There is significant and growing interest in telehealth5 among all specialties, although interest for training, supervising and consultations with other practitioners is much stronger than interest in using telehealth to connect directly with patients. Telehealth is currently used by fewer than 10 percent of specialists surveyed, but an additional 41 percent stated that they definitely or probably will start using telehealth within the next 3 years (Exhibit 5). Within specific segments, diagnostics (~24 percent) emergency practitioners (~18 percent) and obstetrics/gynaecologists (~18 percent) are the most likely to have already started using telehealth services. Appendix 3 provides additional details on telehealth use by segment.
Most telehealth is currently for consultations between practitioners and/or for training purposes, and these two applications retain the greatest potential for future use (62 percent of practitioners who definitely or probably will start using telehealth are very interested in using it for training and 55 percent are very interested in using it for consultations with other healthcare practitioners. Far fewer specialists (43 percent) are interested in telehealth for remote monitoring and remote consultations with patients (38 percent). Specialists interviewed were much more interested in providing advice to GPs and other specialists in remote areas than in connecting with patients, and in many cases (e.g. teledermatology) specialists did not believe that the patient even needed to be present for them to provide a diagnosis.
Many telehealth systems have been developed by strongly motivated clinicians, who promote and market them through their own networks with little support from the IT and telecommunications industry. Not all are compatible with the current or proposed structure of the MBS telehealth items, as not all require that the patient be physically present or consulted by videoconference.
A key motivating factor for telehealth services is the reduction of patient travel costs and waiting times, particularly the avoidance of referral to a bigger centre. Another is the reduction of long distance and overnight callouts for doctors who are ‘on-call’. Telehealth is also being pursued for life and death situations where rapid treatment is required, or where supervision is otherwise ideal: for example, the telestroke initiative, and the assessment and management of neurosurgical emergencies.
The following applications were explored during initial clinician and stakeholder interviews. These examples show that, though the potential efficiencies and learnings from these early telehealth initiatives are significant, incentives may need some realignment so that telehealth parties are not penalised for treating patients locally.
- An Australia-wide teledermatology program run by the Australian College of Rural and Remote Medicine. Rural doctors can email patient histories and a set of photographs to a secure website supported by a dermatologist in South Brisbane, who makes a diagnosis and sends educational materials and a treatment plan back to the GP. Significant savings on patient travel and public-sector wait times, though increases GP workload beyond a simple referral.
- A ‘telestroke’ program operating in a rural Victorian town with a large hospital, enabling thrombolytic therapy to commence immediately after a stroke without wasting time transferring the patient to a city hospital. The patient examination is videoed and the diagnostic images sent to a neurologist in Melbourne, who confirms the diagnosis and approves the thrombolytic therapy. The program saved patient transport and improved clinical outcomes, but the hospital’s pharmaceutical budget was stretched as a result of undertaking treatment locally.
- The iCBT cognitive behavioural therapy program run by the Clinical Research Unit for Anxiety and Depression at St Vincent’s Public Hospital. Carefully selected patients are enrolled in an online program as an alternative to medication and psychotherapy. Very little clinician input is required and about 50 percent of selected patients recover using this tool alone, with significant savings to the health system. This program is now being replicated in several states with a view to decreasing the workload of psychologists and GPs who are freed up to focus on more complex cases.
- A telehealth-based system of trainee supervision and assessment to allow a greater proportion of surgical training to be undertaken in rural and remote hospitals. This is currently under development through the Royal Australasian College of Surgeons.
5For the purposes of this research, telehealth has been defined more broadly than under the Medicare Benefits Scheme (MBS). Refer to the Definitions section for additional detail.