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Digitally Enabled Service Models for Australia’s Residential Aged Care Technology, People, Processes and Policy
A Whitepaper from the ACS Telecommunications Board
1. Introduction Quality of life is just as important for older Australians as it is for the rest of the population. Older Australians generally want to remain as independent as practical, in control of how and where they live; to stay connected and relevant to their families and communities; and to be able to exercise some measure of choice over their care and daily life.
For the majority, increasing frailty and care needs means that their final years will be spent living in a residential aged care facility. These facilities provide a community living environment with varying levels of care, from independent living units, through low care, to high care and dementia-‐specific needs.
Moving into residential aged care is usually a reluctant decision for the individual and their family, associated with a loss of control, connectedness and choice; often made as a last resort when families feel unable to provide adequate care for their elders at home. Expectations around quality of life in their new home are not high. Residents are usually physically isolated from the rest of the community, family contact is limited, staff are often not highly skilled, and wages are often low.
The Health Sector, including provision of aged care services, overtook the Retail Sector in 2011 as the largest employer in Australia and yet it continues to struggle with growing challenges in health service delivery. Despite the estimated spend of $147b in 2012-‐131, the sector faces long term challenges including the changing case mix driven by Australia’s ageing population, and substantial increases in levels of chronic disease. At the same time, many rural and regional areas in Australia are under-‐served, with limited access to appropriate care resulting in higher hospitalisation rates and poorer health outcomes for people living outside major urban centres. Compounding the challenge, the sector faces widespread staff shortages as our ageing health workforce heads for retirement (an estimated shortfall by 20,000 or more nurses by 2025)2. In 2012 in remote Australia, there were 1302 FTE nurses and 243 FTE clinicians per 100,000 residents compared with 1134 nurses and 396 clinicians in major cities3 4. Nurses and clinicians in remote and very remote Australia also worked longer hours than their counter parts in major cities (for
1 AIHW, “Health expenditure Australia 2012-‐13” http://www.aihw.gov.au/publication-‐detail/?id=60129548871 2 Health Workforce Australia, “Workforce Australia 2025 – Doctors, Nurses and Midwives” https://www.hwa.gov.au/our-‐work/health-‐workforce-‐planning/health-‐workforce-‐2025-‐doctors-‐nurses-‐and-‐midwives 3 “Medical Workforce Force 2012”, AIHW http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129546076 4 “Nursing and Midwifery Workforce 2012”. AIHW, National health workforce series no. 6. Cat. no. HWL 52.) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129545314
clinicians, 46.3 versus 42.7 hours per week) Finally, in 2010, the Productivity Commission estimated the productivity “gap” in the Health Sector to be between 10 -‐ 20%5. These challenges place substantial pressure on Australia’s economy, living standards and government finances and will continue to do so. Already an estimated 20 cents from every dollar of Government revenue raised is going into the provision of health care, and this is predicted to rise to 40 cents by 20436. Error! Reference source not found. shows the estimated growth in health sector costs including a specific component associated with addressing challenges associated with Australia’s ageing population. Fundamental reform is required to overcome the delays, discontinuities, constraints and shortages that currently exist in the provision of aged care services, and to respond to future challenges. The industry understands some the challenges that lie ahead and many residential aged care and community care providers are examining new models of care delivery, including telehealth and in-‐home monitoring, to potentially extend their services to more Australians living independently.
Figure 1. Total Australian Government Health Expenditure with and without non-‐demographic growth (2009-‐10)
2. Challenges in Health Delivery for Aged Care Changes to the aged care system over past decades have increased the range and quality of care and support available to older Australians. However, there are significant variations in the quality of services, and the media provides ongoing evidence of specific instances where the system has failed to meet its duty of mental, physical or health care for some residents. One example is the ABC Lateline report of 15 July 2013, which reported on some specific incidents with appalling consequences for the individuals and their families7. Sadly, these types of incidents continue to be
5 “Public and Private Hospitals: Multivariate Analysis, Supplement to Research Report”, Productivity Commission, 2010 http://www.pc.gov.au/__data/assets/pdf_file/0008/97964/supplement.pdf 6 “Australia to 2050: Future Challenges”, Department of Treasury, January 2010 http://archive.treasury.gov.au/igr/igr2010/report/pdf/IGR_2010.pdf 7 Lateline. www.abc.net.au/lateline/content/2013/s3803710.htm.l.ABC, 15 July, 2013.
reported, making it clear that there is more work to be done to improve the current situation and ensure all residents receive respectful care of an adequate standard.
A range of recent reports on Australia’s aged care sector has identified a range of needs and challenges that need to be addressed. An example is provided by the Department of Health and Ageing report8. These challenges include:
• Existing unmet demand, which is reducing incentives around efficiency and quality of service delivery, and providing a limited choice of providers for those entering the systems
• Changing community expectations around greater diversity, and higher expectations
• A highly fragmented industry, associated with a wide variety of business practices, difficulty in standards development, and reduced efficiency. The aged care industry has more than 1400 providers, the largest 10 of which account for only 20% of government spending.
• Forecast direct cost increases of more than $70b per annum (2011 values, inflation adjusted) between 2004 and 2043, due to future demand for aged care and related health services, corresponding to 5.8% of GDP9.
• Future workforce challenges, with a forecast simultaneous age-‐related tightening of the labour market, and an increased demand for aged care services.
Fundamental reform is required to overcome the delays, discontinuities, constraints and shortages that currently exist, and to respond to future challenges. The need has been identified in the 2004 Hogan Review10, the 2009 National Health and Hospitals Reform Commission Report11, the 2010 Henry Review12, and 2011 Productivity Commission Inquiry13. As our population ages over the next 20 years, more Australians will be requiring residential aged care, and it will be increasingly difficult for a system under growing stress to address quality issues, resolve funding issues and innovation around service delivery to improve productivity and the quality of life for its residents.
The industry understands some the challenge that lies ahead. In anticipation, many residential aged care and community care providers are already examining new models of care delivery to potentially extend their services to more Australians living independently. This may lessen the growth in demand for people entering residential aged care facilities; reduce government budgetary pressures in funding this growth, and enable providers to extend the scope and impact of their operations. The opportunity for growth provides a positive path to work with the industry around developing and implementing a practical, sustainable, evidence-‐driven reform agenda that addresses the needs of all stakeholders in this ecosystem.
2.1. Understanding the sector Government funding of Australia’s aged care system is currently around $10b per year across community and residential services. As at 30 June 2011, there were around 169,000 people living
8 Department of Health and Ageing. http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-‐rescare-‐servlist-‐providers-‐services.htm#as02 9 “Year Book Australia, 2012”, Australian Bureau of Statistics. http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/1301.0~2012~Main%20Features~Value%20of%20goods%20and%20services%20produced%20by%20Australian%20Industry~240 10 “Review of Pricing Arrangements in Residential Aged Care”, Department of Health, April 2004, http://www.health.gov.au/internet/publications/publishing.nsf/Content/health-‐investinginagedcare-‐report-‐index.htm 11 “National Health and Hospitals Reform Commission Report”, June 2009, http://www.health.gov.au/internet/nhhrc/publishing.nsf/Content/nhhrc-‐report 12 “Australia's future tax system: Report to the Treasurer”, Dept of Treasury, December 2009, http://taxreview.treasury.gov.au/content/Content.aspx?doc=html/pubs_reports.htm 13 “Caring for Older Australians: Inquiry Report”, Productivity Commission, August 2011, http://www.pc.gov.au/projects/inquiry/aged-‐care/report
in residential aged care, nearly all on a permanent basis. Of these, 77% were aged 80 and over and 57% were aged 85 and over, representing around a quarter of the 85+ demographic. The industry sector is highly fragmented, with around 1,200 residential aged care service providers receiving government funding across 2,760 facilities in 2010-‐1214. There are no dominating national organisations: the 10 largest providers accounted for only 20% of the Government funding that year15. An additional proportion of older Australians are still living in the community, either in their own homes or with family or carers, and receiving support from Community Care services, as shown in Error! Reference source not found.16. In 2009 there were 645,000 Australians at this early stage of their care needs journey, including approximately 60% of the 80+ age bracket. In 2010, their support services were provided by 519 Community Care organisations, 275 of which also provided residential aged care services17, making them critical stakeholders in the transitional pathway into residential aged care.
Table 1: Number of older Australians accessing formal care, 2009
Formal care People % total Aust Population aged 65+
Residential Aged Care 158,863 19.7 Low level 43,950 5.5 High level 114,913 14.3
Community Care 645,833 80.3 Home and Community Care (HACC) 595,056 73.9 Community Aged Care Package (CACP) 42,694 5.3 Extended Aged Care in the Home (EACH) 5,515 0.7 Extended Aged Care in the Home – Dementia (EACH-‐ -‐D) 2,568 0.3
Total 804,696 100.00%
As early as 2003, an ABS survey highlighted that there is already evidence of unmet demand for aged care services. The survey reported that of the 2.3 million people aged 65 years and over living in households at that time, 43% (around 1 million) expressed a need for some form of assistance to help them stay at home. Of the 43% needing assistance, 31% (or 306,100) reported that their needs were partly met, and 5% (or 51,800) report that none of their needs was met, even partially18.
On the supply side, community expectations around aged care are changing. There is increasing diversity among older Australians in their preferences and expectations. These include expectations of a higher quality of life than previous generations, a greater desire for independent living, and for culturally relevant care. This is particularly relevant for culturally diverse, linguistically diverse, sexually diverse, and indigenous communities. In future, Australia’s ageing population is projected to drive further increases in demand for aged care services. Error! Reference source not found.2 shows Australia’s demographic profile in 2002 and that projected for 2101. By 2050, the total number of older Australians, officially 14 “Residential aged care in Australia 2010-‐11: a statistical overview. Aged care statistics series no. 36. Cat. no. AGE 68.” Australian Institute of Health and Welfare; and ABS 3101.0 -‐ Australian Demographic Statistics, Dec 2012. 15 “Data on approved service providers and aged care places”,Department of Health and Ageing. June 2012. 16 “Future of Aged Care in Australia, A public policy discussion paper prepared for National Seniors Australia”, Access Economics, Access Economics, September 2010. p12 http://www.nationalseniors.com.au/icms_docs/Future_of_Aged_Care_Report.pdf. 17 http://www.health.gov.au/internet/publications/publishing.nsf/Content/hacc-‐pub_mds_sb_07-‐08.htm , Based on 2008 data: 18 “Older Australians at a glance”, Australian Institute of Health and Welfare. 2007.
defined as anyone aged 65 or over, will increase from 3.0 million (13.3% of the population) in 2010 to 7.5 million (22.2% of the population)19. The number of Australians aged 85 and over is projected to increase as well, from 0.4 million in 2010 to 1.8 million (5.1% of the population) by 2050.
Figure 2. Australia’s changing demographic profile
The demographic changes are mitigated somewhat by increases in healthy longevity. However, by 2050 it is expected that over 3.5 million older Australians will access aged care services each year, with around 80 per cent of services delivered in the community20. An estimated 475,000 Australians are currently primary carers. However, the relative availability of informal carers is expected to decline, reducing the ability of some older people to receive home-‐based care in future21. The shift in age profile has significant implications in terms of the nature and cost of associated health services. These increases are due to management of dementia, diabetes, and other chronic diseases associated with longevity, as well as palliative care and falls. Organizations operating residential aged care facilities have a duty of care towards their residents, which includes enabling access to health services at need, which need to be sourced externally. There are known difficulties in getting GPs to attend the facilities, which can result in poor health outcomes for residents, who have been reported with extreme pain from undiagnosed conditions or who receive inadequate or late responses to potentially fatal progressions of chronic conditions and infections. Few receive appropriate palliative care. The ageing population is also placing increasing pressure on the public hospital system, with anecdotal reports that 3-‐10% of all emergency department ambulance arrivals are from residential aged care. Emergency department clinicians also report that they arrive without a medical history making treatment more difficult. Many hospital managers have reported that the scheduling and overall admission rates for older people from residential aged care facilities could be reduced with better coordinated care management. ABS data in Error! Reference source not found. shows
19 “Population projections, By age and sex, Australia -‐ Series B. ABS 3222.0”, Australian Bureau of Statistics. Table B9.2008. 20 “Caring for Older Australians”, Productivity Commission. April 2011. http://www.pc.gov.au/projects/inquiry/aged-‐
care/report. 21 “Community Care (Facts and Figures)”, Aged & Community Services Australia. May 2011: www.agedcare.org.au/publications
80-84>85
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20022101
Males FemalesAge
5 4 3 2 1 0 0 1 2 3 4 5Percent Percent
80-84>85
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that a higher percentage of older Australians are admitted to hospital than other demographic groups.
Figure 3: Percentages admitted to hospital in last 12 months (a), by Age and Sex
Error! Reference source not found. shows the overall impact of the ageing population on government expenditure on aged care and related health services between 2003 and 2044. Required spending under current models is forecast to increase by 5.8% of GDP. This represents an almost doubling of current costs, before the effects of inflation, and corresponds to $76b per annum in 2011 dollars22.
Table 2: related government spending as % of GDP
22 “Year Book Australia, 2012”, Australian Bureau of Statistics. http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/1301.0~2012~Main%20Features~Value%20of%20goods%20and%20services%20produced%20by%20Australian%20Industry~240.
2003-‐04 2044-‐45
Direct spending on elderly
Health careAustra l ian Government 4.0 7.5 3.5 87.5%State/Terri tory Governments 1.8 2.8 1.0 55.6%Sub-‐total 5.8 10.3 4.5 77.6%
Aged care & carersAustra l ian Government 1.0 2.2 1.2 120.0%State/Terri tory Governments 0.1 0.3 0.1 100.0%Sub-‐total 1.1 2.5 1.3 118.2%
Age pensionsAustra l ian Government 2.9 4.6 1.7 58.6%Sub-‐total 2.9 4.6 1.7 58.6%
Total Direct Govt Spending on the elderly 9.8 17.4 7.5 76.5%
Other Age-‐related govt spending
Australian GovernmentOther socia l safety net 3.8 3.1 -‐0.6 -‐15.8%Education 2.0 1.8 -‐0.1 -‐5.0%Sub-‐total 5.8 4.9
State/Territory GovernmentsEducation 3.3 2.9 -‐0.4 -‐12.1%Sub-‐total 3.3 2.9
Total Other Age-‐related govt spending 9.1 7.8
Total 18.9 25.2
Source: Economic Implications of an Ageing Australia, Productivity Commission, March 2005 www.pc.gov.au/__data/assets/pdf_file/0006/13587/ageing1.pdf
Item % of Govt Expenditure Increase in % points
% Increase
3. Telehealth Pilots – Exploring Digitally Enabled Aged Care With the commencement of the rollout of the NBN in 2010, a number of influential groups developed white papers and discussion documents including National ICT Australia’s review of Telehealth projects in Australia23 and the Australian National Consultative Committee for Electronic Health in early 201224. In April 2013, the National Telehealth Society released a report which indentified key priority groups 25
• aged care • poorly mobile / disabled • outer metropolitan, rural and remote
In early 2013, the Federal Department of Health and Aging and the Department of Broadband, Communications and the Digital Economy, announced a fund for Broadband Enabled Telehealth Pilots Program. The Program funded pilot projects to develop and deliver Telehealth services to NBN-‐enabled homes with a focus on aged, palliative or cancer care services, including advance care planning services. Whilst not yet fully complete, projects within the program are expected to demonstrate opportunities for the extension of Telehealth services in the future as well as the
23 “Telemedicine in the context of the National Broadband Network”, National ICT Australia report for Department of Broadband, Communications and the Digital Economy, June 2010. http://www.nicta.com.au/__data/assets/pdf_file/0020/31538/4421_publication_Telemedici_3640.pdf 24 “A National Tele-‐health Strategy for Australia”, Australian National Consultative Committee for Electronic Health, 2012 http://www.globalaccesspartners.org/joint-‐ventures/ancch 25 “Towards a National Strategy for Tele-‐health in Australia 2013 -‐ 2018”, National Tele-‐health Society, April 2013.
business case for doing so. The projects have developed and are trialling services which demonstrate how
• Telehealth services can be delivered to the home in new and innovative ways, enabled by high speed broadband;
• Health services can become more accessible, in regional, rural, remote and outer metropolitan areas;
• Health related transport needs can be reduced; • Consumers can collaborate and communicate with their carers and health service
providers to improve quality of care and health outcomes; • Unnecessary hospitalisations may be reduced; • Telehealth services are scalable and able to provide an increased volume of care without a
corresponding increased cost; • Location dependent or regional health workforce skills shortages may be mitigated; • Use of the infrastructure may increase healthcare access and reduce social isolation; and • Communication during health emergencies could be improved; • Organisational change management required to embed telehealth service delivery as a
routine or normal alternative to existing services; • To change workplace cultures that mitigate against the introduction of telehealth services.
Broadband -‐enabled Tele-‐health trials 2012-‐2014
Funding Recipient Name of Project Australian Government Funding (excluding GST)
CSIRO Home Monitoring of Chronic Disease for Aged Care
$2,747,975
CSIRO Broadband Enabled Indigenous Tele-‐eye Care
$1,300,000
Feros Care Pty Ltd My Health Clinic At Home $2,461,311
Hunter New England Local Health District
Cancer Care Self-‐Management BroadbandTelehealth Program
$1,545,640
Integrated Living Australia Ltd
Staying Strong: Enhanced Aged Care for Aboriginal & Torres Strait Islander
Australians
$2,104,236
Leading Age Services Australia
Serving Older Australians – a National Approach to Broadband Enabled
Telehealth
$1,829,236
The Flinders University of South Australia
Telehealth in the Home; Aged and Palliative Care in SA
$2,528,095
The Royal District Nursing Service
Integrated Home Telehealth $2,993,037
Uniquest Pty Ltd Comprehensive Telehealth Assisted Care $2,756,241
4. Technology, People, Processes and Policy Considerations Many of the telehealth pilots included above explore critical aspects of new digitally enabled service models for Australia’s residential aged care system. There are many aspects to consider when exploring new service delivery models however the criteria for any such model must include:
• improving the health, wellbeing, quality of life and quality of care for aged patients in care • enhancing productivity for aged care providers, and • supporting greater transparency of performance and satisfaction.
The rationale for this focus is the need to address the quality and consistency of care in residential aged care facilities while identifying opportunities to optimise and improve the efficiency of existing practices and explore new service delivery models. The scope also includes the needs of older people that require higher levels of support to live independently. This group is at an earlier stage of the ‘aged care journey’ that begins with community support services and culminates in residential care. Including earlier stages of the journey increases the potential to reduce demand on residential aged care facilities, creates opportunities to explore new models for “virtual residential aged care” and supports a much-‐needed smoother transition into residential care.
There are many technical and non-‐technical issues to address in order to make the telehealth pilots successful. These challenges include overcoming challenges of integrating electronic systems (documents, files), ensuring data security and data privacy, and being able to unambiguously authenticate people online. In the health services sectors, the patient or client experience is also critically important. A level of trust and a sense of confidentiality is required in dealings between the patient and the health care provider. Under circumstances where the patient or client is in difficult circumstances such as a hospital bed or in confinement, delivery of a meaningful tele-‐presence experience is even more challenging.
Specific challenges to be addressed can be grouped into categories covering:
Social connectedness and wellbeing • Keeping the aged connected with the world they were part of before entering care • Opening windows into and within the ‘black box’ life of aged care residents • Outreach and volunteering opportunities – enabling residents ability to contribute • Encouraging physical activity and adoption of preventive health measures • Particular needs of special minority groups, such as indigenous Australians • Access to government and external services through the digital economy
Quality of life and quality of care
• Options for providing safe and efficient resident choice and control • Analytics from quantitative and qualitative data enabling ongoing evidence-‐based
performance metrics, quality assurance, accreditation, compliance, benchmarking, and more transparent standards of care
• Complaints management, providing residents and families with a safe and actionable path for complaints and about what has become their only home, without fear of retribution.
Access to and coordination of Health and Aged Services
• Interactions with external primary, palliative, acute care providers and ambulance • Care planning and care management • Community and related social services
• Wound, pharmaceutical, and chronic disease management • Nursing services and protocols • Clinical decision support and risk stratification tools
Business models and business performance
• Analytics, logistics, scheduling and forecasting to responsibly improve business productivity
• Operational optimisation that includes resident perspectives • Technology support and back end operation of digital services • System-‐wide benefits, including effects of cost shifting between community care,
residential aged care, acute care and primary care sectors.
Managing the transition
• Digitally enabled services in the home, including health and community services • Care coordination and management • Future needs forecasting, personalised risk management and stratification • Demand pipeline management for care providers • New models of care to smooth the transition (e.g. virtual residential care at home)
Telecommunications Technology
Tele-‐delivery of health services and aged care services is ultimately dependant on the widespread availability of reliable, broadband communications of appropriate quality. In 2012, CSIRO produced a report examining how differences in bandwidth and latency (see Figure 4) between these types of broadband connection can have critical implications for telehealth services26. National availability of telehealth and aged care services require an understanding of the maturity of provider offerings of appropriate quality. Understanding which homes have access will help clarify the scale of the remaining challenge. Figure 5 shows the Australian population density classified as remote or very remote by the ABS27, these are the same regions with known poor health outcomes. The figure also shows the NBN rollout plan announced in 201028.
Whilst the rollout plan for the NBN is under review, the overarching plan is that the most densely populated areas will be connected with optical fibre technology. A smaller percentage of premises will receive fixed wireless connection wireless, while the most remote areas (marked with hexagonal shapes) will connect using satellite broadband.
As the 2013 CSIRO report shows, the features and differences between satellite communication and other kinds of broadband need to be taken into account when considering the development of telehealth applications and the services they can deliver.
26 “Caring for the last 3%: Telehealth potential and broadband implications for remote Australia”, CSIRO, November 2012, http://www.csiro.au/Outcomes/ICT-‐and-‐Services/National-‐Challenges/Satellite-‐Telehealth.aspx 27 “Statistical geography volume”, Australian Bureau of Statistics, http://www.abs.gov.au/websitedbs/D3310114.nsf/home/remoteness+structure#Anchor2c 28 “Satellite Access Services – Product Overview”, NBN Co. 2010
Figure 4. Telehealth service element framework – Bandwidth and Interactivity
Figure 5. Map of Australia illustrating the Remoteness Structure (2006) and NBN Planned Coverage (2010)
Legend Grey - Wireless coverage Red – Optical Fibre town Blue - Transit network Green Satellite coverage
5. Business Models and Business Performance The telehealth market is immature although with rapid growth in multiple segments. The global home-‐based telehealth market segment was estimated at $3.5b in 2011, growing at around 22%. In Australia, the market is still in infancy, and Home-‐based telehealth is yet to be fully supported by government clinical funding models.
It is worth focussing on what is likely to be the major challenge to growth of telehealth in Australian, the ability to charge for (or be paid for) the delivery of a service electronically when we have traditionally expected such a service be delivered in person. Whilst there has been movement in this area for some limited service provision, this still represents a major change for health care in Australia.
An essential cornerstone of the process required to create that change is providing solid evidence for the benefits of Telehealth care models across the Australian healthcare ecosystem. This means unambiguously quantifying the benefits, costs, effectiveness and risks of these new means of health service delivery. It is also essential that at the conclusion of the Telehealth trials, that the Telehealth services being deployed be ready to be scaled up nationally -‐ from an organisational and technical perspective. Understanding costs and benefits provide the basis for a business case for new technology.
The second major challenge then is to develop sustainable business cases for the major stakeholders in the healthcare system. Figure 6 shows a simplified model of the Public Health Operational Relationship Map and the flow of funds, or relationships, between different stakeholders. The complexity of this system requires multiple business cases to be developed, and multiple relationships to be navigated, each with multiple drivers to be addressed. To put the size of the spending in context,
Figure 7 shows the percentage of funds expended by different agencies or groups in both the Public and the Private health systems.
The outcomes of the Broadband Enabled Telehealth Pilot projects will form an important part of the evidence base for sustainably funded home based telehealth services, as an emerging model of care to improve management of chronic disease and reduce costs elsewhere in the Health system.
Figure 6. Public Health Operational Relationship Map
Federal Government Depts & Agencies
State Government Public Hospital
Funding
Service Delivery
Taxes
SME Software Developers
Info System Vendors
Clinicians
Diagnostic Hardware Vendors
Products
Reporting
Influencing Clinical Diagnostic Services
Patients/Public
Figure 7. Sources of Funding – Public vs. Private funding in 2010-‐11 ($m)
6. Recommendations The telehealth market is immature globally although with rapid growth in multiple segments. In Australia, there are relatively few companies currently offering telehealth devices and services although new players are continuing to enter the market.
The outcomes of the Broadband Enabled Telehealth Pilot projects will add to the growing body of evidence supporting the capacity for telehealth to deliver beneficial change in health services and aged care. The trials will also help better quantify the financial costs and benefits of telehealth and which interventions are most ready for scaling up nationally.
These trials alone however will not be sufficient to effect the major change needed in the Health Sector. What is needed is the development of a sustainable funding model for home based Telehealth services based on a comprehensive socio-‐economic analysis of telehealth.
A major consideration is developing such a sustainable funding model is enabling the GP to continue to act as a key player in optimum care coordination. This includes determining which interventions are most appropriate for individual patients.
A further consideration for sustainability is the development of resources to assist health service agencies to develop new telehealth services appropriate for the care in the community.
To help move the Australian health care system, a number of recommendations are offered
1. Telehealth trial evidence
Ensure that the benefits, costs, effectiveness and risks of telehealth service being piloted are quantified as part of the completion of the trials, to inform further policy
$252
$449 $927
$2,298
$4,883
$1,347
$613 $14,359
$20,221
$765 $316
$671
$1,159
$1,446
DoHA and other federal government State and local govt. Dept. Of Veterans' Affairs Health insurance premium rebates Health insurance funds Individuals
Public: $39b Private: $10.8b
Expenditure on public hospital services, by source of funds, 2010-‐11
($M)
Expenditure on private hospital services, by source of funds, 2010-‐11 ($m)
development. This requires careful and impartial evaluation against the baseline conditions.
2. Scaling up pilot programmes
It is essential that at the conclusion of the Broadband enabled telehealth trials, all services piloted be evaluated for scaling up nationally. This evaluation must be considered from an organisational and technical perspective as well as considering what works best (efficacy) at lowest cost (efficiency) and is financially sustainable for the businesses involved.
3. Appropriate grade of telecommunications service
The deployment of telehealth services will not achieve widespread uptake without provision of appropriate grade of telecommunications service from major carriers and internet service providers in Australia. If the business case for Optus, Telstra or iiNET for example is clear, then a critical barrier is overcome. Encouraging statements in this regard are however already being made. In October 2013, Telstra announced it will target home health and aged care as part of a new healthcare services business.
4. Availability of appropriate tele-‐communications service
Identification of tele-‐health grade broadband service and development of a national availability map of telecoms regularly updated by providers.
The Broadband Enabled Telehealth Pilots build on many years of pilots in Australia. They are expected to provide services to around 2,500 patients in over 50 sites across Australia by June 2015. This delivers value in its own right, but is a long way short of what is needed to address the national challenge in healthcare.
The healthcare challenge in Australia is a matter of national significance. Telehealth offers a partial solution to this challenge however to reach the scale needed to meet the needs of our nation, and to have meaningful impact on the cost of delivering services, much needs to be done beyond proving the technology. We echo the conclusions of the Australian Telehealth Society in their 2013 report:
“We particularly seek further government, healthcare and industry sector ‘ownership’ for the creation of a final comprehensive document defining a National Strategy for Telehealth in Australia, and acceptance of responsibilities for the actions and other activities proposed within it”
