 - Broadband Definitions). Access to broadband can provide significant and immediate health connectivity advances and, in doing so, deliver a range of benefits to consumers, providers and the community at large. Business grade broadband under BFHP included:

• 512/256kbps upwards (or 512/192 kbps for satellite) • carrier firewall • antispam • antivirus • email service • download allowance • professional installation • support • broadband specific hardware up to and including the ethernet point (this

was provided by the Service Provider and excluded computers, keyboards etc).

The BFHP provided incentive payments to eligible practices to cover the costs of broadband connection and a 12-month subscription to Qualified Services. Practices were also able to purchase additional services (such as VoIP) up to a capped level according to their location. (Attachment 3 – Value Added Services). For the purposes of the BFHP, types of broadband were classified as terrestrial (DSL and cable), wireless and satellite. Satellite incentives were only available where access to terrestrial or wireless services were not available.



Eligibility Eligibility requirements provided in the documentation provided for BFHP are at Attachment 2. Eligible practices were required to select a Qualified Service and sign a contract with the chosen Qualified Service Provider (QSP). A payment claim form could then be submitted to Medicare with a Statement of Supply from the QSP. The program targeted:

• ACCHS • Community Pharmacies • General Practices • RFDS • After hours general practice services




Description of the Program, Continued

Existing Broadband Users

Incentive payments were available to any eligible healthcare organisation even if they were current broadband users, providing they were using a Qualified Service provided by a QSP. Practices/services could transfer to a QSP to establish eligibility for the program incentive.

Incentive Setting

The initial incentive was based on the lowest cost qualified service in each postcode on the date of contract signature. This had a significant effect in bringing down the price of business-grade services available under the program. It also meant, however, that health care providers were choosing the most inexpensive (fully subsidised) services and in some cases receiving poorer customer service in return. Complaints received regarding these services resulted in the need for the Department to intervene where QSPs were not complying with program guidelines. To enable health care providers to move to more advanced services, and provide a simpler model for administration, the capped Remote, Rural Metropolitan Area (RRMA) (Attachment 4 – RRMA Definitions) incentive was introduced. The incentive was set at a level sufficient to meet the full installation and 12-months usage costs of at least one qualified service and to provide the opportunity to purchase of additional value-added services, capped by geographic zones. Incentive levels were reviewed quarterly throughout the program. The amount of incentive payment reduced over the life of the program in an attempt to assimilate the cost of business grade broadband into normal business costs. Incentives were stratified across the RRMA levels (Table 1).

Incentive Levels

Table 1: Incentive by RRMA Terrestrial /Wireless Satellite

RRMA Category up until 31

st

December 2006 from 1 January 2007

up until 31st

December 2006 from 1 January 2007

RRMA 1 $1,549.00 $774.50 $4,743.00 $2,371.50 RRMA 2 $1,626.00 $813.00 $4,980.00 $2,490.00 RRMA 3 $1,707.00 $853.50 $5,229.00 $2,614.50 RRMA 4 $1,793.00 $896.50 $5,491.00 $2,745.50 RRMA 5 $1,883.00 $941.50 $5,765.00 $2,882.50 RRMA 6 $1,977.00 $988.50 $6,053.00 $3,026.50 RRMA 7 $2,009.00 $1,004.50 $6,356.00 $3,178.00





State-Based Implementation Officers

As part of the program, a State-Based Implementation Officer (SBIO) was established in each state and territory. The SBIOs were coordinated and led by the Australian General Practice Network (AGPN). The role of the SBIOs was to promote the program to the target groups and broadband service providers and facilitate effective working relationships and solutions. The SBIOs were required to engage and support Divisions of General Practice, ACCHS and pharmacies to take up broadband services and to provide user support and training. In order to contribute to the wider implementation at a national level, SBIOs collected relevant state/territory data, mapped broadband usage and maintained Issues Registers (Attachment 6 - Role of SBIO). Of particular benefit to the program was the SBIO’s demand aggregation role. Participants were encouraged to work together in connecting broadband services to make them more cost effective. The SBIOs also had a key role in promoting the program via conference forums, Divisions newsletters and liaison with eligible health care organisations, Medicare Australia and the Department.

Service Delivery

Strong policy and program guidelines were developed in order to ensure that the program offered incentive payments to participants that would allow the take-up of broadband connections of the greatest benefit to their business. Subsequent to the development of the policy governing the program, it was recognised that a flexible approach would allow for the continual improvement of service delivery throughout the life of the incentive. The key aspects of the service delivery approach were: • The qualification of 63 internet service providers to provide services under

the program, representing approximately 95 % of potentially qualifiable services used by the sector. The Department was proactive in identifying service providers currently serving health clients and encouraged their application as a Qualified Service Provider.

• The introduction of greater flexibility to qualifying service providers in rural areas to allow for increased equity of access. This included a change in accounting for the ‘reseller’ and ‘proxy’ approach used in remote areas.





Service Delivery (continued)

• Increased security awareness through the use of the Security Awareness and Conformance Report (SACR) which has been integrated into relevant standards and accreditation programs;

• The development of the business grade broadband definition as a key step in attracting vendors and allaying fears regarding applicability for the privacy conscious health sector;

• The identification of the primary care sector as a discreet market segment for telecommunication service providers. As a result of the BFHP, vendors are now providing customised programs targeted to primary care (Case Study - page 26).

• The availability of value added services to enable providers to tailor services to specific settings. In one instance the provider changed the hardware to meet the needs of a group of users. Another example was the provision of online back-ups.

• The engagement of Enex Pty Ltd to conduct monthly data speed testing to ensure the services offered were competitive in terms of industry development and that QSPs were delivering services in line with Program requirements.

Exceptional Circumstances

Once deemed to be eligible , participants were issued with a Unique Identification Number (UIN) to identify them as participants with Medicare Australia, the Department and Qualified Service Providers. The program guidelines allowed practices who were not initially issued with a UIN to be able to outline their claims in writing, including evidence of assessment of the Qualified Services. For a range of administrative reasons the initial roll out in 2004-05 resulted in a number of primary care services not being assigned a UIN. A large number of ACCHS (over 50), including substance use treatment services, sought exceptional circumstances consideration. In all cases, these organisations were found to be fully eligible under the existing criteria. The Department also agreed to assign individual location UINs to a large number of smaller clinics (approximately 30) associated with ACCHS, typically in remote areas. These sites exist within the framework of a larger ACCHS organisation and are therefore not identified as unique entities. Nonetheless, the sites represented unique stand-alone points of care and were considered as fully eligible for a location UIN under the eligibility criteria.





Exceptional circumstances continued

There were few exceptional circumstance applications made by organisations deemed ineligible for a UIN relative to the number of applicants. Most applicants deemed ineligible on first assessment were later assessed as eligible following an assessment of the merits of each case. This attests to the program’s governing policy being simultaneously robust and flexible.

Security

Security Awareness and Conformance Audit Report

The Australian Government sought to raise awareness of secure computer management in practices through the program. From 1 July 2005 practices applying for the incentive were required to complete a Security Awareness and Conformance Report (SACR) to be eligible for an additional $1000 payment. The report was developed in partnership with the General Practice Computing Group and security experts and provided a checklist to enable practices to review their security arrangements. The $1000 one-off payment was available through the program to encourage practices to complete the report and address any security issues identified as relevant to their specific business. The checklist aimed to significantly enhance practices’ understanding of IT security issues. An action guide was available to assist practices in both assessing and improving their security. The incentive was intended to cover IT provider labour and practice manager hours, but in some cases was used to support firewall and antivirus licenses. This approach strengthened the security culture within the sector necessary to participation in advanced eHealth activities. Information gained from the SACR was gathered to assist in identifying future areas of support and focus. No repeat survey was undertaken. The Government’s Practice Incentive Program IM/IT incentive introduced security incentives from November 2006 which required compliance with the SACR.




Security, Continued

SACR Survey In total 3,183 participants across all sectors of the program took part in a

survey on the SACR. The following SACR requirements were fully met by most (85% or more) of the survey respondents: • Passwords are kept secure • Maintain appropriate confidentiality of information on computer

screens • Screensavers or other automated privacy protection device enabled • Back-ups of data done daily • Back-ups of data stored offsite • Anti-viral software installed on all computers • Automatic updating of virus definitions enabled (daily if possible) • Hardware and/or software firewalls installed. The following requirements were met by fewer (60% or less) of the survey respondents: • IT security coordinator’s role description written • IT security training for coordinator provided • Security Coordinator’s role regularly reviewed • IT security policies and procedures documented • IT security policies and procedures documentation regularly reviewed • Staff trained in IT security policies and procedures • Disaster recovery plan tested • Recovery plan regularly updated • Back-up procedure included in a documented disaster recovery plan A more detailed description of the categories and results are at Attachment 5 – Security Awareness and Conformance Report.



Governance

Overarching governance

A clear model of governance was established to oversee the program through the Broadband for Health Working Group (BFHPWG), which jointly reported to the National Broadband Strategy Implementation Group (NBSIG) and National Health Information Group (via HealthConnect). As part of a whole of government strategy to improve broadband take-up, the Department also increased their representation on the NBSIG. The Department successfully worked with a range of stakeholder groups and peak agencies to ensure the program was well marketed and promoted through appropriate channels and any issues could be dealt with effectively. The groups involved included the:

• Office of Aboriginal and Torres Strait Islander Health • National Aboriginal Community Controlled Health Organisation • National Rural Health Alliance Council • Rural Doctors’ Association of Australia.

In order to ensure the BFHP was closely aligned with similar programs in other sectors (Broadband Connect, Backing Indigenous Ability, Clever Networks, Mobile Connect, Metro Blackspots) the Department actively ensured:

• close alignment of the BFHP with other programs and incentives; • the health sector was capable of adopting the demand aggregation model

for sustainable access to broadband services in regional, rural, and remote areas, including working with state and national Demand Aggregation Brokers; and

• the health sector was represented in policy making regarding broadband connectivity in Australia.

Use of Peak Agencies

The Department worked with organisations with established relationships and communication channels with the target stakeholder groups. This significantly extended its ability to reach target groups for communication, troubleshooting, and monitoring at the local level. The Department entered into an agreement with the Pharmacy Guild of Australia to establish broadband support officers in each jurisdiction. This aimed to enhance take-up by community pharmacies, as part of the Pharmacy Development Program and led to the pharmacy sector achieving extensive take-up.




Governance, Continued

Peak Agencies continued

The Department also supported the GP sector through SBIOs provided to support and advise GP Divisions and general practices wishing to advance eHealth strategies. This utilised the established network and was closely aligned to the AGPN’s vision “to embrace an eHealth agenda focused on supporting general practice with better capacity to conduct their business through enhanced interoperability, shared patient information between providers and smarter, more effective clinical decision and business support systems9.”

Administration

Operational Support

A range of supporting documentation, which was updated regularly as the program evolved, was developed and targeted to each service type. This material was maintained on the Department’s BFHP web page and distributed through established communication channels to general practices, community pharmacies, ACCHS and RFDS and their respective peak bodies. QSPs were selected following an open tender process. Terms and conditions were stipulated for QSPs and there was the ability for QSPs to be appointed throughout the Program. The Department took a proactive and flexible approach to addressing issues as they arose including working to assist small providers to qualify so their existing customers could be eligible for the incentive.

Operational Issues

Generally speaking the program was administered effectively. The main challenge to program administration related to the delays around payment processing. Once this was identified, the Department and Medicare Australia worked together closely to change the manner in which payments were processed with the objective of improving workflow and reducing delays in payment. The delays in processing payments were largely due to the time lag in developing the electronic payment system that replaced a cumbersome manual system. Once the electronic system was implemented payments were processed in an increasingly timely manner (Figure 1).


9 Australian General Practice Network. An Annual Report of the Divisions’ Network 2005 – 06.



Administration, Continued

Operational Issues

Figure 1: Medicare Processing Rates10

Medicare Australia Claim Processing*

1

10

100

1000

May-05

Jul-0

5

Sep-05

Nov-05

Jan-0

6

Mar-06

May-06

Jul-0

6

Sep-06

Nov-06

Jan-0

7

* Receipt, Assessment and data entry

Num

ber o

f Day

s fro

m re

ceip

t to

entry

on

to F

INN

ET

Minimum PeriodMaxium PeriodAverage Period

A spike in claims occurred in June each year throughout the program, as clinics took this late opportunity to ensure access to the incentive for that financial year. The spike also showed that information regarding the need to apply in the current financial year to access the incentive for that year was effective.

Marketing

A number of marketing strategies were used throughout the duration of the

program. These strategies included: • Website information • Letters to eligible practices • Qualified Service Provider information • Communication through the Pharmacy Guild and the AGPN • Telephone marketing • Sponsorship of medical conferences, roadshows and inclusion in

information booths • State Based Implementation Officer activities


10 Department of Health and Ageing data



Marketing, Continued

Marketing The Department’s Broadband for Health website provided numerous pages of

information including: • an overview of the program • eligibility requirements and how to get connected • links to other relevant sites • guidelines, publications, claim forms etc • frequently asked questions • broadband providers and subsidies. Letters were sent to eligible general practices, ACCHS, RFDS and community pharmacies in August 2004 informing them of the program and providing details on how to apply. Further mailouts occurred during the program to provide updates on changes and progress.

Service provider information

An open tender process was conducted to select Qualified Service Providers (QSPs). QSPs were issued with guidelines and terms and conditions of service. In March 2005 the number of qualified services represented approximately 25% of potentially eligible services used by GPs and ACCHSs and less than 2% of potentially eligible services used by the pharmacy sector. A significant change was introduced to the qualification process in April 2005, resulting in approximately 95% qualifications of QSPs used by GPs and ACCHSs, offering over 160 different qualified packages (Figure 2). Ongoing communication with the sector and flexibility in approach, particularly for those in rural and remote communities operating through onsellers, ensured a high level of participation from QSPs.

Figure 2: Percentage of Potentially Qualified Service Providers11

Number of Potentially Qualified Users

0%10%20%30%40%50%60%70%80%90%

100%

Pre April 2005 Post April 2005






Liaison with Peak Agencies

As discussed in the governance section, the Department actively promoted the program through involvement in jurisdictional committees and forums. In particular the Department worked closely with the Pharmacy Guild of Australia and the Australia General Practice Network to ensure communication, support and promotion throughout their respective sectors. Links to the BFHP website were promoted through the AGPN website. The Department entered into agreements with both the AGPN and the Pharmacy Guild of Australia to fund SBIOs to enhance take-up of the program. This proved successful with take-up increasing significantly. The Department worked in conjunction with colleagues in the Office for Aboriginal and Torres Straight Islander Health (OATSIH) and National Aboriginal Community Controlled Health Organisation (NACCHO) to ensure high take-up across ACCHS.

Telemarketing Following the low take-up in practices in the first year, the Department

conducted an outbound telephone marketing campaign in late 2005. The survey specifically targeted general practices throughout Australia. This was instrumental in promoting the program to those unaware of its existence and in developing a better understanding of the Sector. The intention of the telemarketing campaign was to establish whether practices: • used computer technology in their practice, and to what extent; • knew about the Broadband for Health incentive; • were interested in the incentive (and if not, the reasons why); • were connected to the internet and, if so, via broadband or dial-up; • and via which Internet Service Provider (ISP); • used computers in the practice and, if so, to what extent; and • would like to be contacted with more information about the incentive. A total of 2,145 practices were telephoned, of which: • 1,067 asked to be contacted with further information about the incentive; • 617 advised that they were already receiving the incentive or had applied;

and • 461 advised that they were not interested in the incentive (or in fully

completing the telephone interview), however many of these did provide useful information (detailed on following page).





Overview of interviews

The telephone questionnaire targeted practice managers or staff with similar roles and responsibilities. The survey focussed on practices that had been identified as those who had not yet applied for the incentive. The survey found that 65% of GP practices had internet access via broadband, 14% reported having internet access via dial up and 21% reported having no internet access. On the basis of these figures it is estimated that 78% of individual GPs had access to the internet via broadband, 10% had access via dial up and 12% did not have access to the internet. Although the estimate is a crude measure it is a guide to penetration of broadband among practices surveyed. There was a low awareness of the BFHP among those surveyed with 75% acknowledging they were unaware of the program. Among the 461 practices not interested in the incentive (Figure 3). The main factor for non-participation related to the use of technology.

Figure 3: Reasons for Non Participation

Reasons for not taking up incentive

48%

33%

8%

7%1%

1%2% Technology is too much to deal w ith

Other

Loyal to current ISP provider

Costs too much

Don’t w ant to w ork w ith government

Don’t w ant to change our email address

Don’t w ant any dow ntime

Almost half (48% or 223 practices) who were not interested gave the reason that the ‘technology is too much to deal with’. The ‘Other’ reasons (33%) were varied, ranging from apathy to ‘just too busy to worry about it’.



Case Study

Case Study – Pacific Internet and Hunter Urban Division of General Practice12

Pacific Internet was awarded ‘Best Broadband Solution in the Hunter Valley’ at the Australian Telecommunications Users Group Awards Hunter Valley – 2005 for its work performed in partnership with the Hunter Urban Division of General Practice (HUDGP), a representative body for general practitioners (GPs) in the Newcastle and Hunter area. Pacific Internet worked with HUDGP to deliver specially designed broadband plans to 84 of its local medical practices. Pacific Internet’s work with HUDGP is a prime example of an industry group working with a solution-focused service provider to embark on a technology roll out where there has historically been a slow take-up of broadband. The agreement gives GPs access to 1500kbps business grade Pacific Internet broadband DSL connections, bundled with Cisco 800 series routers for additional security to protect patient data. The plans also feature 24x7 business grade technical support and a 99% service level guarantee. The specially designed HUDGP Pacific bundle also includes free data traffic between HUDGP and all its GPs, making the potential use of shared online health applications affordable and effective. In the partnership, HUDGP provides the on-site broadband installation services, local network reconfiguration, firewall monitoring and first line technical support. Doctors, as a result of improved connectivity, can now easily and cost-effectively participate in eHealth initiatives. They are also reaping efficiency gains by using their high-speed connection for online banking and medical and pharmaceutical research. Some practices are utilising Pacific Internets MPLS private network service to connect geographically dispersed surgeries that belong to one practice. All these applications have increased the practices’ organisational efficiency and capacity for patient care.

Participant Feedback

Comments received from participants in the Department of Health and Ageing’s telemarketing survey reflect the overall success of the program: ‘Received the incentive and was extremely happy with it. It has made a wonderful contribution to my practice.’ ‘Applied the first time round and the program is working fine. Everyone in the practice is happy with it.’ ‘Received the program in October and I don’t know how the practice managed without it in the past’.

12 Pacific Internet Press Release - November 30, 2005



Findings: Community Pharmacy Program

Take Up rate The take-up of the program in community pharmacies achieved 96.6%

coverage by February 2008 (Figure 4). The take-up was most significant in the first year with progressive improvements until the end of the program. At the end of each financial year an increase in applications were received as a result of the need to claim within that financial year to be eligible. Take-up was fairly consistent across all jurisdictions measured as a percentage of eligible pharmacies in each jurisdiction (Figure5).

Figure 4: Cumulative Take-up by Pharmacies

Cummulative Uptake of Pharmacies

2,000

2,500

3,000

3,500

4,000

4,500

5,000

May-05

Jul-0

5

Sep-0

5

Nov-0

5

Jan-0

6

Mar-06

May-06

Jul-0

6

Sep-0

6

Nov-0

6

Jan-0

7

Mar-07

May-07

Jul-0

7

Sep-0

7

Nov-0

7

Jan-0

8

End of FY End of FY

End of FY

Figure 5: Pharmacy Take-up by Jurisdiction

Phamacies: Take-up by StatePeriod Sep 2004 to Oct 2007

93.2% 89.3%100.0%

84.2%

99.8%88.0% 90.1%

81.7%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

ACT NSW NT QLD SA TAS VIC WA

Perc

enta

ge




Findings: Community Pharmacy Program, Continued

Type of Service Pharmacies already connected to non-qualified broadband services had the

opportunity to move to an approved service. Figure 6 shows the percentage of pharmacies that used BFHP to connect for the first time and those pharmacies that took advantage of the option to move to an approved provider and/or service.

Figure 6: % Pharmacy Connections for First Time

Pharamcy: Connected to Broadband for 1st timePeriod to March 2007

66%

34%

1st Time Broadband Transfers from another Broadband Band product

Types of Connection

Under the BFHP Guidelines ADSL was the preferred connection method. Where this was not available, other terrestrial and satellite services attracted an incentive payment. The majority of incentives payments (above 95%) were for ADSL service types.

Qualified Service Providers

There were 31 Qualified Service Providers providing a service eligible for BFHP incentives to community pharmacies (Attachment 7 – Qualified Service Providers).



Findings – General Practices

Practice Locations

The BFHP was targeted at eligible general practices, Royal Flying Doctor Services (RFDS) and Aboriginal Community Controlled Health Services (ACCHS).

Take-Up A total of 4618 practices took advantage of the BFHP representing a total of

66.18% of all eligible practices13. The progression of take-up is illustrated in Figure 7. The sharp spike in 2005 is thought to be as a result of practices attempting to apply prior to the end of the first financial year and coincides with improved payment processing practices. Strategies implemented mid-program by the Department (including telemarketing, improved flexibility with QSP and targeted work with the AGPN) appear to have been successful in prompting a 20% increase in take-up rates in that financial year. Take-up as a percentage of eligible practices was very high in remote areas as a result of the smaller overall number of remote services. High take-up levels by ACCHS (88%) and RFDS (100%) positively impacted on the overall rural take-up figure. The high levels of pre-existing use, the higher number of general practices and group practices impacted on the overall take-up in metropolitan areas. Full take-up in rural and remote areas was limited to some extent by availability of affordable, sustainable services (Figure 8).





Findings – General Practices, Continued

Figure 7: Cumulative Take-up by Practices

Cummulative Total Take of Practices

0500

1,0001,5002,0002,5003,0003,5004,0004,5005,000

Sep-

04O

ct-0

4N

ov-0

4D

ec-0

4Ja

n-05

Feb-

05M

ar-0

5A

pr-0

5M

ay-0

5Ju

n-05

Jul-0

5A

ug-0

5Se

p-05

Oct

-05

Nov

-05

Dec

-05

Jan-

06Fe

b-06

Mar

-06

Apr

-06

May

-06

Jun-

06Ju

l-06

Aug

-06

Sep-

06O

ct-0

6N

ov-0

6D

ec-0

6Ja

n-07

Feb-

07M

ar-0

7A

pr-0

7M

ay-0

7Ju

n-07

Jul-0

7A

ug-0

7Se

p-07

Oct

-07

Nov

-07

Dec

-07

Jan-

08Fe

b-08

DoHa Telemarketing

End of FY

End of FY

Figure 8: Eligible Practice Take-up by RRMA

Practices: Percentage Eligible Practice take-up by RRMA Category Period Sep 2004 to Jun 2007

57%61%

86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Capital Cities / MajorMetroplitan Areas

Rural Areas Remote Areas





Take up by Jurisdiction

Figure 9 illustrates the take up by jurisdiction as a percentage of total eligible practices. Take-up was highest in Tasmania and Northern Territory (NT) and lowest in ACT and Victoria. In relation to take-up levels in the ACT, it is noteworthy that the territory did not have one of the SBIO positions filled for the duration of the program. When the position was later filled, the SBIO conducted a survey which indicated that around 20% of clinics had non-qualified broadband plans. This may indicate either a lack of penetration of the message that eligibility could be attained by moving to a qualified service or that these practices were satisfied with their current arrangements. The ACT also has significant levels of corporate GP practices which appear to have accessed the program less than smaller practices14. Victorian take-up was thought to be heavily impacted by pre-existing broadband usage. Positive take-up rates in the NT and NSW were thought to be heavily influenced by enthusiastic and proactive SBIOs in those jurisdictions.

Figure 9: Practices Take-up by Jurisdiction

Practices: Take-up by jurisdiction as percentage of total eligible practices in each jurisdictionPeriod Sep 2004 to Jun 2007

45.1%

63.5%70.8%

64.7% 65.0%69.4%

46.7%

59.5%

0.0%

20.0%

40.0%

60.0%

80.0%

ACT NSW NT Qld SA Tas Vic WA


14 Information supplied by AGPN




Transfers The majority of participants in the BFHP were using broadband for the first

time (Figure 10). This is particularly significant given the overall objective of increasing secure business grade connectivity as a platform for further eHealth

evelopments. d

Figure 10: Practices % New Users

Practices: On signup - Previous connection to BroadbandPeriod to April 2007

38%

62%

Transfers First Time to Broadband

Qaulified Service Providers

A total of 63 QSPs were utilised to provide a qualified service. Attachment 8 lists the 45 QSPs providing more than 10 services up until July 2007.




Barriers and challenges

Barriers and challenges

ential improvements in future programs.

• The development a de broadband for health was difficult for a number of reasons. As the speed of available broadband is constantly evolving this impeded the development of a robust definition. The definition was not revised mid-way through project. Thus broadband speeds for Program participants did not increase at the same rate as industry was increasing broadband speed. This led to an erosion of real value compared to the market.

• There were issues associated with the interpretation of program requirements. As an example, deeds signed with vendors required a network firewall. Vendors were, however, able to interpret this differently in terms of the functionality they provided. The intention was that users would be protected by an extra layer of security. In reality, however, the additional security measures were often complicating factors and impeded use.

• Value-added services were difficult to define in terms of what exactly was provided such as broadband speed, download and contracts.

• Relationships with providers were not always easy and required a concerted effort by various stakeholders to progress issues. One example reflected a very complicated relationship with issues relating to products, security and the skill-base of employees installing the hardware. A number of parties were intensely involved in the risk management of these issues.

to Broadband were halved. This change did not encourage take-up by those services who had previously not engaged with the Program.

• There were broadband services available cheaper than thoqualified service. As service providers were required to set up specific plans, abide by minimum standards and provide organisations with Statements of Supply under the BFHP this may have necessitated higher charges.

As with all major change programs barriers and challenges were encounteredduring the implementation of the BFHP. The barriers do not appear to have had a significant impact in the take-up of the program and are provided here as the basis for pot

nd use of the definition of business gra

• The level of support to rural and remote locations by QSPs was variable. • During the final six months of the program the incentives to connect

se available as a



Lessons learned

Lessons learned s

• Program Guidelines;

E

The review of this program provides the opportunity to learn from its successeand challenges to inform future work. These lessons can be broadly grouped under the following headings: • Program Administration;

• Communication; and • National leadership. ach of these lessons is outlined below and further detail provided.

Program Administration

MD me frames, a paper-based payment system

sy a F h the ro ayment

m es are

aa W yments to

e

edicare Australia administered the program on behalf of the Department. ue to the tight implementation ti

was initially used which proved to be slow and cumbersome. An electronic stem and database were later developed and this considerably improved

dministration processes.

uture programs require consideration of appropriate lead times to establisbust administrative systems required to support such a large p

scheme. It may also be appropriate to consider information provided in arketing and communication systems to ensure eligible servic

forewarned of potential delays in payment. This will avoid raised expectations nd the resultant level of stakeholder management which is time consuming nd ineffective.

here possible consideration should be given to attaching paexisting payment schemes to streamline the administrative burden for both thpayee and payer.

Program Guidelines c

mso ns, for example, following up with vendors to receive statements of supply, prior to

ing able to claim incentives. This mechanism did, however, provide useful information relating to contracted broadband connections. Clear, user-friendly guidelines are required to support users throughout any program. These should aim to balance the need to ensure rigorous application of criteria in the expenditure of public funds against unnecessary, non-value adding administrative requirements.


The initial guidelines and application process provided to users were onsidered to be cumbersome. An interim review of the program resulted in a ore streamlined and structured application process. Similarly the nature of me of the administrative tasks required were onerous for organisatio

be



Lessons learned, Continued

Communication s

king definitive improvements. Th stralia and AGPN were key agents in promoting and im rganisations report a lack of timely information regarding progressive take-up and emerging issues. Timely and relevant data

orking relationships with such organisations beyond the

The SACR reporting document was considered to be useful and collected valuable information. No follow-up questionnaire was distributed which limitthe usefulness of the tool in trac

e Pharmacy Guild of Auproving take-up. Both o

can empower people and encourage further participation in programs.

Continuing proactive winitial high activity related to the start-up of programs will be beneficial, particularly in long term programs.

National Leadership

s is e health sector, to ensure synergistic

nd its

The Department’s role as an active player in whole of government programssential to provide advocacy for the

approaches to new programs and to influence future policy and strategy. The Department’s involvement through the BFHP has enabled this to occur acontinuation in providing national leadership highly recommended.



Future eHealth Programs

Where to next The evaluation of the BFHP has highlighted the ongoing challenge of

technology advances keeping pace with market attitudes and levels of readiness. While significant improvements to secure internet access have been

ade with this program, the available technology and broadband speeds in

for any . The ability for healthcare providers to have

he use of peak agencies to drive the change agenda within their sectors also

unities, in encouraging partnerships and promoting competition.

msome cases are already outdated. The ongoing challenge for any future program will be how to keep abreast of such advances. The diversity of the health sector will also continue to pose challenges centrally-driven programflexibility in the way the incentives were used locally was very successful in allowing local needs to be met. This element should be retained in futureprogram development.

Tproved to be a successful collaboration. The ability for all ISPs to apply to be an eligible provider allowed competitionand for local services to be able to meet their local clients’ needs. This is important, particularly in meeting the needs of those in smaller comm

Future Programs

The encouragement of ongoing relationships between the telecommunications industry and health organisations should be fostered. It is through this collaboration that new programs and projects become possible. Similarly relationships between the Department and key stakeholders such as the AGPN and the Pharmacy Guild of Australia should be maintained when appropriate. There will be a continuing tension between encouraging innovation, meeting local needs and promoting a standardised and interoperable approach. Future eHealth programs should focus on assisting organisations to move to a uniform approach based on relevant standards and long-term goals. By keeping things simple and providing incentives, organisations have proved they are willing to become involved and commit to future eHealth programs. Future eHealth programs will be assisted by the continued development of legislative frameworks to support eHealth activity, and the release of the National E-Health Strategy in December 2008. The Strategy will provide guidance and direction for successful national eHealth activities.




Future eHealth Programs, Continued

Conclusion The degree of take-up from this program is testament to its success. Th

Government’s objective of assisting individual business units across thsector to have the building blocks in place to advance the eHealth agenda has been well served by the program. The program has been effective. The take-up achieved h

e e health

as laid a solid undation for the progress in take-up of other initiatives such as secure

it to the introduction of the electronic payment system.

g forward with a collaborative pproach to eHealth.

foelectronic messaging and projects under the Managed Health Network Grants Program. The overall administration of the program was efficient and effective, albewith initial delays prior The program has improved relationships between key participants in the eHealth arena which is essential in movina



Attachment 1: Broadband Definitions

Broadband Broadband refers to high speed, always-on access to the internet. It has th

capacity to transfer large amounts of information. Access to this technology has the potential to bring many benefits to the health sector, particularly those in rural and remote areas.

e

are DSL e of

SL refers to a group of technologies, the most common being ADSL (or

e t the same time, by transmitting the two on different frequencies. It is usually

to

Cable uses either the pay TV cable network or an optical fibre network to eliver broadband services. Cable is much less widespread than DSL and is

mostly confined to larger metropolitan centres. Wireless is an emerging broadband technology that is being progressively established in Australia, and used particularly for 'last mile' connections through local area networks (LANs) and wide area networks (WANs) that interconnect into the national telecommunications networks. Satellite is available everywhere, and is particularly useful where the other broadband technologies are not available. This is not considered a preferred approach as it is more expensive, less secure and less reliable than the other means of connection. Broadband is available at varying qualities – largely determined by the speed of the service. Lower speeds can be unreliable and of reduced. Business grade broadband is delivered at a higher speed and incorporated security features. Advanced broadband which includes virtual private networks (VPN) are fast, secure, and guaranteed performance packages to meet full communication needs.

There are four main broadband technology options in Australia. These (the most widely used technology), cable, wireless and satellite. The typtechnology that is used will depend upon what is available in the local area. DAsynchronous Digital Subscriber Line), that use existing telephone lines. It allows voice communication and high-speed data transmission on the same linaonly available within 4 km of an ADSL-enabled exchange to have access this broadband technology.

d



Attachment 2: Eligibility Criteria

Aboriginal CommControlled Health

d Health Organisations) funded by the Australian Government Department of Health and Ageing, Office for

unity Service

For the purpose of attracting the Incentive, an Aboriginal Community Controlled Health Service (ACCHS) was a non-government organisation (including Aboriginal Community Controlle

Aboriginal and Torres Strait Islander Health, for the provision of primary health care or substance abuse services.

After Hours GP S Medical Practice/General Practitioner (GP) Service was:

r

s l Practice working in partnership with other health

service organisations in the local community to provide after

more of the following

ervices For the purpose of attracting the Incentive, an After Hours

- an organisation or groups of local GPs working together ounder the sponsorship of the local Division of General Practice to provide after hours primary medical care services;

- a Medical Deputising Service; or - a consortia made up of groups of local GPs and/or Division

of Genera

hours primary medical care services. After hours primary medical care was defined as general un-referred GP services during one ortimes: - after 8pm on weekdays; - after 1pm on Saturdays; or - anytime on Sundays or Public Holidays.

Pharmacy (Eligibl

pply PBS medicines under Section 90 of the National

Health Act 1953.

er

nce with these Guidelines.

e Location) For the purpose of attracting the Incentive, an Eligible Pharmacy Location was a Pharmacist/s approved to carry onthe business of a Pharmacy at, or from, a particular premiseto su

An Eligible Pharmacy Location was also:

(i) eligible to receive a Unique Identification Numb(UIN) in accordance with these Guidelines; and

(ii) issued a UIN by Medicare Australia in accorda




Attachment 2: Eligibility Criteria, Continued

Eligible Practice Locatio

n ctice f

C

awb tive Practice as defined

alth Department premises; ch the Royal Flying Doctor

was a location for After Hours GP Services as defined

For the purpose of attracting the Incentive, an Eligible PraLocation was a physical location that was not also the place oresidence and was required to meet one of the following threecriteria: (1) the Practice Location was recorded in Medicare Australia’s General Practice Register as being ‘eligible’ for thePractice Incentives Program (PIP) either as a practice or an additional location; (2) the Practice Location was an Aboriginal Community

ontrolled Health Service (ACCHS) as defined within the rogram Guidelines; or P

(3) the Practice Location: . met the definition of a General Practice as defined ithin this document; . satisfied the definition of an Ac

within the Program Guidelines; c. was not principally a place of residence (also see Section 3.7); d. was not a State/Territory Hee. was a location at whiService (RFDS) was based and from which it operated its aero medical services; or f.within this document.

General Practice

General Practice care meant

omprehensive, coordinated and continuing medical care al and

environme

For the purpose of attracting the Incentive, a General Practice was defined as a location that provided universal un-referred access to whole person medical care for individuals, familiesand communities. cdrawing on biomedical, psychological, soci

ntal understandings of health.

Royal Flying Doctor Service

For thDoctor Ser ro medical health service which provided aero medical evacuation and primary health care to the people who lived, travelled or worked in rural and remote Australian communities beyond thinfrastructure which was available to most of the population.

e purpose of attracting the Incentive, a Royal Flying vice (RFDS) meant the ae

e normal medical



Attachment 3: Value Added Services

Value Added Noting thServices

at the prhave been less thaoffer add-on servvalue up to the capped amount: 1. The princi as the

value of ba. Suc

Service Provider. The services did not include land line or mobile telecommunications but may have included Voice Over Int t Pr

b. Val o: i. wnload amounts ii. iii.iv.v. vi.vii.viiix.x. Loxi.xii.xiixivxv.xvixvixvi xix

Should the Servic y additional services, then the e received was the

and 1

ices (installation and 12-months subscription) offered may t the RRMA-capped amount, service providers were able to

ices (valued added services), at their discretion, to bring the

ple w that the service contributed to and demonstratedroadband connectivity to the eligible practice h services may have been offered at the discretion of the

erne otocol (VoIP) ue Added Services offered included, but were not limited t

Access to higher doIncreased Bandwidth Ad ditional Service Installation

Additional Internet Services Image/Record Digitising Services

Email (additional accounts) Hig her grade firewall

i. Higher grade virus protection Hig her grade spam interception

cal area network support Filtering of specific sites Network addressing and privacy

Remi. ote Backup facilities . Web hosting services Voice over Internet Protocol(VoIP), . Internet Protocol (IP) videoconferencing i. Virtual private network capability ii. Assisting the eligible practice in completing the Security. Awareness and Conformance Report

e Provider not offer, or the practice not accept, anaximum incentive a practice would hav m

installation 2-month subscription costs.



Attachment 4: RRMA Classifications

RRMA classificat 15ion

e

The RRMA classification consisted of three zones (Metropolitan, Rural and Remote) and seven classes as shown in the table below.

Code used in Zon BFHP Category

M1 1 Capital cities Metropzone

olitan

M2 2 Other metropolitan centres (urban centre population > 100,000)

R1 3 Large rural centres (urban centre population 25,000-99,999)

R2 4 Small rural centres (urban centre population 10,000-24,999)

Rural zone

n centre population < R3 5 Other rural areas (urba10,000)

Rem 6 Remote centres (urban cen1 tre population > 4,999) Remote zone

2 (urban centre population < Rem 7 Other remote areas5,000)

The RRMA w ns Statistical Local Area (SLA) using 'd res containing a population of 10,000 pers or m ersonal distance'. Personal distance relate op emoteness' or average distance of res f It is important te to a rural or remote zone is er ution of the population wit A , for example, that within a remotvice versa.

as co tructed for each non-metropolitanistance factors' related to urban centons ore, plus a factor called 'ps to p ulation density and indicates the 'ridents rom one another.

to no that this method of allocating an SLA not p fect. Both the size of SLAs and the distribhin SL s vary enormously. This can meane SLA there can be pockets that are rural rather than remote, and

15 http://www.aihw.gov.au/ruralhealth/remotenessclassifications/rrma.cfm



Attachment 5: The Security Awareness and Conformance Report

SACR T

1 IT security coordinator appointed 2. IT security co3. IT security training for coordinator provided 4. ri oordinat s role regularly reviewed 5. Person e.g. IT s rity c (and

revise) security policies an6. sec policies d pro7. secu y policies d pro8. Staff trained in IT security policies and procedures 9. Staff p y develo on l ystems 10. Staff have created personal passw11. Passwords are kept secure 12. Consideration given to changing passwords periodically 1 t very p dev14. Disast very p teste15. Recovery plan regularly up16. Aware of need to maintain appropriate confidentiality of information on

1112 ed (by performing a restoration of data) 21. Back-up procedure has been included in a documented disaster recovery

222

edures manual 25. Hardware and/or software firewalls installed 26. Hardware and/or software firewalls tested 27. Computer hardware and software maintained in optimal condition

(includes physical security, efficient performance of computer programs, and program upgrades and patches)

28. Uninterruptible Power Supply (UPS) installed (to at least the server) 29. Encryption systems considered - Encryption used for the electronic

transfer of confidential information Services were asked to rate whether they met, partially met or did not meet each of the above categories. The results are shown in the following pages.


he SACR categories were as follows: .

ordinator’s role description written Secu

ty C or’(s) ( ecu oordinator) appointed to document

d procedures IT IT

urityrit

an an

cedures documented cedures documentation regularly reviewed

olic ped evels of electronic access to data and sords to access appropriate level

3. Disas er reco lan eloped er reco lan d

dated

computer screens 7. Screensavers or other automated privacy protection device enabled 8. Back-ups of data done daily 9. Back-ups of data stored offsite 0. Back-up procedure regularly test

plan 2. Anti-viral software installed on all computers 3. Automatic updating of virus definitions enabled (daily if possible) 4. Staff trained in anti-virus measures as documented in policies and

proc


Broadband for Health Evaluation Evaluation Report Broadband for Health Evaluation Evaluation Report

Attachment 5: The Security Awareness and Conformance Report,

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 287 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 288 290%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6 8 29


Met P artially Met Not Met

Continued

Self Reports Against the SACR



Attachment 6 – Role of State Based Implementation OfficerThe role of the SBIO was:

s

• to promote Broadband to the health sector by identifying opportunities for usage and examples of working success stories;

• to contribute to the wider implementation of eHealth activity at a national and state and territory levels;

• to develop strong working relationships with other key stakeholders in Broadband and eHealth;

• raise awareness and communicate specific requirements of the BFHP to both health services and Broadband service providers;

• to undertake data collection and mapping to develop a comprehensive picture of Broadband usage;

• the facilitation of user support and training to health services; • engage Divisions of General Practice to support the take-up of Broadband services and

eHealth implementation; • to work closely with the Department, National Aboriginal Community Controlled Health

Organisation (NACCHO) and state affiliate organisations towards enhancing take-up by community controlled health and substance misuse services;

• assistance with engaging the pharmacy sector where appropriate in their State/Territory; • the provision of support Broadband demand aggregation to:

Negotiate and facilitate economies of scale in their State/Territory. This included encouraging health services in an area to take up Broadband as a group; and

Engage the interest of Broadband suppliers regarding the potential benefits of this approach.

• to communicate BFHP Program Guidelines to both health services and Broadband industry players and confirm their understanding of potential benefits; and

• to maintain issues registers which: Identified reasons why GPs/ACCHS had not signed up; Established if there was awareness a Analysed and inves users; Investigated whether there were misconceptions that Broadband was more expensive

or com lex to install than it actually was; Identified whether GPs/ACCHS were fully aware of the funding arrangements

available to them; Investigated if and why there was a resistance to change, and how this should be

addressed; Established if the accessibility and usability of Broadband was fully appreciated; Defined the key decision makers regarding BFHP take-up (eg Practice Managers); Investigated whether such decisions fell in the remit of the Practice Manager; and Determined whether there was evidence of a correlation between take-up of

Broadband and the age of the Practice.

s to the advantages of Broadband; tigated any negative feedback from

p



Attachment 7 – Qualified Service Providers

Table 2: Count of QSP Name by end 06/07

Program Totals

QSP Name Numbers Percentage PCA NU SYSTEMS 1463 37.4% TELSTRA 802 20.5% OPTUS 400 10.2% WESTNET 310 7.9% CHARIOT 188 4.8% PACIFIC INTERNET 127 3.2% INTERNODE 96 2.5% NETSPACE ONLINE SYSTEMS 81 2.1% EFTEL 78 2.0% NEXON ASIA PACIFIC 74 1.9% PREFERRED INTERNET PROVIDER 61 1.6% EXPERT SOLUTION PROVIDERS 60 1.5% SYNAPSE IT 34 0.9% ADAM INTERNET 21 0.5% MULTIEMEDIA-NEWSAT 21 0.5% VOIPEX P/L 18 0.5% ECOPOST 15 0.4% SPT TELECOMMUNICATIONS 15 0.4% TPG 14 0.4% BENDIGO COMMUNITY TELCO 11 0.3% NEIGHBOURHOOD CABLE 7 0.2% TRANSACT 5 0.1% NETWORK TECHNOLOGY (AUST) P/L T/AS ON THE NET 4 0.1% ACE INTERNET SERVICES 1 0.0% GOULBURN INTERNET 1 0.0% HOTKEY 1 0.0% MCPHERSON MEDIA 1 0.0% NETYP 1 0.0% SWARH 1 0.0% Grand Total 3911 100.0%



Attachment 8 – Qualified Service Providers by Practices

Providers Total Telstra Corporation Limited 1,408 Internode Systems Pty Ltd 340 WestNet Internet Services 334 Optus Networks Pty Ltd 226 Pacific Internet Australia Pty Ltd 189Effel Pty Ltd 128Multimedia Ltd 121Chariot Limited 117Preferred Internet Provider 110Netspace Online Systems P/L 0 11TPG 85 NEC Australia 78 Synapse IT Pty Ltd 51Neighbourhood Cable 33 Network Tech. (Aust) P/L T/As On the Net 32 PCA NU Systems Pty Ltd 26People Telecom 25 Adam Internet 25 UNKIN 23 CSM Tech. & Mgmt Serv. Pty Ltd 21Ecopost 20 IP Systems 14 Bendigo Community Telco Ltd 14 Expert Solutions 12 Highway 1 11 Nextep Broadband 10


Documents

Broadband for Health€¦ · 62% of participants were connecting to broadband for the first time. This represents a significant improvement from the situation in 20031 when: • 9%