Telehealth, Teleconsultation and Telemedicine:

uses and successful implementation

Dr Victoria WadeClinical Director, Adelaide Unicare e-Health and Telehealth Unit

Research Fellow, Discipline of General PracticeThe University of Adelaide

Editor-in-Chief, Journal of Telemedicine and Telecare

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A fast moving field with many new words:

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virtual health

u-health

online health

the quantified self

health apps

What does it all mean?

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Why Telehealth?

1. Increase access to health care for underserved groups: rural, disadvantaged, disabled

2. Help solve health workforce maldistribution and rural retention

3. Improve health service integration and system safety

4. Improve quality of care5. Reduce costs and inefficiencies of travel6. Deliver effective chronic disease management

to the home

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More about Telehealth

Types of Telehealth

1. Real time (synchronous)

2. Store-and-forward (asynchronous )

Types of Data Sent

• Video

• Audio

• Still images

• Text

• Device outputs

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Telehealth Examples

• Home medication management

• TeleDerm service

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More Examples

• Pre-anaesthetic checks

• Speech pathology for rehab after stroke

• Virtual paediatric rounds in rural hospitals

• Neo-natal intensive care

• Geriatric assessments

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A Brief History of Telehealth

1900 – 1950 Radio and telephone

1960s Satellite, microwave, astronaut telemetry, tests of video communication

1970s – 1980s ISDN lines, early telehealth video trials

1990s Internet, PCs, video consultation over ISDN grows, early trials of home telehealth

2000s Broadband, mobile phones, social media: expansion of home telehealth and chronic disease management

2010s Smart phones, tablets, fibre, data & video integration

2015 Mobile apps, wearable devices, larger home trials

Next??? Smart homes, patient portals, large scale take-up of virtual consultations, haptic communication

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Video Communication Developments

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Does Telehealth Work?

• Mental Health: telehealth as effective as in-person for assessment, psychological treatments or case management

• Acute stroke: increases access to thrombolysis

• Heart failure: home monitoring decreases mortality

• Cardiac rehabilitation: greatly increases access

• Diabetes: improves HbA1c

• Overall: reduces hospital admissions and ED visits

• BUT: many areas of service delivery still in the early trial and feasibility test stages

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Telehealth delivering improved regional outcomes in Australia

Began 12 years ago; been statewide for 5 years

Includes a telephone hot line, ECG interpretation, Point of care testing, TNK delivery, clinical guidelines, video consulting … they have halved the death rate for acute cardiac presentations in rural South Australia; it is now the same as the urban rate.

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Is Telehealth Cost-Effective?

It Depends!!!

• Telehealth is almost always cost-effective from the societal perspective

• Variable from the health services perspective: less costly if it is replacing PAID TRAVEL ie outreach services or patient transport schemes

• Home care: most studies have found better outcomes for increased cost; moving feast as technology prices crash. Watch this space.

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Telehealth in Australia Now: Current Situation Private Sector- Medicare

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Telehealth in Australia Now: Current Situation Public Sector

Public Sector Highlights

• Queensland: large telepaediatrics service, telehealth being rolled out to all outpatient specialist services

• WA: main focus on tele-ophthalmology, burns care and forensic psychiatry

• Victoria: large tele-stroke trial

• NSW: regional activity in ED support, chronic disease trials

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Applications of Telehealth in Large Scale Businesses

1. Health and medical services to the workplace

2. Workplace health and wellbeing services

3. Video communication

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Deliver health and medical services to the workplace

1. Remote Areas Support

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2. Accidents and injuries

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3. Teleconsultations from the workplace

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• Reduce time away from work to attend semi-urgent or routine consultations

• Both employees and employers save time and money

Varkey, Prathibha, et al. "Telemedicine in the work site: a study of feasibility, and patient and provider satisfaction." Journal of telemedicine and telecare 14.6 (2008): 322-325.

Workplace Health and Wellbeing

Telehealth can:

• increase the scale of workplace programs

• increase the length of time of programs

• increase communication, feedback and engagement

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Telehealth and Workplace Safety

1. Reduce workplace travel

2. Reduce critical incidents (especially home health)

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How to Scale Telehealth Up?

Veterans Health Administration in the US

2013/14 financial year:

• 2 million telehealth services

• To 690,000 Veterans (12% of the total Veteran population

• Increasing at a rate of about 10% per annum: fastest growing program: tele-audiology

• 55% of services to rural areas

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What’s coming up in the (near) Future?

• Surgery at a distance

• Patient portals

• Haptic communication (remote touch)

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Questions?

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