Spreading healthcare around the nation

Nurses are the very important 'glue' that holds together the delivery of services using telehealth. By David Allen

With rapid growth in the use of technology and communication systems including the internet, the application of that to healthcare is inevitable.

Telehealth, in other words healthcare at a distance, has been around for many years. Ready access to inexpensive new technologies has made it more accessible to healthcare professionals and patients across the world.

We know that telehealth can:

• Improve the management of chronic diseases [1, 2] which is one of the biggest obstacles that both patients and health workers in remote and regional areas face

• Significantly reduce hospital admissions for heart disease: 30-40 per cent reductions in heart failure [3]

• Provide local health professionals contact with specialists that they would otherwise rarely or never directly interact with [2]

• Help in improving indigenous health [4]

• Be a platform for delivering training [5]

• Reduce greenhouse gas emissions by minimising patient travel [6]

With MBS payments for telehealth having come into effect, there has been a dramatic increase in the interest in telehealth throughout Australia.

In my practice in occupational health, we have been delivering telehealth services nationally from our facilities in Sydney on a 24/7 basis to industry. This is of course not constrained by Medicare reimbursement.

Research has shown that this is effective and certainly extremely well received by patients.

Generally it shows that patient acceptance is extremely high for telehealth.

Initially there were concerns that lack of a hands-on examination may limit patient acceptance but this has not been shown to be the case. Patients highly value the convenience of telehealth.

In some areas where doctors are very scarce patients may sometimes have to wait many weeks to see a doctor and many patients choose not to see a doctor at all. There is also lack of access in areas such as aged care. Patients often choose no care rather than travelling long distances.

Nurses can and do provide the hands for the physician to facilitate an examination and support the patient through the consultation. Nurses involved in consultations with specialists also become more closely involved in the management of that patient and have a better understanding of the medical issues in that case.

That improved understanding will enable them to provide better advice to the patient and ongoing care.

As nurses become more skilled at telehealth and facilitating and consultations, the process will become easier at both ends. This is a win for doctors, nurses and patients.

Telehealth can be used to support remote practitioners who often feel isolated and are under a good deal of stress when confronted with complex problems that can obviously occur in isolated areas.

Telehealth provides a means by which those practitioners can access advice from colleagues on particular cases. Having worked personally in rural and remote settings, it is quite anxiety provoking when confronted with a difficult clinical situation. Where nurse practitioners are working alone, telehealth provides a means whereby they can access prompt advice when they need it.

The growth in telehealth in Australia has been slow but over time it will continue to grow.

When encouraging clinicians to take up telehealth, whether they be nurses or doctors or Aboriginal health workers, we need to keep it simple. I encourage them to think of video-conferencing as an addition to telephone advice.

Doctors and nurses provide advice by the phone on a regular basis. This is by definition telehealth.

With video-conferencing we are adding extra information which allows a better assessment of the patient. It also improves patient acceptance and makes the experience much more personal.

Appropriate support and training is needed to ensure that telehealth uptake grows.

My experience in providing telehealth consultations across Australia is that patients are extremely grateful to be able to access care in such a timely fashion.

It is a very personal experience to provide a video-consultation and I would encourage the nursing profession to get more involved.

I believe the nursing profession will be the "glue" that holds telehealth together in Australia and more uptake of this will have a major impact on improving access to care and healthcare outcomes particularly for rural remote patients.

David Allen is managing director Telehealth Solutions Australia and Quality Occupational Health as well as conjoint senior lecturer, University of NSW.

References
1. Seto, E., Cost comparison between telemonitoring and usual care of heart failure: a systematic review. Telemed J E Health, 2008. 14(7): p. 679-86.
2. Smith, A.C. and L.C. Gray, Telemedicine across the ages. Med J Aust, 2009. 190(1): p. 15-9.
3. Dang, S., S. Dimmick, and G. Kelkar, Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. Telemed J E Health, 2009. 15(8): p. 783-96.
4. Muttitt, S., R. Vigneault, and L. Loewen, Integrating telehealth into Aboriginal healthcare: the Canadian experience. Int J Circumpolar Health, 2004. 63(4): p. 401-14.
5. Conde, J.G., et al., Telehealth innovations in health education and training. Telemed J E Health. 16(1): p. 103-6.
6. Merrell, R.C. and C.R. Doarn, Telemedicine is green! Telemed J E Health, 2009. 15(8): p. 731-2.
7. Muula, A.S., Specialist training programs for African physicians. Croat Med J, 2006. 47(5): p. 789-91.
8. Dos Santos, A.D., et al., Evaluating the Experience of Training Through Videoconfer-ences in Primary Care. Telemed J E Health.

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