Issues in Telehealth for Rural and Remote Australia - Case Study Example

ISSUES IN TELEHEALTH FOR RURAL AND REMOTE AUSTRALIA STUDENT NAME UNIT NAME DATE Table of Contents Introduction 3 Methodology 3 Telehealth 4 Benefits of telehealth implementation in the rural and remote Australia 6 Improved access to services 6 Better in-home care 6 Facilitating team-based and multidisciplinary care 7 Enhanced access to professional development and support 7 Issues in telehealth implementation 7 Policy Priority 8 Funding and time 9 Equipment skills 10 Technical issues 11 Infrastructure 11 Preference for the traditional approach 12 Other Potential barriers to telehealth adoption 12 Discussion 17 Conclusions 20 References 20 Introduction The benefits of delivering health service using modern enhanced technology have been of interest to the Government of Australia for decades. Australia being a geographically expanded country with majority of the population living in the rural and remote parts of the country with limited and undeveloped medical infrastructure, poor transport infrastructure and insufficient medical professionals. Implementation of telehealth in rural and remote areas in Australia would increase the capacity to offer improved and reliable medical services that would otherwise have been impossible for the population to get access. In spite of telehealth seeming as the potential strategy to addressing the pitiable health state of health service provisioning to rural and remote Australians, the strategy has not been fully implemented due to various challenges that bar its implementation. The paper would be looking at the various issues and particularly challenges in the implementation of telehealth for rural and remote Australia. The report would give an overview of what telehealth is, examine the necessary infrastructure for the implementation of telehealth, current status of telehealth implementation in Australia and finally illustrate some of the challenges in telehealth implementation in telehealth in rural and remote Australia. Methodology The research incorporated both peer-reviewed journals published from 2000 as technology is dynamic and grey literature. To gain insight into the issues in telehealth databases such as PubMed and Medline and Google search tools by the use of such key words as telehealth, telehealth as used in the US. Several conference proceeding journals on telehealth conducted from 2000 were reviewed to give the upto date state of the art of telehealth implementation in Australia. Telehealth According to Maheu, Whitten, and Allen (2002), telehealth is the use of information communication technologies (ICT) to support long clinical health care,patient and professional health-related education, public health and health administration from a separate location. Some of the ICT Technologies that support telehealth include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications (Moffatt, &Eley, 2011). As a better alternative to providing health service over a long distance telehealth a great potential to deliver health services to all more efficiently and equitably. Patients in the rural and remote areas of Australia are bound to benefit from having access to better healthcare services, the health practitioners get reliable support working in the rural areas, and ensures equitable healthcare in the whole country. Sustainability in regard to health care systems can be a make any difference intended for carrying on with matter. Telehealth technological know-how are that can work, and therefore are accepted as the workable alternative in future health care delivery, making it possible for health care organisations to supply treatment in a additional monetary in addition to detailed technique. Thus telehealth is usually considered completely ready intended for wider adopting. Even so, telehealth incorporates a weak record regarding setup along with a very patchy heritage regarding adopting, using a slow, wrinkled in addition to fragmented uptake into the on-going in addition to regime operations regarding health care. Telehealth evolved into practicable right at the end in the 1980s using the option of low-cost precessing in addition to digital camera telecommunication (e. gary. ISDN). Because it's invention, a lot of telehealth purposes are screened in small-scale reports, although most of them get still did not endure further than the 1st (funded) exploration phase, so definitely not growing to be stuck seeing that strategies of regime wellness services delivery. Although profitable telehealth purposes absolutely really exist, they're typically even now operate through local telehealth champions in addition to funded while on an random schedule. Hardly any telehealth purposes get prevailed in achieving large-scale, enterprise-wide adopting This failure to reach widespread adopting has triggered studies in the factors active in the success in addition to failure regarding telehealth purposes. In telehealth, success can be a relative term, not a bare attribute. That's, a profitable telehealth program should produce premium quality care at low priced compared to an alternative such as usual treatment. Many components are related to successful telehealth purposes, including demonstrable financial savings, adequate loans, acceptance through clinicians, improved use of healthcare in addition to avoidance regarding travel intended for patients in rural in addition to remote areas. Successful telehealth applications should also be sustainable (i. elizabeth. they have to be adopted straight into everyday practice and always function soon after any pilot funding works out, possibly with substantial activity levels). In essence, a profitable application have to be cost-effective. Benefits of telehealth implementation in the rural and remote Australia Ideally, a crucial service such as healthcare is expected to be available across the state as per the needs and the population density. However, in really life it is not possible because of the geographical and financial barriers which results in a substantial disparities with the rural population getting disadvantaged. The supplies of medical professionals in the rural Australia are low and the doctor to patient ratio is very high in the rural areas. With the use of the telehealth service the rural patients would ripe the following benefits Improved access to services With the available of the ICT services such as fast internet that support high-definition videoconferencing, telehealth can facilitate more befitting access to a variety of health services, and thusfacilitating the provision of timely prevention, diagnosis and treatment. Telehealth can mainlybe beneficial for the aging or isolated, who might find it challenging to travel away from home to seek for health and support services. For those in rural and remote Australia, telehealth would enhance access to health services and reduce the travellingexpenses and reduce time wastage. For instance, telehealth can permit a patient in rural and remote clinic can consult a medical consultants based in a hospital in city. Better in-home care The older population in Australia with chronic illnesses can significantly benefit from the Home-based telemonitoring. Utilizing telehealth technologies to distantly monitor an person’s situation may: facilitateprompt identification and monitoring any changes in the patientillness, thus minimizing the dangers of complications and avoidablehospitalization. Telemonitoring further enhances self-management through continuous observation and attention in alliance with primary healthcare providers offerimprovedsupportfor older population in the rural Australia delivered at the comfort of their homeand thus enhancing the quality of life and minimizing social isolation. Facilitating team-based and multidisciplinary care Team based and multidisciplinary way of care provided by telehealth, allow health professionals to deliver ample, suitable and integrated health. For example, complex prerequisites can be discussed in high – quality videoconferencing by professional, common practitioner and an allied health expert from different geographical areas as a team. Enhanced access to professional development and support Since in rural area there less or have no appropriate facilities for health practitioners to proceed with their medical education or do professional development ,thus video conferencing and online applications like virtual classroom have been used to provide this services. Senior practitioners can supervise rural practitioners by use of videoconferencing. Issues in telehealth implementation The major themes arising from the analysis were: funding, time, equipment skills, infrastructure and a preference for the traditional approach. Each is discussed in turn and where there are links between themes, these are identified. Telehealth is on the increase in Australia, driven by many stresses on traditional modes of health service provision and incentivised by new telehealth rebates under the health advantages design. High profile implementations are being financed in diverse jurisdiction. whereas these implementations are needed to have evaluation constituents there is no expectation that they will use normalised ehealth evaluation guidelines or structures, and evaluations are finished for compliance more often than for research. The advanced number of telehealth tests and the negligible information on conclusions make a more open and collaborative approach to evaluation vital in alignment to boost befitting adoption and amplified use of telehealth. According to one review, “although telehealth clearly has a wide range of potential benefits, it has also some disadvantages. The main ones that can be envisaged are: a breakdown in the relationship between health professional and patient; a breakdown in the relationship between health professionals; issues concerning the quality of health information; and organizational and bureaucratic difficulties. On balance, the benefits of telehealth are substantial, assuming that more research will reduce or eliminate the obvious drawbacks Policy Priority According to Kaplan and Harris-Salamone (2009) most Large Information Technology (IT) projects having been known to have a high failure rate. Telehealth being one of IT projects that requires a substantial resources for its implementation its failure may results in tremendous losses in terms of time wasted, finances and the effort (Kaplan & Harris-Salamone, 2009; Baccarini, Salm, & Love, 2004).It is essential for telehealth participants to have the necessary tools and mechanisms to measure and determine telehealth readiness, and to evaluate the society readiness status beforehandto avoid implementing a project that is bound to fail. To be able to overcome the risk of implementing telehealth which are caused by the use of new and untested technologies, telehealth implementers must work closely with the community to be able to gather all of their concerns and be able to respond to their concerns accordinglyby building a powerful system that meet there requirement. One of the ways to minimize the risks is to have clear policies in place governing the implementation and utilization of the telehealth service. The government should formulate policies that address the funding of the project or service payment and charges, policies governing the use and provisioning of ICT services. Telehealth is becoming popular as an instrument for linking the local and global health-care boundaries. Nevertheless, incorporating telehealth into traditional health structure presents a formidable trial for Australian government, policy creators, telehealth promoters and health-care personnel. The formulation of detailed inter-jurisdictional telehealth guidelines will considerablyfacilitate the capability to overcome this challenge. Funding and time According to the finding on a research conducted by Moffatt and Eley (2011), most of the research participants they interrogated sited the issues of funding as one of an important impediment to the implementation of telehealth in rural Australia and this can also be generalized as a universal issues. Mauldon (2007) on his research on telehealth in America found that most telehealth projects do not go past the financingstage, owing in part to schemes independently sustain itself and generate profits. For more the participants in Moffatt and Eley (2011) research particularly pinpointed the lack of funding for doctors, both GPs and specialists and their staff, to conduct telehealth consultations. The government have not provided incentives for practitioners using telehealth from a distant computer. Presently telehealth practitioners are not rewarded through Medicare with the exemption of particular telepsychiatryamenities. In addition to insufficient of compensation, telehealth is expensive for the consultantsinceadditional work are tangled, which require extra time than the tradition healthcare services. For instance it is projected that a teledermatologysessionlast up to 35 minutes which differ greatly with the 15 minutespermitted for a traditional session (Kaplan,& Harris-Salamone, 2009). With the current state of telehealth there is no way of compensating the consultant for the extra time spend using the telehealth scheme. Moreoverthe time taken learning the technical aspects of a telehealth consultation and the time it take to applying the knowledge may be long and may divert the consultant from concentrated on offering healthcare service to concentrating on the technology underlying the service. The Australian Medicare system reimbursements a doctor for providing a service to a client in a face-to-face situation. Medicare does not currently reimburse physicians for telehealth services. At this time, the major use of telehealth is by psychiatrists who tend to be funded on a salary or sessional basis or by radiologists on private contract. Physician reimbursement is likely to become an issue as more private-practice physicians become involved in telehealth. Equipment skills Equipment skills are essentialneeded to use firsthand equipment. Equipment skill can also require to a new skills on how to use existing equipment in a different new methods. On the same research by Moffatt and Eley (2011) found that many medical practitioners in the rural and in the city are constrained by their inability to use some technologies and equipment limit their ability to carry out telehealth consultation. For instance some doctors and patients may not know how to upload a file to a mail, or a doctor may not be in a position set an x-ray machine to produce a clear image. This generally requires training to allay fears and boost confidence on the use of telehealth. Technical issues Appreciating that many medical practitioners do or can carry out online sessions with the technology in place, it is not projected that the venturealso involverigid requirements for the apparatus used. Nevertheless, a rationalguarantee will be essential that a General public and practitioners engaging in a consultation for the first time will have the capability to connect quickly andconduct the sessionwithout experiencing any technical shortfall. Consultations will be essentialin deciding on the best approaches necessary to providing a high degree of data security (Magnusson, Hanson, & Borg, 2004). The differing technical requirement for the varied specialties may also pose technical issues in telehealth provisioning. For instance, some specialties may possiblyneed a high definition video resolution more than others;in the other hand other specialties may require higher data bandwidth than others. All the parties in the health sector must come together and define their requirements clearly. Infrastructure Inefficiency in the telehealth infrastructure has been a major challenge in the implementation of telehealth in the rural areas in Australia. This particular area is the issue of internet unavailability an inability to purchase the basic equipment needed for implementation of telehealth inrural areas (Magnusson, Hanson, & Borg, 2004). The poor internet accessibility has been attributed to the distance from the city where this infrastructure is available. In some areas the broadband is not available and thus rely on the satellite. For better service in telehealth teleconferencing is crucial. This technology requires a larger bandwidth which is not available in the rural areas. More vital difficulties recognized as hurdles in the implementation of telehealth is the unaffordability of computers, cameras and the necessary software that support this services. Preference for the traditional approach According to the literature review doctors and even patients prefer the traditional was ways of health service provisioning (Olenik, & Lehr, 2013).Literature showed that whereas some individuals have a liking for the old-stylemethod which can be linked with life practice, others do not want to learn nor explore new technologies and some participants find it hard to master the skill. Australia’s population is mainly composed of elderlyand getting them to learn new technology might be a challenge (Roine, Ohinmaa,& Hailey, 2001). Some medical practitioners are lesscontented and assured of deducing an accurate diagnosis when usingtelehealth environment Other Potential barriers to telehealth adoption Telehealth has an enormous potential for minimising the disparity of diagnoses and improving clinical administration and provisioning of health care services all over rural and remote Australia by improving availability, quality, efficiency, and cost. Telehealth can assist people who are disadvantaged – those in rural and remote areas with limited health services and practictioners –as it bridge the geographical distance and time barriers between health-care providers and patients . Further, evidence points to important socioeconomic benefits to patients, families, health practitioners and the health system, including enhanced patient-provider communication and educational opportunities. Despite its pledge, telehealth submissions have achieved varying levels of achievement. In both industrialized and evolving nations, telehealth has yet to be consistently engaged in the health care scheme to consign routine services, and few navigate projects have been adept to maintain themselves one time primary kernel funding has completed. Several routinely cited challenges account for the need of longevity in many telehealth endeavours. One such dispute is a convoluted of human and cultural components. Some patients and health careworkers oppose adopting service forms that disagree from customary approaches or indigenous practices, while other ones lack ICT literacy to use telehealth advances effectively. Most demanding of all are linguistic and cultural dissimilarities between patients (particularly those underserved) and service. A shortage of studies documenting financial benefits and cost-effectiveness of telehealth submissions is also a challenge. illustrating solid enterprise cases to assure policy-makers to embrace and invest in telehealth has contributed to shortcomings in infrastructure and underfunding of programmes. lawful concerns are a major obstacle to telehealth uptake. These encompass an absence of an worldwide legal framework to permit health professionals to deliver services in distinct jurisdictions and countries; a lack of principles that rule persevering privacy and confidentiality visà- vis data move, storage, and sharing between health professionals and jurisdictions (16–18); health professional authentication, in specific in e-mail submissions; and the risk of health liability for the health professionals proposing telehealth services. Related to lawful concerns are technological challenges. The schemes being utilised are complex, and there is the promise for malfunction, which could initiate software or hardware malfunction. This could boost the morbidity or death of patients and the liability of health-care providers as well. In alignment to over come these challenges telehealth should be regulated by definitive and comprehensive guidelines, which are directed broadly, ideally worldwide. Concurrently, legislation ruling confidentiality, privacy, get access to, and liability desires to be instituted. As public and private sectors enlist in closer collaboration and become increasingly interdependent in eHealth submissions, care should be taken to double-check that telehealth will be established intelligently to maximize health services and optimal value and assurance that for-profit endeavours do not deprive people get get access to to to fundamental public health services. In all countries, matters pertaining to confidentiality, dignity, and privacy are of ethical concern with esteem to the use of ICTs in telehealth. It is imperative that telehealth be applied equitably and to the highest ethical measures, to sustain the dignity of all persons and double-check that dissimilarities in learning, dialect, geographic position, personal and mental proficiency, age,and sex will not lead to marginalization of care. Infrastructure in evolving nations is largely insufficient to utilize the most present Internet technologies. This need, and insufficient access to computing are obstacles to telehealth uptake for numerous evolving nations. At the most basic level, the volatility of electric power provision, prevalent unavailability of Internet connectivity after large towns, and data and communication gear that is not suitable for tropical climates enforce limitations on where telehealth can be applied. Unreliable connectivity,computer viruses, and restricted bandwidth continue to present trials when and where Internet get access to is get access toible. Internet jamming can lead to delayed imaging; poor likeness resolution may limit the efficacy of isolated diagnosis; and slow bandwidth can prohibit the use of real-time videoconferencing. Even when basic infrastructure is in location, prevalent interoperability standards for programs are lacking and gear country and Remote Australia computer system failure continues an ever-present likelihood. Case study 2 highlights a programme in Mexico that has administered effectively with the challenge of reduced bandwidth to provide breast cancerous diseaseous disease screening to country residents. Financial cost also impersonates both a real and seen barrier to the submission and adoption of telehealth in evolving nations. gear, transport, maintenance, and teaching costs of localized employees can be intimidating for nations with little earnings or limited funding for the implementation and upkeep of telehealth plans. furthermore, convincing evidence to support the general cost-effectiveness of specific telehealth schemes may be weak, while the financial significances of such schemes in different settings may not yet be renowned. localized abilities, knowledge, and assets may furthermore limit the submission of telehealth in evolving nations. A lack of computer literate employees with know-how in managing computer services, combined with the lengthy process needed to expert computer-based peripheral medical instruments can hinder uptake. While there may be a demand for expanse discovering, gathering local informative desires can be tough due to differences in the diagnostic and therapeutic resources accessible, as well as the literacy and dialect abilities across multiple sites. Moreover, while telehealth may enhance expert diagnosis, treatment choices accessible are constrained by logistical challenges encompassing the training of localized medical personnel, availability of medical gear and provision, and getting medicines to patients. Another barricade encountered is the sociocultural dissimilarities between sites, which can limit the pertinence of telehealth collaborations in the developing world and dispute heritage perspectives associated to health and wellness. A foremost contributing factor to telehealth malfunction is the oversight of incompatible cultural subsystems that avert the move of knowledge from one cultural context to another. health professionals in the industrialized world may be unfamiliar with the available amenities and alternate management strategies in isolated areas and vice versa. Telehealth therefore risks the exchange of inappropriate or insufficient health data. Without a good comprehending of the local context, it may be tough to integrate telehealth in a useful way Discussion The paper drew its finding from a review of a number of the reliable articles. The authors of this articles some are researchers in telehealth have had a long term interaction with the practicing practitioners in the field. More information was also gathered from the government document on the implementation of telehealth.Telehealth is still a new scheme and most of the regions in Australia are still piloting with the scheme and it has not been fully implemented. As the scheme is implemented more challenges would come up that requires the attention of the stakeholders. Typical barriers that had been documented in various literature based on the results from research in various countries that have piloted with telehealth such as the US, CanadaUk, Japan and other countries (Baccarini, Salm, & Love,2004).The challenge might vary depending on the countries but the common barriers were inadequate funding, lack of governing policies, undeveloped infrastructure, lack of technical and professional skills to facilitate the implementation of telehealth and cultural factors. The finding from various review literature suggest indicate a common pattern across all the countries thus link telehealth stakeholders together with a view of drafting changes to curb and eliminate the barriers (Farmer&Muhlenbruck, 2001). A comparative research on the policy issues bedeviling telehealth conducted by Pong and Hogenbirk (2002) identified the following policy based challenges: Reimbursement, state licensure and regulation, liability concerns and privacy.In Australia for example made of several states, physician licensure is only given by the state and each state has its own license (Khosravi&Fayaz-Bakhsh, 2012). For a practitioner to offer consultancy service across several states they must obtain license for each state.Unlike in Europe where single license is used by practitioners across all the European countries. This is after in April 5, 1993 Council Directive of the EuropeanCommunities demanded the unrestricted association of physicians in all the European communities. Canada like Australia where the country is divided into provincial boundaries, licensing of physician is the prerogative of the provincial medical licensing authorities. Australia should come up with a unified licensing Authority to be able to formula a policy that lead to legislation convergence between the various states in Australia (Yellowlees, 2001). Time and funding have beenidentified as related barriers. Time is an issue particularly for rural and remote doctors because they have higher workloads and spend longer hours in clinical practice than their urban counterparts (Roine, Ohinmaa, & Hailey, 2001). Therefore a set of additional tasks that requires more time would not be taken-up in the absence of some stronger incentive. The knowledge that better patient outcomes or increased cost-effectiveness may be an outcome of using telehealthare potentially such incentives. However clinical effectiveness has been shown in only a small number of disciplinesand there is a lack of evidence of its cost-effectiveness (Wakerman, Humphreys, Wells, Kuipers, Entwistle, & Jones, 2008). So not only is there a lack of evidence that telehealth is clinically or cost-effective, currently in Australia, but also a cost burden on the practitioner who chooses to extend the service to include telehealth (Wakerman et al, 2008). Ways of compensating the practitioners for the services offered to the public was been a challenge that has hampered the implementation of the telehealth. Many practitioners prefer the traditional methods of face-to-face since the patient can be billed. The stakeholders of telehealth need to come-up with better for billing the patients, rates to be charged to avoid exploiting the patient and also to cushion practitioners from losses. Setting up telehealth infrastructure requires a substantial funding. The vast geographical nature of Australia setting up ICT infrastructure all over the country might not be an easy task. In 2006 virtually half (46%) of persons in main Australian urban centers had accessto broadband, nonethelessmerely a quarter (28%) of individuals in rural remote Australia did (Moffatt, &Eley, 2011). Undeveloped telecommunications infrastructure for rural and remote Australia is a well-acknowledged. The prerequisite for a particularpractical knowledge to carry out a telehealthsession has extensively been pointed as ahurdle to embracing and on the other hand the delivery of usable technology can be thought as a motivation for its adoption (Mauldon, 2007). The comparatively increasing staffturnover in rural and remote Australia pose as a challenge to any new medical care endeavors, nevertheless this is anobstacle that has to be tackled for a successful implementation of telehealth in the rural and remote Australia (Khosravi,&Fayaz-Bakhsh,2012). The state should provide incentives to practitioners who want to invest in telehealth in the rural population. Conclusions The literature review indicate that utilizing telehealth is, in the contemporaryenvironment, a sensible response to addressing the inequitable distribution of healthcare in the rural and remote Australia– it is rapid, convenient and alsoeconomical.Notwithstanding efforts to tackle the unbalancedprovisionof health amenities between rural and urban residents and the discrepancies in health standing, important policy matters are to contain the barriers to telehealth implementation. 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