Chapter 3 Health
Health is undoubtedly seen as the sector that will benefit most from the
NBN. This was evident throughout the course of the inquiry—health was discussed
in more than two thirds of submissions and at all of the hearings.
The Broadband Commission for Digital Development’s recent report argued
E-health is one of the most compelling applications to take
advantage of high-speed broadband networks. In countries with a clear policy
for an advanced broadband infrastructure, e-health allows citizens to enjoy
advances in medical technology and services, at more affordable costs.
The terms e-health and tele-health are often used interchangeably. The correct
use of the terms was clarified in the submission of the Australasian Telehealth
The term Tele-health refers to healthcare delivery, or
closely-related processes (such as education), when some of the participants are separated by distance and information and communications technologies are
used to overcome that distance …
Tele-health is usually considered to be a subset of e-health,
which refers to the use of Information and Communications Technologies (ICT) in
healthcare. A primary focus of e-health is the implementation and use of
Electronic Medical Records.
This chapter looks at the development of e-health in Australia,
particularly tele-health services, and examines the likely impact of the NBN.
Why is e-health important?
As has been widely publicised over recent years, health care costs are
expected to increase dramatically in the future. The situation was summarised
in the Department of Broadband, Communications and the Digital Economy’s
An ageing population, increasing rates of chronic disease and
a shortage of health and care professionals is expected to put significant
pressure on Australia’s health care systems and budgets in coming years. The
percentage of the Australian population over the age of 65 is predicted to grow
from 13.5 per cent in 2010 to 22.6 per cent in 2050. Over the same period real
health spending on those aged over 65 is expected to increase seven fold.
Against this background there is a need to find new ways of delivering health
care services efficiently and effectively, that also meet patient expectations.
A similar point was made by NSW Health:
With the rise of chronic disease expected to account for
almost three quarters of all deaths by the year 2020, and chronic disease
already accounting for more than 80 per cent of the burden of disease and
injury in Australia, establishment of a national telecommunications network
which would support delivery of services via tele-health is critical to
minimise the influence that chronic health has on health budgets.
The widespread implementation e-health, facilitated by the NBN, will
improve the efficiency of the health sector and generate significant financial
savings for government, as well as savings and quality of life improvements for
citizens. This point was made in the submission of the Institute for a
Broadband Enabled Society (IBES):
Ubiquitous and high-speed broadband has the potential to
dramatically transform the health care sector. The application of
video-conferencing, sensor networks and enhanced information management systems
can drive productivity growth in hospitals, general practice and support
patients in their home.
The Broadband Commission for Digital Development has suggested that ‘cost
savings through the use of e-health are expected to be between 10 per cent and
20 per cent of total healthcare costs, while maintaining a good quality of
service.’ An Access Economics Study
from 2010 found that the benefits to Australia from extensive implementation of
tele-health may be in the order of $2–4 billion per annum.
The Australian Information Industry Association cited a Booz & Co study
… estimated that rollout and adoption of core e-health
capabilities in Australia is expected to be worth an estimated $7.6 billion
annually by 2020, with the primary benefits stemming from reduced errors,
enhanced adherence to best practice, and enhanced workforce productivity.
The Australasian Telehealth Society described some of the ways that
savings can be realised in practice:
- Early intervention
for patients in rural and remote areas can help to avoid costly hospital stays
and more expensive treatment if the condition is left untreated.
- Trauma patients
admitted to emergency departments of rural, remote and regional hospitals can
receive appropriate intervention in the ‘golden hour’ following their injury,
reducing further costs.
- Ageing in place
delays the commencement of full-time residential care and the high personal and
community costs of that care.
- Self management of
chronic disease helps avoid costly interventions and residential care.
- Better targeted
evacuations of patients needing care in major hospitals reduces the costs of
caring for those patients, especially if they require special care during
evacuations (e.g. ICU patients).
- The cost of visiting
major centres for outpatients and their families can be reduced or avoided
- Medical errors and
the costs of dealing with their consequences can be reduced.
The submission also described how e-health applications could help
improve the utilisation of an already stretched health workforce:
While tele-health cannot create new health professionals, it
can play a role in ensuring that the existing workforce is used efficiently and
to its full capacity. For example, a specialist located in one hospital can
deliver some services across a number of centres, helping to maintain
facilities such as intensive care units in centres which might not be large
enough to make use of such a specialist on a full time basis.
Implementation of e-health initiatives is currently constrained by the
inconsistent nature of broadband across the country, particularly in rural
areas. CSIRO gave an example where broadband access has restricted the
widespread implementation of a worthwhile e-health initiative:
The Virtual Critical Care Unit (ViCCU) … was successfully
trialled between Katoomba and Lithgow hospitals. The ViCCU system was an
outstanding success, however, it was not rolled out across the state, due to
the lack of a broadband communications network. A national high-speed network
will reduce network connectivity costs and will stimulate the use of such tele-health
While many of the e-health applications discussed in the remainder of
this chapter do not require high-speed broadband, the Committee notes that
there are many that do, and as tele-health develops in the next decade,
high-bandwidth applications are likely to become commonplace. Successful e-health
implementation also relies on other factors such as ubiquity and reliability of
service, as explained by the AIIA:
While not all [e-health] activities necessarily require high
speed broadband, the health system is exactly that—a system. An online health
system requires uniform capability to enable all parts. Ubiquity is essential
to ensure all Australians can benefit from all these (and more) services.
Many hospitals and other health facilities, particularly in metropolitan
areas, are already connected to high-speed fibre broadband and can take
advantage of a range of e-health applications. There are, however, many more premises,
including homes and doctors’ surgeries, which do not have access to the
symmetric and reliable broadband connections necessary for many e-health
The inquiry received a significant amount of evidence about the various tele-health
applications that exist already or that become feasible with the advent of
ubiquitous, high-speed broadband. This section discusses some of those
Remote consultations, diagnostics and treatment
The NBN will enhance the capacity for people to undergo a medical
consultation without travelling, as explained in the submission of DBCDE:
Pervasive high-speed broadband is a key enabler for the
widespread use of high quality video consultations. In combination with work
underway to provide Medicare Benefits Schedule rebates for tele-health
services, this can support tele-health to become a mainstream complementary
option for health service delivery in Australia.
The Medicare changes mentioned above commenced recently—from 1 July
2011 participating medical practitioners will receive Medicare rebates for
undertaking tele-consultations (further discussed below in the section on the
role for government).
The submission of the Royal Australasian College of Physicians (RACP) described
how remote consultations can either be a direct patient to doctor exchange, or
can involve the assistance of another health professional. The submission
provided some examples where the different types of remote consultation might
- A patient with
epilepsy who requires six monthly or annual consultations to monitor his/her
response to anti-epileptic medication: in this case, the patient may consult
the neurologist without an accompanying health care professional present.
- A patient recovering
from a stroke at home who requires a review of her/ his progress: in this case,
the patient may consult the neurologist together with the local GP, where the
GP or health care professional can carry out physical examination as directed
by the neurologist (this would also be appropriate for review by rehabilitation
specialists and others).
- A patient suffering
an acute stroke who may benefit from thrombolysis: in this case, the emergency
care physicians may consult with the neurologist on whether to administer
thrombolytic therapy and to assist in monitoring the patient’s condition after
The RACP submission also outlined the specialties that are currently
involved in remote consultations or that may be appropriate for remote
consultations in the future:
Consultation and cognitive specialties are more likely to
adopt tele-health consultation, whereas examination based, investigative or
procedural specialties require direct consultation. For example in Queensland,
specialties involved include:
- Cardiology (Heart
- Clinical Pharmacology;
- Nephrology (Renal
Other specialities are currently involved in providing
services by means of tele-health, include dermatology, palliative care and neurology. Many
other scenarios are yet to be explored in Australia, although developments
overseas indicate that tele-health is capable of effectively delivering a far
greater range of services across a greater range of specialties.
The inquiry heard about a number of specific examples where remote
consultations are already being used or are being investigated. CSIRO told the
Committee about the development of its Remote Immersive Diagnostic Examination
System (RIDES), as discussed in Box 3.1.
|Box 3.1 RIDES
CSIRO has been active in the development of broadband tele-presence
systems for healthcare for the past ten years. The Remote Immersive
Diagnostic Examination System (RIDES) is one example of a broadband
application it has developed for tele-health.
The RIDES system provides an immersive, high-definition specialist
consultation overcoming the need for travel by a specialist or the need to preemptively
transport patients long distances. Apart from high quality video
and audio, the system allows high quality image exchange, data exchange and
three-dimensional (3D) viewing of the patient. The system also allows the
specialist to project their presence by remote use of laser pointing and
CSIRO advised that RIDES requires a symmetric connection of 30 to 50 Mbit/s
to and from the patient, which is not possible with current ADSL or HFC
networks. Costs for the equipment required for this type of system are falling
and it is possible that, in future, this type of technology will either run on
home entertainment systems or be a module that healthcare providers can
deliver to a patient’s home and connect to a high speed broadband network.
Such a development also has the potential to reduce the demand on aged care
services. For example, the use of remote health monitoring and ‘always on’
high definition video, audio and data communication available in the
patient’s home may delay their need to move to full-service residential aged
Source: CSIRO, Submission 171, pp. 8-9.
IBES told the Committee about its ‘telestroke’ project, which allows
stroke sufferers in rural areas to be administered with a potentially
life-saving drug. The drug can only be prescribed by a specialist because of
its serious side effects:
The National Stroke Foundation estimates that seventy two
percent of Australian hospitals are unable to provide acute stroke treatment.
The Telestroke pilot study is demonstrating the feasibility and effectiveness
of a remote consultation system between a comprehensive stroke centre at the
Royal Melbourne Hospital and a rural hospital in Wangaratta. To date, 93
patients have been enrolled in the study. Of these patients, 20 were assessed
with the telestroke system and nine of these were administered the ‘clot
busting’ medications with an average treatment time of 82 minutes.
At its site visit to the IBES laboratory in Melbourne, the Committee was
shown a demonstration of a remote dentistry project which aims to improve the
quality of dental care received by residents in aged-care facilities using
high-definition video technology. IBES informed the Committee that this type of
technology could help dentists to better plan their workloads before visiting
such facilities in person. The IBES submission explained:
Face-to-face patient examinations are regarded as the most
accurate method for correct oral health diagnosis. However, only 11 per cent of
aged care residents have seen a dentist in the past 12 months. Few dentists
provide dental care for residents of aged care facilities …
The project … is investigating whether improvements in
accessibility and appropriateness of oral health services can be achieved by
using broadband technologies to screen for oral disease in older people living
in residential aged care facilities.
The Committee notes that at the site inspection the presenters at IBES
indicated that the applications it demonstrated required bandwidth of no more
than 20 Mbit/s.
The DBCDE submission outlined the operations of the Victorian Virtual
Trauma and Critical Care Unit (ViTCCU), which has demonstrated the capability
of high-speed broadband to improve critical and emergency care in regional
ViTCCU provides support for regional doctors in smaller
towns, dealing with trauma or specialist cases, by linking them (via video-conferencing
supported by high-speed broadband) with trauma and critical care specialists at
major Melbourne hospitals. This allows quicker decisions on the right treatment
for the patient, and also helps to determine if they can stay in their local
hospital or need to be sent on to a larger hospital.
The CSIRO submission explained how remote eye screening could contribute
to disease prevention:
… a national broadband communications network will support
the delivery of telemedicine-based eye screening programs for sight threatening
diseases such as diabetic retinopathy (DR) and Age Related Macular Degeneration
service is currently being developed by CSIRO using leading edge,
computer-aided ophthalmic diagnostic image analysis technologies as well as
commercially available retinal scanner devices. The system will allow
healthcare professionals (nurses in the first instance) to perform screenings
for eye disease in Port Hedland, Western Australia, and then seek specialist
consultation as needed from an ophthalmologist in Perth who decides on the
course of action. In addition to providing the remote ophthalmologist in Perth
with a ‘real-life experience’ through an immersive video-conferencing
environment using 3D images and patient interactivity, the system will enable
the upload of images, videos and medical history using a web-based diagnostic
system (with Electronic Health Records) that can be read by other
At the Committee’s Sydney hearing, Dr Dean Economou, a Technology
Strategist at National ICT Australia (NICTA), detailed a tele-health
application for skin cancer:
A company called MoleMap has a team of dermatologists that
specialise in skin cancer. It turns out skin cancer is a subspecialty. If you
go to your average GP he or she may not really know about whether something is
a skin cancer and they might send you to a dermatologist. The average
dermatologist is barely better, at skin cancer, than that. So, there are people
who specialise in this. But the efficiency of getting a person into a doctor's
office, making a booking and taking the map makes it a very slow process. They
have this team and you go to some sort of clinic where they take the
appropriate pictures, upload those pictures and then they have their team of
dermatologists basically doing one patient per minute. 
Dr Economou expanded on the efficiencies gained and improvements in the
quality of service delivered:
The stats that came out from this MoleMap company were that
they did 20 000 more patient consults with the same sized team. The thing that
is really marvellous is that you have taken this very specialised set of
patients with specialised needs and you have matched them exactly to the right
people. Rather than everyone getting some sort of average service, those
specialists are getting the patients that are most relevant and those patients
are getting the best service. That is 20 000 extra patients covered by the same
team. If you extrapolate that kind of thing to the wider medical system you can
see there are some real efficiencies. They think they probably saved 250 lives
because those people are so specialised they would have caught things that
others would not. You hear a number like that, and that is just because the
digital economy allows you to organise things and match the work to the people.
The NICTA submission described an example of remote surgery from
Ontario, Canada. The ability to undertake the surgery is reliant upon a
15 Mbit/s symmetric connection with very low latency:
To date, 21 telerobotic laparoscopic surgeries have taken
place between North Bay and Hamilton …
Telerobotic remote surgery is now in routine use, providing
high-quality laparoscopic surgical services to patients in a rural community
and providing a superior degree of collaboration between surgeons in teaching
hospitals and rural hospitals. Further refinement of the robotic and
telecommunication technology should ensure its wider application in the near
Electronic storage and transmission of medical data
The ability to store and forward medical data has become a crucial element
of modern health services, and the NBN will improve the ability of health
providers to undertake these activities. The Australian Medical Association
(AMA)’s submission identifies the importance of timely access to information:
[Broadband] minimises slow download times, thereby both
enabling medical practitioners to make time-critical treatment decisions, and
preventing busy medical practitioners wasting time waiting for data to arrive
The AIIA made a similar point in its submission:
Healthcare decisions and service delivery depends on the
ability to access the right information when and where it is needed. Access to
information reduces over servicing, informs healthcare decision making, reduces
the incidence of medical misadventure, enables preventative healthcare
strategies and ensures citizens are empowered in the healthcare delivery
The Medical Technology Association of Australia’s (MTAA) submission
commented on how the NBN will improve the transmission and usability of medical
High speed broadband will enhance image quality and increase
the speed of data transfer. This will benefit radiology specialties where large
files must be transferred and disciplines that use medical photography (e.g.
for wound care). Large data intense files such as magnetic resonance image
(MRI) and computer aided tomography (CAT) scans will be able to be downloaded
and transferred more easily.
There are a range of data-intensive medical activities that will be
enhanced by the bandwidth capacity of the NBN, as identified by the
Australasian Telehealth Society:
- Ability to rapidly
transfer and interact in real time with large data sets, as generated by some
3D imaging modalities such as CT or MRI.
interaction with camera- or computer-generated images.
transmission of several video and/or data channels, which can support team
interaction in complex critical care applications.
- Broadcast-quality (or
better) video-conferencing to create a high sense of presence and trust,
without latency-induced time delays.
- Real time guidance or
even robotic control of some procedures.
interactive teaching, accessible by medical trainees or practitioners seeking
continuing medical education, wherever they happen to be located.
Mr David Ryan, Chief Information Officer of the Grampians Rural Health
Alliance, told the Committee about the limitations of the current network
infrastructure in his area when dealing with high volumes of data:
… you can have a video-conference and throw up an image of an
X-ray, but that might then mean that your video-conference drops out or that
one will be of a lesser quality than the other, if you are limited by
bandwidth. So, on a 100-megabit link, you should be able to get video, data,
voice and high-quality X-rays projected all at the same time. But you would not
be able to do that on a four-megabit link …
The Committee heard that dial-up and ADSL services are inadequate to
upload medical data in a timely fashion. This point was illustrated in the
National Rural Health Alliance’s supplementary submission:
A chest x-ray image would be about 10 MB—there are usually
two per session. Thus if connections are optimal, one chest x-ray image (10 MB)
would take approximately:
- 24 minutes on a 56 kbit/s
- 2.6 minutes on 512 kbit/s
- 1 second on the 1
Gbit/s internal hospital network.
A breast screen image is a similar size, 10–15 MB, but there
are usually 10 per exam so 100–150 MB in total; the time for downloading the
full set would be multiplied.
… transmission of high resolution images from [a] clinic
setting with [an] ADSL connection would be a slow process and the specialist
would not be able to receive it during the consultation, especially if another practitioner in [the] clinic was using the
internet connection at the same time.
The ability to transmit large data files also has wider benefits in
allowing Australian businesses to export medical services (more general export
opportunities are discussed in Chapter 6). At the Committee’s first Perth
hearing, Richard Bone, President of the Western Australian Internet
Association, explained how the availability of fast broadband has enabled new
business opportunities in medical imaging:
In the area of health, we have a customer … providing a
medical analysis service out of Western Australia, but their service is
supplied around the world. Effectively, MRI images taken from locations around
the world are transferred through a secure protocol to Perth. Perth basically
processes them overnight and sends the results back overnight.
The availability of ubiquitous broadband enables the widespread use of in-home
health monitoring applications. Many of the current devices in this area are
more dependent on the availability of a reliable broadband service than high speed.
However, this is likely to change over time as two-way video is incorporated
into the applications.
The MTAA’s submission provided a comprehensive list of monitoring
applications that are becoming available:
- Implantable cardiac
devices are able to wirelessly transmit cardiac data or information regarding
the performance of a device, which can be assessed by a specialist without the
need for a face-to-face routine check up.
- Vital signs
monitoring uses equipment and medical devices installed in the patient’s home
to identify trends and send alerts when necessary, in order to detect symptom
exacerbations and intervene early.
- Online health alerts
and medication reminders can be delivered to patients online to enhance
medication compliance and remind patients to take the right medication at the
assessment does not have to take place in a hospital or nursing home setting. A
device with enuresis sensors can record incontinence events over a 72 hour
period while the patient is at home.
- Diabetic patients can
have insulin levels and other vital signs monitored using automated data upload
and online services.
- There are a number of
wireless devices that combine satellite global positioning systems and can be
used to track dementia patients who wander.
- Cognitive assessments
can be performed in a patient’s home using a personal computer and data
automatically scored and sent to a specialist in a different location.
- Patient safety can be
monitored in the home using a range of alarms, alert systems and sensors.
- Health education can
be delivered online to a patient at home.
- There are a range of
Therapeutic Goods Administration (TGA) approved home monitoring systems that
record and transmit daily vital signs. Peripheral devices can be used to
monitor pulse, weight, blood pressure, temperature, epilepsy and subjective
symptoms associated with a range of chronic diseases.
The submission went on to detail the benefits that have been measured
from a range of worldwide trials of remote monitoring applications:
improvement in glycemic control in diabetics who transmitted blood glucose and
blood pressure data to a nurse.
- A 71 per cent
reduction in emergency room admissions in respiratory patients who had oxygen
saturation measured by pulse oximetry and monitored daily.
- A 25 per cent
reduction in numbers of bed days of care and a 19 per cent reduction in
hospital admissions in 17 025 veterans with chronic disease who were enrolled
in a home tele-health program.
- A 43 per cent
reduction in hospitalisations and a 68 per cent reduction in bed days of care
in cardiac patients who transmitted daily electrocardiogram (ECG) and blood
- A reduction in office
visits and earlier detection of anomalies in patients with implantable cardiac
devices who were monitored using automated, wireless technology.
- A significant
decrease (45 per cent) in the need for in-patient hospital evaluation in 1339
patients with implanted cardiac defibrillators who were remotely monitored.
- Detection of a far
greater number of clinical or device related events than during scheduled
office visits in patients with implantable cardiac devices.
- A 50 per cent reduction
in mortality in a large sample (69 556) of patients with implantable cardiac
devices, including cardiac defibrillators.
- A decrease in blood
pressure and a reduction in the number of medications needed to treat high
blood pressure in an analysis of 37 clinical trials, including 9446 individuals
using home blood pressure monitors.
The IBES submission provided the Committee with information about the
development of a device to monitor knee osteoarthritis:
The project is developing a prototype device that will be
integrated with a mobile phone to enable remote monitoring of patients as they
undertake typical daily activities. It is expected that real time monitoring
over extended periods will enable more accurate assessment of knee joint usage
patterns, natural disease progression, and development of more effective
Neuroscience Research Australia outlined how remote monitoring
applications will become important in managing neurological disorders:
Successful and continued independent living in older people
or those with neurological damage or disease depends on a number of key
physical, cognitive and social markers of health. Monitoring these markers of
health over time, and comparing them to clinical models, enables us to draw
conclusions about the current physical, cognitive and social health of the
individual. However, this necessitates labour intensive assessment by clinical
professionals that requires the individual to travel to a central clinic or
hospital facility. In remote and rural communities, especially in a country
like Australia, the distance, inconvenience and expense of travel often make
routine assessment of function very difficult. There is therefore a pressing
need to develop data on routine or semiroutine measures that can be gathered
from peoples’ home environments.
Daily, weekly or monthly home-based monitoring of health also
improves our ability to detect and act upon changes in these markers should
they deviate significantly from an individual’s history or accepted clinical
models of good health. Tele-health technology, which combines digital data
acquisition and broadband communication technologies to monitor health status
in the home, is gaining attention as a promising strategy for acquiring
accurate, reliable and time critical health marker data.
The ACT Government’s submission described its program that enables
families to monitor babies in the special care nursery from home:
An example of the kind of bandwidth intensive application
being developed is NICUCAM at the Centre for Newborn Care at the Canberra
Hospital. NICUCAM offers remote viewing of individual babies via a secure
website, so that parents who are unable to be by their newborn's bedside can
view them via live video.
The submission further described how many ACT residents cannot access
the service because of poor broadband coverage:
While this service is technically available to everyone, some
families are restricted to access by where they live and the broadband services
they currently receive. For example, many areas of the ACT are still unable to
access the internet speeds required for such applications.
At the Committee’s Hobart hearing, Professor Paddy Nixon outlined that
technology could be utilised to remotely monitor if people have taken their medication,
but also noted that there remains a human element:
Many [applications] simply spot whether you have taken the
tablet out of the cupboard and not whether you have actually taken it. So there
are always technological solutions to those particular things. There is still a
human-technology interface that you have to work with and that is always the
single most challenging part. As a technologist myself I can devise anything
you want, but whether it works for you as an individual is the key question.
Rehabilitation and preventative health
The NBN will improve rehabilitation outcomes by providing patients with
regular and real-time feedback. One project in this area was outlined in the IBES
submission and demonstrated to the Committee on its visit to the IBES
IBES researchers are investigating the use of Haptic
tele-rehabilitation for stroke recovery. Haptic devices provide sensory
feedback between two people in different locations, enabling them to share the
sense of touch. Through the application of broadband technologies, haptic devices
can provide alternative rehabilitation methods for stroke survivors. This
project is developing a low-cost in-home tele-rehabilitation system to assist
stroke patients in the rehabilitation process. The prototype system consists of
a robotic platform on which the patient places his or her arm, and a simple
rehabilitation software program that provides exercises with various degrees of
difficulty. Clinicians can interact with a patient via the Internet, which
allows them to monitor and change computer-based movement tasks according to
the patient’s performance and needs.
Another example of remote rehabilitation was outlined by Neuroscience
Research Australia and involves using conventional modern gaming systems such
as the Nintendo Wii:
… by using engaging video game therapy, patients can
significantly improve their movement and the range of tasks they can perform
using their stroke-affected hand and arm. More importantly, patients no longer
consider rehabilitation therapy a chore. This form of therapy is highly
effective after only two weeks of therapy.
Another way in which home-based rehabilitation can be improved is
through the use of technology to give reminders to patients and maintain
motivation through interactivity. This is the aim of a CSIRO program being
developed to improve the rehabilitation of heart attack sufferers:
Cardiac Rehabilitation Program … is delivered by mobile phones and through a
web portal. The aim of offering the program in this way is to double the number
of patients completing a rehabilitation program after a heart attack. This
system has the potential to save $50 million per year in readmission costs
alone in Australia. The range of possible applications, similar to the Cardiac
Rehabilitation Program, is huge.
This mode of health service provision could readily be
extended to treat chronic illness, diabetes and support aged care. The key to
the development of such applications is that they are interactive; this will
require ubiquitous broadband communications connectivity to all homes.
For some ailments an important component of rehabilitation is group
therapy. However, as identified by Dr George Margelis, the Australian General
Manager of Intel-GE Care Innovations, in-person therapy sessions can be
inconvenient and costly, and broadband-enabled technologies can offer a better
The classic example is that cardiac rehab is done normally in
group clinics at a hospital. We are doing a project in Melbourne at the moment
with a hospital where they have a cardiac rehab program. Their biggest
limitation is getting eight patients with
congestive heart failure to their hospital for that one-hour session, because
it requires eight taxis to pick up eight people from around Victoria, get them
to the hospital, do the session and take them back home. It is important
because they need to have that community effect. One-on-one does not have the
same effect. If they are in the room with their peers who have similar issues
they can relate to it, but there is no reason why that cannot be done virtually
with the advent of video conferencing capabilities and multiuser video
Dr Steve Hambleton, then Vice-President of the AMA, told the Committee
that broadband video-conferencing technology can enable doctors to remotely
demonstrate to patients how to perform ‘Epley maneuver’ exercises, which are
used to help patients with dizziness and inner ear problems. He explained that
the exercises can enable patients who otherwise may need to spend seven to ten
days in bed to be ‘completely cured from their dizziness very quickly’. Mr
Hambleton suggested that greater broadband capacity would enable these type of
demonstrations to be more effective:
In my surgery, with my bandwidth, sometimes I cannot get the
video to show. When I do get it, it is two inches by two inches, so it is very
difficult. If you could have the whole screen and proper vision to show the
patient, it would be even better … it would be great if I could actually say,
‘Here are the videos and here is the download site where you can do them and I
will show you how to do them. If you are doing them at home then I could watch
The Committee notes that there is significant potential for
broadband-enabled technologies in the area of preventative health. For example,
Mr Ian Fry, Executive Officer of Ballarat ICT, told the Committee that a
company in Ballarat has started online fitness courses using a fibre connection
at the University of Ballarat’s technology park. Mr Fry suggested that these
courses could have the capacity for people who cannot make it to gyms, such as
young mothers, to take part in video-based guided exercise regimes from their
Ageing populations are an important consideration in the likely uptake
of tele-health services around the world, as recently identified by the
Broadband Commission for Digital Development:
Aged care services are at the forefront of developments for
in-home technologies using broadband. It is estimated that there are currently
around 550 million senior citizens worldwide. The elderly outnumber children in
countries such as Japan, Bulgaria, Germany, Greece, Italy, and Spain.
In this context, the capacity of the NBN to be a conduit for home-based
aged care services is of fundamental importance:
A key component of solutions will be homecare services.
Video-based broadband connections allow people to stay at home and still have access
to medical staff at monitoring hubs that provide services ranging from
automated analysis of data from personal health systems, to advice from
qualified nurses on call throughout the day.
These layered response systems can alleviate demand for expensive
clinical staff and significantly ease the anxiety levels experienced by family
carers. The nurses maintain contact with people who need medical assistance and
other medical specialists can be brought in as required via video link.
While one important advantage of widespread home-based service is the
financial savings and efficiencies, an equally important advantage is the
improvements to quality of life. This was identified by Dr George Margelis of
Intel-GE Care Innovations:
If we can deliver services that enable people to delay or if
possible totally remove the need for them to spend their last years in a
nursing home, we can improve that person’s quality of life and also improve the
quality of life of their family. The major issue we face in nursing homes [is] that
family and friends cannot come and visit when the nursing home is 20 kilometres
away from work and they need to go and spend the day. So, how we use these
technologies in the home is critical.
The Australasian Telehealth Society’s submission recognised that
technology has been important in aged care for many years, and this will
increase as broadband coverage and speeds improve. The submission went on to
describe the features of modern technologies in this field:
Recent systems can provide various forms of interaction for
the subjects (such as high quality video-conferencing with a carer), as well as
automated systems for monitoring vital signs and other measures of well-being.
A recent trial of aged care technology in the Hunter region has
demonstrated the practical benefits that can be delivered. This project was
detailed to the Committee by Dr Margelis of Intel-GE Care Innovations:
… we delivered technology into the homes of about 50
patients who were at that stage receiving regular care by a home nursing
service. Hunter Nursing is a nursing service and it has about 400 nurses. They
basically go and visit people in their home and deliver healthcare services.
What we did is pick 50 of those patients who had the highest needs. These were
patients whose average age was about 83. We delivered a little white box into
their home, which for all intents and purposes was a small computer but was designed
to be used by someone who did not know anything about computers. So, the
classic patient had never used a computer before in their life and had never
had to worry about those sorts of things. This device spoke to them, gave them
very large onscreen prompts, took them through a process of healthcare delivery
and enabled them to also communicate with their healthcare provider remotely.
So, the nurse sitting at her desk at Hunter Nursing could video-conference to
this patient and discuss their health concerns. They could get information
about their blood pressure, weight, blood oxygen, general wellbeing and
actually ask the patients questions about how they felt, and it did all that
quite simply. Ninety-nine per cent of the patients were satisfied with the way
it was used. It was very easy to use. We had no issues around the technology.
Dr Margelis identified that the biggest challenge for the project was
getting a reliable broadband connection:
I had the resources of the
world's largest microprocessor company running around trying to get those
network connections, and the engineers spent more of their time finding a
network connection … We really came to the understanding that, if we had
access to ubiquitous connectivity in these people's homes, our job would have
been a lot easier. I would not have had my guys running around the streets
literally with antennas trying to find the best spot to find a 3G connection
and run a cable out of people's homes.
As mentioned above in relation to in-home monitoring, many current
applications are more dependent on reliable broadband than fast broadband. But
as identified in the Hunter trial, the ability to have two way video
interactions is vital for the most effective delivery of home-based aged care
services. Dr Dean Economou of NICTA told the Committee about an example in
Korea where high-definition video conferencing capability is used to supplement
sensor alerts. The video quality allows experts to make informed decisions
about the type of care required in emergency situations.
The DBCDE submission highlighted that the NBN will also enable improved
support for carers:
Comprehensive, rich online training content and environments
and ongoing real-time interactive support for carers of people with dementia
could assist not only in providing best practice care for those with dementia
living in the community, but also in reducing uncertainty and pressure on the
more than 100 000 carers.
The Committee heard evidence about the benefits of the NBN in the delivery
of mental health services. The Department of Health and Ageing claimed that the
reach of these services will be improved. The department further noted:
Low bandwidth internet connections can be a deterrent to
seeking treatment, particularly when consumers are already suffering a degree
of stress or anxiety. A slow response by web based systems can create
significant barriers to seeking help online, which is designed to provide
consumers with choice and an anonymous avenue for seeking help.
The inquiry heard on a number of occasions that while mental health
issues are becoming more prevalent in society, young people, in particular, are
reluctant to see mental health services in person. This point was made in the
submission of the Inspire Foundation, who also commented on the damage caused
by mental illness:
The research shows that whilst one in four young people aged
16 to 24 experiences a mental disorder, 70 per cent of those same young people
are unable or unwilling to receive clinical care—a problem that is compounded
in the case of young men and those living in rural and remote areas of
Australia. Left untreated, mental health problems worsen, impacting
significantly on the quality of a young person’s life including their
relationships with family and friends, and their eventual educational and
vocational achievement. In 2009 mental illness cost Australia $10.6 billion in
lost productivity, underemployment, absenteeism, welfare payments, health care
expenditure and carer costs.
The submission of the National Rural Health Alliance further outlined
the case for online service delivery and the plight of those in regional areas:
Mental health services are increasingly being provided via
the internet and have been found to be effective, particularly for young
people. In Australia, suicide rates have consistently been found to be higher
in rural than in metropolitan areas. Adolescent and young adult males,
especially those in rural or remote areas, have particularly high suicide rates . The availability of the NBN will enable
people living in rural and remote areas to have the same access to online
mental health support as people in metropolitan areas.
The Committee heard valuable evidence from Helen Pepper, a Youth
Ambassador for the Inspire Foundation, and a recent beneficiary of online
mental health service delivery. Ms Pepper provided her perspective on the NBN
and its capacity to improve mental health services:
To be honest, when I first heard about the government’s plan
for the National Broadband Network, I did not entirely support it. I wondered
how it could be of higher priority than investing in Australia's health system.
I thought, ‘How can it be more important for young people to be able to view
web pages and complete downloads faster when mental health disorders and
suicide account for approximately 14 per cent of Australians’ total health burden’.
I got so caught up in the stereotypical view of young people and the internet
that I looked over my experience of how they can work so fantastically
ReachOut already connects young people from all over the
country through their forums, but text based discussions can only go so far and
offer so much. So online interactive media would complement ReachOut's youth
involvement strategy amazingly by bringing young people together without the
financial and time costs associated with face-to-face interactions.
Emma Stace, Deputy CEO of the Inspire Foundation, described how online
services might evolve over time:
My philosophy is that the internet is a displacer, not a
replacer, meaning that it will complement and enhance what people are doing
already but it does not stop what people are doing already. I certainly see—not
now but in the future—that the ability to deliver a highly interactive
multimedia-rich interaction could potentially, one day, begin to replace
face-to-face engagement with a health provider. But that is probably quite a
long way off.
Aram Hosie, also of the Inspire Foundation, explained how current
broadband coverage has restricted the organisation’s ability to deliver mental
health training to teachers:
The consistent feedback we get from teachers is that the
reliability of the video streaming and the quality of the interaction are
really poor. In all the evaluations we do of our program they say that the
content was great and the ability to access a webinar was great but the frustration
was that the link kept dropping, the video kept dropping and the quality was
poor—and there is nothing we can do about that at the moment. As speeds and
bandwidth go up, that will get better.
Improved service in regional areas
The tele-health applications outlined above clearly provide the most
benefit in the areas where there are difficulties in accessing quality health
services. The inquiry received substantial evidence about the capacity of the
NBN to improve health services in regional areas. Dr Jenny May of the National
Rural Health Alliance summarised this proposition at the Committee’s first
hearing in Canberra:
The alliance believes the NBN provides a real opportunity to
improve the health outcomes of those in rural Australia, as well as the wellness
and liveability of rural communities. It has the capacity to improve the lot of
those who live in rural, regional and remote areas by enhancing access to
health information, education for our children and jobs for our spouses. Not
only do Australians who live outside metropolitan centres have higher risk
factors for many ailments, they also, as we know, have poorer access to health
care and health personnel. With the support of a high-speed broadband system,
improvement in health outcomes can be achieved through the development of
The submission of the Telehealth Society also observed that while equal
access to healthcare is considered a fundamental right by most people, ‘Australia’s
large distances and widely distributed demographics create challenges in
providing this equity of access’. The Society cited a recent Australian
Institute of Health and Welfare study which found that ‘life expectancy for
non-indigenous males living outside major cities was three years less than the
life expectancy for their metropolitan counterparts’.
Dr May of the National Rural Health Alliance explained that the
availability of broadband is currently the missing link in the provision of
e-health services to regional areas:
Many valuable applications for tele-health and e-health more
broadly are already technically feasible but available only where there is
high-speed connectivity. Real-time video-conferencing for specialist
consultation, the transfer of digital images such as X-rays and CAT scans and
the transfer of other information is already here and making a difference where
it can occur. Highspeed broadband will provide the platform for making these
proven modalities—as well as those yet to be developed—available everywhere. In
emergency care, for example in a place like Marble Bar, it will enable the
linking of a remote outpost to a major burns unit so that a remote specialist
can visualise a burn, assess the condition of a patient and advise local staff.
The Grampians Rural Health Alliance is one regional healthcare provider
that is already demonstrating the types of benefits that can be delivered in
regional areas with broadband. See Box 3.2 for details. Mr David Ryan, CIO of
the Alliance, outlined that his service is spread across multiple campuses and
the use of video‑conferencing has been significant, both for meetings and
for seeing patients. Mr Ryan also commented that:
It is a significant reduction on travel and in fact it has
almost eliminated travel for some people, which is therefore an accrual of
savings back to the health service directly. That also means that the clinician
has a much more productive day. There are also the safety issues with jumping
in a car and travelling long distances on country roads. That is also a major
The McKinlay Shire Council outlined how the NBN might impact those
people living in the most remote areas:
The Julia Creek Hospital is staffed by a full time GP
position. Members of the community are required to travel 250km to Mount Isa or
650km to Townsville to receive medical services from specialists. The NBN could
enhance medical services through the virtual appointment of specialist services
at the Julia Creek.
Regional Development Australia (RDA) Townsville and Northwest Queensland
also highlighted that the NBN will enable easier access to specialists:
Regional Australians are at a disadvantage when it comes to
access to health services. High speed broadband will enable greater and more
efficient interaction between specialists in regional and metropolitan centres
and their patients and local GP.
It is likely that the NBN can contribute to improving health outcomes in
very remote Indigenous communities. The Telehealth Society’s submission presented
the example of Numbulwar, located on the north-east coast of the Northern
Territory, with a population of 672 people—just over half the population is
under 25 and 95 per cent are Indigenous. The community does not have a resident
medical practitioner. Darwin is accessible only by poor quality roads that are
impassable in the wet season. The Society further described:
Presently, tele-health services are delivered via the only
internet connection available, a 512 kbit/s Telstra link shared by all
services. The satellite link planned as part of the NBN may make a substantial
difference to healthcare available in this isolated community.
|Box 3.2 Grampians Rural Health Alliance
The Grampians Rural Health Alliance is a not-for-profit joint venture
established to represent all the public health services in the Grampians region
of Victoria, including community health, acute health, sub-acute health and
aged care. There are approximately 40 sites with about 160 network
connections across the region, for which the Alliance provides the ICT
support and telecommunications services.
Video-conferencing is now being used in many different ways throughout the
region covered by the Alliance, including for professional development and
training, for specialist to GP issues, and increasingly for clinical engagement.
The mobile high-definition video-conferencing units used by the health
service in rural areas are currently working on 2 Mbit/s symmetrical links,
shared between voice and data. However, whereas it is possible to have one
video-conference using this infrastructure, the bandwidth is not sufficient for
two or more high quality conferences at once.
The Alliance said that the bandwidth capacity provided by the NBN will
bring equity of health services across the region, particularly for specialist
services in more remote rural areas for which video-conferencing is
increasingly relied upon.
Source: Mr David Ryan, Executive Officer and Chief Information Officer, Grampians
Rural Health Alliance, Committee Hansard, Ballarat, 17 March 2011, p. 34.
Health professional in regional areas
The submission of the National Rural Health Alliance highlighted the
ongoing difficulties in attracting medical practitioners to rural areas, and
explained how the NBN might improve this situation:
There is a continuing struggle to secure more health
professionals for rural and remote areas: doctors, nurses, allied health
professionals, dentists and other oral health workers, paramedics as well as
aged care workers. Major change is needed to the models of education and
training for students of health professions. Every effort should be made to
provide this training close to where students live and the NBN is critical to
In addition, rural and remote placements and other programs
to consolidate and expand the rural health workforce rely on the support of the
NBN to keep students and new health professionals in touch with their peers,
able to access professional advice and continuing professional development, and
to work with current technology. And good telecommunications are not just vital
for professional work and support; they also enable people to maintain their
social networks and links with their families.
The issue of networking and mentoring is a particular issue for
regionally located health professionals. The Telehealth Society described how
improved access to professional support may reduce costly mistakes:
Despite the high quality of health care in Australia, ‘adverse
events’ in the hospital system have been estimated to cost the nation between
$1 billion and $2 billion annually, with a large proportion of such events seen
to be preventable. In a number of recent, well-publicised cases, medical
practitioners in regional areas were found to have been practising beyond their
level of training, and without adequate supervision or contact with their
peers. There is likely to be a role for tele-health in creating such contacts,
and providing facilities for mentoring and monitoring the performance of
The inquiry heard there is demand from students who want undertake their
medical education in regional areas. Ms Meredith Feist, Manager of Operations
and Community Engagement at Flinders University Rural Clinical School,
[The courses] are oversubscribed. People actually want to do
the course—they want to come to the country—and part of the reason for that is
that often the academic marks are better. They come away from their third year
with a high level of clinical exposure and skills because they have had the
continuity of patient care and they have had lots of things that they do not
get elsewhere. I guess our drive is to get them out here, convert them, tell
them that the country is a wonderful place and immerse them in that community
for one year so that we increase that chance
Ms Feist also told the Committee that improved access to broadband would
help attract and keep doctors and nurses in regional areas:
The benefits [of the NBN] to this community, as I see them,
will be in helping to get health professionals to stay in the area or return to
the area. Our current research indicates that about 65 or 67 per cent of
students who go through a [Parallel Rural Community Curriculum]-type program do
return at some point to rural and remote areas, and we just want to keep
An important component of e-health is the development of e-health
records. The Committee heard that the NBN will be a catalyst for the continued
development e-health records. This point was highlighted in the Broadband Commission
for Digital Development’s recent report: ‘A national broadband network offers
the unique opportunity for transformation of isolated and inefficient systems’.
The Department of Health and Ageing’s submission explained the problems
and inefficiencies with current systems used to manage health information:
Patients currently have limited access to and control over
their own health information. Their health information is largely fragmented
and held in paper based record systems across each health care provider they
have seen. Each health care provider usually only has an incomplete record of a
patient’s medical history and care needs. This means a patient’s critical
health information may not be available when and where they are being treated,
especially in emergencies or when seeing multiple doctors …
As well as being frustrating for patients and their health
care providers, deficiencies in the availability of a patient’s health
information can have damaging effects on patients’ health and the quality of
care they receive. Many adverse drug events and poor transitions from one
health care setting to another could be avoided with better access to patients’
health information across care settings.
The IBES submission explained how the NBN will improve information flows
in the health system:
The health sector is an information rich environment, in
which the medical profession has traditionally controlled both access to and
the form of information. Health data is currently stored in multiple places,
often ‘siloed’, and has the challenge of privacy, data accessibility,
comparability and initial collection. The advent of ubiquitous and high-speed
broadband will allow sharing of patient information rapidly between sites, and
allowing clinicians to access real time data during a patient consultation.
The Government is currently working toward the provision of a ‘Personally
Controlled Electronic Health Record’ for all Australians, as part of a $466.7
million commitment in the 2010-11 Budget. The DBCDE submission
outlined how the NBN is likely to assist this process over time:
By providing a high capacity, ubiquitous and reliable
network, the NBN will enable the benefits of system-wide electronic health
records to be fully realised … Doctors and specialist medical practitioners in
various health settings and locations across Australia will be able to have
fast and reliable access to patient health records, including data intensive,
high resolution medical images and videos.
The DBCDE submission also outlined the benefits of e-health records for
Australians with chronic conditions (for example, diabetes, chronic obstructive
pulmonary disease, cystic fibrosis). Such individuals are often high users of
health services, requiring ongoing and integrated care. Benefits would also be
felt by older Australians who may have complex medical needs, and may at times
have difficulties in remembering details of their health history. The DBCDE
submission further suggested that:
Ensuring all relevant information is able to be provided to
key health personnel can support swifter and more effective diagnosis and
treatment, informed by knowledge of existing medications and past health
As outlined in the following chapter, the NBN is expected to have a
significant impact on the provision of education services and the availability
of educational resources. The inquiry received specific evidence about how the NBN
will impact medical education. The DBCDE submission provided an overview of the
range of opportunities which may enhance support services for GPs and other
health professionals, resulting in improvements to skills and capabilities
‘without having to waste time in traffic or long distance travel’. The
opportunities may include ‘content rich online real-time interactive continuing
professional development courses (including, for example, 3D virtual
environments), or mentoring by senior practitioners facilitated through video-conference.’
Professor Don Iverson, Pro Vice-Chancellor of Health at the University
of Wollongong, told the Committee about the expectations of his medical
Each successive group that has come in has greater
expectations on technology. They have grown up with technology and most of us
in this room did not … These young people who are coming through medical school
now are absolutely comfortable with and rely on technology for virtually every
aspect of their life … When they go out to rural areas, they expect to be able
to get their cases online and to be able to go online to check a physician
reference with regard to medication. They are finding it frustrating right now
Professor Iverson also spoke about the significant role that the NBN can
play in developing ‘communities of doctors and nurses that support one another’.
He noted the importance of social connectivity, not just professional
connectivity, for medical students who move to regional areas.
Professor Iverson went on to explain the increasing importance of
broadband in modern teaching methods:
The key to making the model [of locating students remotely] work
is connectivity; it just cannot work without it. We cannot travel those
distances; we cannot do it. The connectivity is important for a number of
functions. The first one right now is teaching. For example, a third of our
class of medical students are actually housed down in Nowra, and they only come
to Wollongong one day a week. All the lectures and that are delivered via video
link, which sometimes works and sometimes, unfortunately, does not work if the
weather turns bad. We actually now have another hub we are developing up in the
Southern Highlands area, and ultimately, if you look down the road 10 years,
there is no reason why a lot of medical education cannot occur in the home town
where people are connected to it. There is just no reason; we are moving that
fast. But connectivity becomes important.
As well as delivering lectures and tutorials, broadband has been used to
provide surgical training. This was outlined in the submission of the
The ability of advanced networks to deliver several channels
of high quality video in interactive settings has been used by the surgical
community to provide training in advanced surgical techniques. Notable among
the international demonstrations have been connections between Flinders Medical
Centre and various Asian centres. Most of these exercises have been set up as ’one-off’
events, but the availability of the NBN will facilitate making such interactive
education available on a routine basis to medical practitioners wherever they
are located. High quality video and interactivity (e.g. the ability to ask
questions of the surgeon) are essential for the success of the learning
Meredith Feist of the Flinders University Rural Clinical School
explained that current broadband infrastructure in some areas is struggling to
cope with new modes of delivery:
What we have here at the moment is a system—and I am not
technical—that delivers two megabits per second for video-conference capacity.
We manage, just, with that, here in Victor. In two of our other sites we have
that capacity at 10, and that is now at maximum and stretched for the work we
need to do. So we think it is vital to keep going. 
Based on extensive evidence, the Committee accepts that the NBN will
play a significant role in substantially improving the implementation of e‑health
systems, but that challenges remain in effecting wider change. The Telehealth
Society noted that ‘the slow uptake of e-health technologies over the last few
decades has shown that such paradigm shifts are very difficult to implement in
the health system’. The Society further suggested that a national strategy is
needed to facilitate and encourage ‘the changes to health care delivery which
will justify the NBN on the basis of its ability to deliver healthcare
While estimates of the savings to be gained from using coherent e-health
systems range from 15 to 25 per cent, the health system
involves a substantial number of unique providers of services, each with their
own business models and proprietary administrative systems. This makes
system-wide change very difficult. Furthermore, the Broadband Commission for
Digital Development has noted that:
A key reason for the delays in implementing e-health is that
its benefits cover society as a whole and do not necessarily have immediate
positive consequences for the commercial aspects of healthcare.
The Committee agrees with the observation of the Broadband Commission
that ‘leadership is needed to develop a trans-sectoral approach to these
problems, so that the multiplier effects that broadband infrastructure has to
offer are fully explored’.
The Government’s recently announced National Digital Economy Strategy
identifies the need for government leadership and sets a number of digital
economy goals for e-health:
- By 2020, 90 per cent
of high priority consumers such as older Australians, mothers and babies and
those with a chronic disease, or their carers, can access individual electronic
- By July 2015, 495 000
tele-health consultations will have been delivered providing remote access to
specialists for patients in rural, remote and outer metropolitan areas.
- By 2020, 25 per cent
of specialists will be participating in delivering tele-health consultations.
As discussed earlier in this chapter, the Government is now providing
funding for Medicare rebates of tele-health consultations (including incentives
for GPs and specialists), and is also progressing the development of e-health
records. In addition, the Government is funding tele-health trials in the NBN
early release sites of Kiama, Armidale and Townsville.
Box 3.3 Neuroscience Research Australia falls prevention software
The rollout of the NBN has enabled the trialling of an innovative new
tele-health program that enables patients to access at home an interactive,
video game-based exercise program designed to improve their balance
and motor skills.
The project involves an exercise regime for older people using a dance mat video game,
which can be monitored remotely by health
professionals using high speed internet. It is envisioned that the
technology will reduce the incidence of falls amongst its older users.
The project was developed by Dr Stuart Smith of Neuroscience Research
Australia, who said:
With a growing number of people having to care for family members living with diseases that
affect their mobility or their mind, a reliable high speed broadband network such as the NBN for
monitoring and improving their state of health is a huge breakthrough.
The project was showcased at an NBN launch event in the coastal NSW
town of Kiama on 29 July 2011.
Source: Neuroscience Research Australia, ‘NeuRA falls prevention research showcased
at NBN launch’, 1 August 2011 <http://www.neura.edu.au/news-events/news/neurafalls-
prevention-research-showcased-nbn-launch> viewed 8 August 2011.
Notwithstanding these initiatives, several submissions and witnesses
commented on issues that will need to be addressed by governments to achieve
widespread e-health implementation, beyond the technical and infrastructure
requirements for reliable and ubiquitous broadband. At the Committee’s Sydney
hearing, Ms Rosemary Sinclair, Managing Director of the Australian
Telecommunications Users Group, described some of the practical considerations,
resulting from a pragmatic understanding of how the Medicare system works:
As a general rule there is no
mechanism in Medicare for paying for e-delivered health services apart from
psychiatric services in regional Australia and the election commitment last
year which created another small element for regional services. But GPs get
funded through Medicare when people turn up to the surgeries for attendance.
The Telehealth Society’s submission also commented on the importance of
All medical practitioner members who contributed to [our]
submission emphasised that the ability to deliver health care services via tele-health
needs to be recognised through the ability to be remunerated through the
Medicare Benefits Schedule (MBS) for a wider range of services than currently
The RACP submission identified that in general specialists have not
adopted technology, which could act as a significant barrier to widespread
adoption of tele-health applications:
Unlike the situation in general practice, computer use is not
a central part of the way in which physicians conduct their practices in their consulting
rooms, the most usual venue in which they deal with patients.
Against this background, the Australian Government’s specific
proposal to provide incentives is welcomed by the RACP, as this will assist
greatly in helping physicians engage with tele-health. The development and
implementation of a specialist practice incentives program is encouraged.
The RACP also identified privacy issues that are relevant to both tele-health
and the implementation of e-health records:
Patients may initially be reluctant to engage in
video-conferencing because of uncertainty that their privacy and the
confidentiality of their information will be adequately protected. The
patients, and the Australian public generally, will need reassurance of the
security and integrity of information obtained and transmitted during tele-health
The availability of fast and ubiquitous broadband will fundamentally change
the delivery of health services in Australia. It will enable more efficient
service delivery, resulting in cost and time savings for citizens and health
care providers. It will also enable better access to services for those who are
isolated by distance or incapacity, resulting in improved health outcomes and enhanced
quality of life.
The ability to deliver services more efficiently is extremely important
in the context of the ageing population and the related increases in healthcare
spending. There have been a number of estimates made about the savings that
might be possible, including a recent UNESCO report which estimated savings of
between 10 and 20 per cent of total healthcare spending. Savings can be
realised in a range of ways, from reduced hospital admissions through to more
productive use of the stretched medical workforce.
The Committee received evidence about numerous tele-health
applications—some which are available now, some which are being developed, and
others which are still in a conceptual stage. It is difficult to generalise
about the broadband speeds required to enable these applications, although it
is possible to conclude that the reliability of service and ubiquitous coverage
are paramount. In terms of speed, there are home-monitoring applications that
rely on the ability to upload at just 512 kbit/s. The Committee heard that even
these speeds are not achievable in many areas today. But, more importantly,
there are very few homes that can receive the broadband speeds required for the
high-definition video interactions required by some tele-health applications.
Participation in remote consultations with specialists may be
commonplace in the foreseeable future. CSIRO told the Committee about its
remote diagnostic system which involves 3D imaging and requires a symmetric
connection of between 30 and 50 Mbit/s. Other similarly bandwidth-intensive
applications were outlined and demonstrated to the Committee, including
tele-dentistry and tele-ophthalmology. It is expected that tele-health
applications will be used in hospitals, clinics, aged-care facilities, and in
the home—hence the need for ubiquitous high-speed coverage.
The ability to store and forward high volumes of medical data is an
important factor in improving the efficiency of the health system, and will
become particularly important when there is a move toward full-scale
implementation of electronic health records. High quality medical imagery
generates large amounts of data and high-definition video generates even more. A
more efficient health system will rely upon the ability to transmit this data
seamlessly, including from the home. The asymmetric broadband connections
available to most Australian premises are not suited to uploading data quickly.
As well as enabling video consultations from the home, the NBN will
expand the opportunities for health monitoring in the home. Current activities
in this area including monitoring blood glucose and pressure, as well as
tracking the performance of implanted devices such as pacemakers. The Committee
heard that home monitoring devices can be supported by video-conferencing
capability, which further reduces the need for medical staff to be physically
The Committee received compelling evidence about the importance of
online delivery of mental health services, particularly for young people. It is
clear that ubiquitous availability of fast broadband will enable improved
content-rich and interactive mental health services.
Australians who have the greatest difficulty accessing services in
person are likely to benefit most from advances in e-health. This includes the
elderly, those with a physical disability, and those located in regional
communities. For the elderly, the provision of broadband-enabled consultations
and in-home monitoring will delay or even remove the need to move to an aged-care
facility. For regional Australians, the NBN provide greater access to
metropolitan standard health services, without having to travel to metropolitan
areas. Improved access to broadband is also likely help attract and retain
medical professionals in regional areas, providing better networking and
ongoing development and training opportunities.
The Federal Government has identified the importance of e-health in its
recent digital economy strategy, setting goals for e-health uptake and
providing funding for tele-health trials in three NBN early release sites. In
addition, Medicare rebates have recently commenced for tele-health
consultations, and work continues toward the development of electronic health
The Committee was made aware of the difficulties of effecting change in
a health system that involves so many unique organisations and systems. Key
challenges to e-health implementation include privacy and the low uptake of
technology by specialists. These are not new issues and are undoubtedly central
to considerations on the e-health agenda. Government leadership on these and
other issues will determine the extent to which the benefits offered by the NBN