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The previous chapter provided a selection of e-health activities from overseas, particularly from the USA, a leader in e-health. A range of case studies of Australian e-health activities are set out in this chapter and elsewhere in this report. The Australian case studies illustrate that Australians' ingenuity in the bundling and application of new technologies is as impressive as the examples from the rest of the world. In a number of the case studies, the Australian e-health activities are unique in the world.

The Australian case studies are not meant to be an exhaustive list of all the e-health activities in Australia. They are deliberately chosen as a cross-section from a range of fields, including telehealth to the home, health call centres, teleradiology, telecardiology, tele-mental health, GP networks, Internet health networks and electronic pharmacy ordering. They also include at least one example from each State and Territory. Generally, the case studies involve the use of telecommunication technologies such as videoconferencing, telephone or the Internet and information technologies such as databases and other electronic ordering, storage and retrieval systems.

The following table shows the breadth of areas where e-health is used and the types of technologies used. The Australian case studies outlined in this report indicate that it is increasingly difficult to draw a line between telehealth and e-health.

Table 6.1: Summary of Australian e-health case studies cited in this report

E-health Activity	Main Organisations Involved	State/Territory	Examples of Information and Telecommunication Technologies Used
Network of GPs, Pathology Labs, Pharmacies, Hospital, etc.	ACT Division of General Practice; General Practice Computer Group, AMA; Telstra	ACT	encrypted email, IP enabling services, databases, telecommunication technologies
Regional E-health	Optus Communications	Bendigo, Vic.	Telecommunication technologies, databases, software
Renal Conferencing	The Queen Elizabeth Hospital, Adelaide and five other hospitals in SA and NT	SA/NT	videoconferencing; radiology and pathology slides accessed from local area network
Hospital without Walls project	CSIRO, Ryde	NSW	sensors, radio, PC, databases, alarms, cable television, Internet
DocTel	DocTel, Adelaide	SA	satellite transmission; videoconferencing; www
National Mental Health Call Centre	Mental Health Call Centre for Rural and Remote	Sydney/National	call centre telephony; database
GP electronic communication	The CompetitiveAdvantage. Medi-safe Communications.	QLD	encrypted email
WA Government Health Call Centre	High PerformanceHealthcare	WA	call centre telephony,database
Telecardiology	Concord General Hospital	NSW	mobile phone with fax display
GP IT/Internet	Health Communication Network	NSW	www, databases, software
Internet education	CMENet; Queensland Rural Divisions Coordinating Unit	QLD	www and CD ROM
Internet Information	Med-E-Serve	QLD	www, databases,software
Teleradiology and Videoconferencing	Women's and Children's Hospital, Adelaide; Alice Springs Hospital, Northern Territory	SA/NT	teleradiology; videoconferencing
Cardiology Call centre	National Heart Foundation, Adelaide	Adelaide/National	call centre telephony; database
Use of mobile phones and hand- held computers, dialing databases and emailing pharmacists from patients' homes	RDNS	VIC	mobile phones; hand- held computers; databases
Pharmaceutical electronic ordering	Project Electronic Commerce and Communications for Healthcare (PECC)	National	secure, encrypted email; electronic catalogue; Extranet gateway trading; electronic funds transfer (EFT); electronic logistics
Telemedicine centre	Johnson and Johnson	NSW	www; video editing; videoconferencing
Use of video- conferencing and Internet for Mental Health Telehealth Professional Development	Women's and Children's Hospital	SA/NT	ISDN videoconferencing; videotapes; www
Links to Antarctic	Tasmania/Antarctic	TAS	satellite transmission; email; video-conferencing; Internet

Case studies

The following Australian case studies reveal the many types of e-health currently operating.

Case Study: HealthDirect in Western Australia

An example of an innovative e-health programme is the HealthDirect service set up by High Performance Healthcare and the Health Department of Western Australia in 1999. This service is likely to receive an estimated 200 000 to 300 000 health advice calls per year.

The use of demand management principles to match consumer need with the most appropriate and cost effective healthcare service (type and location) has increasingly been used as a 'frontline' tool to improve population health management strategies.

However, in order to deliver a consistent and high quality service across large populations, the use of state-of the art telephony and information technology is essential. As has occurred within the broader customer care industry, the rapid convergence of multi -media communication channels will see consumers able to access health information and advice via written, telephonic, Internet-based and video communications. The telephone will, however, remain Australia's prime communication channel for healthcare information and advice in the foreseeable future.

The HealthDirect service utilises three main technology components:

• A highly flexible PABX and associated call management software, which allows ease of call routing and detailed call centre performance reporting and measurement.
• A robust local area network and built in redundancy given the 24x7x365 nature of the service.
• A guideline-driven case management system to ensure consistency in the triage decisions made by the nurses.

The guidelines in place in Western Australia have been locally reviewed and modified by a panel of local general practitioners and relevant hospital bodies to ensure appropriateness for local conditions. They allow the nurse to search by the caller's identified symptoms for an appropriate guideline, determine through a series of questions the appropriate disposition and self-care advice (e.g. see your GP within 24 hours) and then provide the caller with information about service provider availability. To direct callers to appropriate providers, nurses access a database of all health service providers, including GPs.

Over the next 1-2 years there is likely to be the introduction of voice response systems to provide recorded information and the use of Web Agent technology to allow "intelligent" access to nurse agent advice via the Web, perhaps after already accessing a health information library.

Case Study: Teleradiology combined with Videoconferencing

Teleradiology images are regularly transmitted to the Women's and Children's Hospital (WCH) in Adelaide, South Australia, from country towns as well as from Alice Springs and Darwin. Teleradiology enables a range of sub-specialists within the WCH to provide second opinions on complex cases, sometimes in emergency situations.

Records of teleradiology transmissions were kept for the period from September 1998 to February 1999, showing that the teleradiology activities were, on occasion, very significant in the timely diagnosis of patients. In some instances, as a result of the diagnoses, patients and their families were able to avoid the cost and discomfort of travelling long distances. This was particularly important for Aboriginal patients, including children, from the desert areas of the Northern Territory, who prefer not to leave their tribal lands, for the 2 000km trip to Adelaide.

Sometimes teleradiology diagnoses result in the sub-specialists at the WCH recommending immediate retrieval of the patients. On one occasion in June 1999, an image was transmitted from to the WCH from a country site and an abscess on the spine was identified by the WCH radiologists, leading to immediate evacuation and an operation that prevented certain paralysis.

The WCH has conducted a renal case management session where teleradiology images were reviewed while a live videoconferencing session was held with Alice Springs paediatric and radiology staff. The staff at the WCH had the images available on a PC hard disc, for viewing on a 21-inch computer monitor. The staff at Alice Springs Hospital used the original images, displayed on a light box in the videoconferencing room. For the case conference, the two groups were linked by live videoconferencing, using PictureTel equipment and ISDN. To prepare for the meeting, the images of five children were transmitted from Alice Springs the day before and the morning of the videoconferencing session.

The renal case conference resulted in two patients not being transferred to Adelaide. A cost benefit analysis of this session was completed, demonstrating the positive benefits of using the technology. According to the chair of the session, Dr Lloyd Morris from the WCH, a feature of the session was that it enabled staff from a number of different disciplines to participate. He believed that the technology facilitated in-depth discourse and achieved a greater outcome than if fewer specialists were involved, as the decisions taken depended on having a range of specialists present. It was a true multi-disciplinary team approach, with inputs from everybody attending.

The WCH is now combining teleradiology with its digital recording system. Each teleradiology episode is reported on the digital system, enabling easy access to patients' records later. 

Case Study: Examining ECGs from a yacht, using a mobile phone

The following incident is based on a Case Report by Professor Ben Freedman in the Journal of Telemedicine and Telecare 1999; 5:67-69

Recently an 84-year-old woman was brought to the emergency department of Concord Hospital in Sydney by ambulance, after collapsing at home. The house staff conducted tests and carried out procedures, then decided to check with the specialist, who was sailing on his yacht in Sydney's Middle Harbour. The cardiologist was contacted by a long-range pager and the ECG, transmitted to his mobile phone.

Early visualization of a high-quality ECG by the consultant cardiologist was very useful in this case, as he was able to alert house staff to the possibility of right ventricular infarction and left ventricular dysfunction, which led to more aggressive early management with inotropic drugs and fluids.

Professor Ben Freedman, University of Sydney, from the Department of Cardiology, Concord Repatriation Hospital, has recently set up this system of transmitting ECGs to mobile phones. The system allows staff to transmit urgent ECGs from the emergency department of the Concord Hospital to the cardiologist on call.

The transmission of ECGs to a mobile phone was developed in collaboration with Retriever Communications Pty Ltd and Optus Telecommunications Pty Ltd. The telephone (Nokia 9000) has a large display as well as both fax and data interfaces. The system requires digital acquisition of the ECG and its high-quality transmission via fax software and modem.

The ECG is stored on disk immediately after acquisition. Once the modem has been plugged into a telephone line, six keystrokes will result in transmission of the ECG to any one of four preprogrammed telephone numbers. Fax transmission of the ECG to a mobile device is not completely reliable, and may fail if the signal is weak or variable. Hence the ECG is sent to a fax mailbox, which is programmed to deliver it immediately to a pre-designated mobile phone or to send a message via a messaging service in case of failed delivery. The fax can be retransmitted easily by a command from the mobile phone, or can be redirected to a standard fax device. To ensure that the system is robust, the cardiologist carries an alpha-numeric long-range pager for notification that an urgent ECG transmission has been sent and that a telephone consultation is required.

The advantages of the ECG transmission system are that a high-resolution ECG can be sent to a cardiologist wherever there is mobile telephone coverage. Using the digital ECG acquisition device and fax software ensures excellent image quality even when high magnification is selected on the mobile phone display. Standard fax transmission of ECGs recorded on paper is also feasible but the image is degraded.

Professor Freedman believes that while this system appears to be valuable in large city hospitals at nights and weekends, it may be even more useful in smaller suburban or district hospitals, particularly in rural and remote areas, where no doctor is immediately available. Such systems could facilitate the rapid administration of thrombolytic therapy by nurses in the absence of an attending doctor in cases of suspected myocardial infarction.

Case Study: Telstra assists Australian GPs to go online

The ACT Health Communications Trial (an initiative of the Territory Government) officially commenced on 1 July 1998. Originally scheduled for a six-week period, the trial extended for a full three months to 30 September 1998. The trial sought to test an electronic communications environment based on a non exclusive IP platform, open to all health industry participants in the ACT.

In January 1998, a memorandum of understanding (MOU) was signed for the conduct of a trial. Soon after a steering committee was formed (chaired by the ACT Department of Health and Community Care) to oversee the trial. The first draft of the Project Execution Plan (authored by ACTDHaCC) identified the following key applications for the duration of the trial;

• Communicable Disease Notifications to ACTDHaCC.
• Immunisation Reports to ACTDHaCC.
• Requests for Community Care to ACTDHaCC.
• Delivery of Pathology Results from labs to GP's.
• Referral Letters from GP's to Specialists.
• Care or Treatment Advice from GPs to Nursing Homes or other care providers.
• Admission Notifications from Canberra Hospital to GPs.

In a capacity as a principal stakeholder, Telstra provided the necessary funding for the trial. Additionally, Telstra also contributed further funds for the provision of Telstra network product to participants and stakeholders, as well as various Telstra staff services for relationship management, consultancy, project management and training.

During the trial period, some forty GPs, two Specialists (Pathology), ten Pharmacies and two Hospitals participated. In the case of the GPs, all were connected with PSTN. A further three practices were set up with ISDN OnRamp2 and multi-access environments.

Whilst the final list of applications delivered in the trial was acceptable, there were some difficulties encountered with development and implementation due to the large number of organisations involved. The health specific applications ultimately developed and deployed during the trial are as follows:

• Knowledge Map and associated Navigation Tool.
• Immunisation Notifications.
• Pathology reporting.
• The Canberra Hospital Notification of Admissions.
• Community Care (Intake Assessment) Notifications.

Telstra has been involved with another trial in conjunction with General Practice Division Services (GPDS). As a direct result of the involvement with GPDS and based on some of the learning's of the ACT Health Communications Trial, an alliance has been formed with GPDS, to roll out a commercially viable product to be known as "HealthDirect".

Involving the GPDS-owned "GP Network", Alcatel's supply of PCs, training and Telstra's BigPond infrastructure, HealthDirect will aim to provide a comprehensive secure electronic environment, initially for the primary health care provider. The focus of HealthDirect is to assist the health professional to deliver timely and cost effective health care to their patients.

Case Study: Johnson & Johnson opens education institute in Australia

Johnson and Johnson in Australia is opening a world class Institute for Education, Training and Research at their Australian headquarters in North Ryde. The Institute will assist Australian health professionals and industry executives to observe leading edge telemedicine techniques such as real time telesurgery. The Centre provides world class learning facilities and services/solutions to encourage developments to be realised in Australia. The newly created facility offers three conference rooms offering the latest video conferencing and audiovisual equipment, a demonstration room for technical training, an operating theatre room for education and training purposes, an Internet lounge for accessing health resources, video editing facilities and functions area.

The Institute is working with its clinical customers (including surgeons, physicians, general practitioners, hospital and health executives, nurses and pharmacists to deliver course content). An advisory board has been formed to work with faculty sponsors to determine content and services.

The benefits to clinical customers include: Coordination with Delegates (EConferencing); Savings in Travel Time (EConferencing); Distance Learning; Links to Overseas resources including the European Surgical Institute, and Endo-Surgery Institute Cincinnati, Stanford University School of Medicine, University of Southern California, George Washington University, Emory University, Rhode Island Hospital, University of New Mexico, University of Miami, John Hopkins University, Mayo Clinic, and Washington University. Participating in Training and Coursework with the Institute will expand Australian clinical interests.

Case Study: Model e-Health in a Rural Hospital Community

Optus Health Solutions is undertaking a $2 million project designed to achieve the model information and communications based health community. The goal of the project is to re-engineer the communications and information systems of a public hospital and its surrounding community of health care service providers and consumers, to demonstrate improved quality and delivery of services to patients while achieving administrative and cost efficiencies.

The Bendigo Health Care Group is the core of the e-Health project. Bendigo Health Care Group is a multifaceted facility serving a large semi urban and rural population and is the hub group of the Lodden Mallee Alliance of rural hospitals and health care services covering a large area of North Western Victoria.

The Victorian Department of Human Services, which already has a strategic program for information technology, is an active participant in the e-health project, ensuring that the process and outcomes integrate with existing initiatives. The project involves an agreement with the Federal Department of Health and Aged care (DHAC).

Objectives for the e-Health Project include:

• Define means to achieve measurable improvements in service delivery and budget outcomes for the selected hospital and community through IT&T process re-engineering.
• Implementation of the model IT&T foundations for a hospital based community.
• Achievement of commercial best practice in the implementation of e-Health initiatives at all levels.
• Development of a business case framework, which identifies the transportable economic and clinical benefits of the selected initiatives, so that other hospitals and communities around Australia can make rational judgements on the appropriateness of deployment.
• Development of a better understanding within DHAC of the ability of IT&T to impact on Health outcomes and budgets.
• Development of a better understanding within the IT&T industry of the strategic technology approaches required to improve Health outcomes.
• Evolution of a forum for the evaluation of policy, technology and service delivery implications arising from e-Health initiatives.

Optus reports that the following e-health sub-projects have been identified by the Bendigo project as functions which have significant potential to benefit both the hospital and in its community. The Bendigo e-health project will better define these potential sub-projects, potentially identify additional opportunities which should be considered, establish a measure of their respective costs and benefits and thereby prioritise their implementation. The e-health components identified by Optus from the Bendigo project are listed alphabetically, without reference to their relative merit:

• Automate online waiting lists and a theatre/bed booking system.
• Automate supply chain management (ordering, supply and management of all supplies).
• Computerised patient records.
• Electronic pathology/radiology report distribution.
• Establish a full Medical call centre.
• Establish Health Community electronic directory.
• Establish Simplified Billing.
• Management of computerised care in the home.
• Patient discharge notices to primary carer.
• Pharmacy dispensing interface/Pharmacy Intranet integration.
• Pre admission information gathering.
• Private patient Medicare claiming.
• Provide Health community Intranet/email services.
• Provisioning of mobile hand held data devices ('Tablets') for hospital staff.
• Radiology imaging and transfer for remote diagnosis.
• Remote audio-visual conferencing and education.
• Remote patient monitoring in the home.
• Year 2000 review.

Case Study: Bringing Child and Adolescent Mental Health Services to Rural Communities

A telehealth network founded in 1998 involves levels of complexity not normally encountered. The complexities include the provision of child and adolescent mental health services to rural and remote sites from metropolitan and other urban locations, across State/Territory borders in Australia and involving a wide range of health professions, from psychiatrists to psychologists and social workers. To provide services for these widely distributed sites, the Telehealth network uses a combination of service delivery technologies.

The network was established by Child and Adolescent Mental Health Services (CAMHS) at the Women's and Children's Hospital in Adelaide, South Australia, focusing on the need to provide a range of services to mental health professionals located in rural communities. The programme is supported by a Rural Health Support Education and Training (RHSET) grant. The main remote sites involved in the network are Darwin and Alice Springs in the Northern Territory and the mining towns of Roxby Downs and Coober Pedy in South Australia. CAMHS delivery sites include Port Pirie, Port Augusta, Whyalla, Port Lincoln and Adelaide.

The technologies used in the network include videoconferencing, the World Wide Web and videotapes. Each fortnight a seminar or case conference is conducted via videoconferencing to a range of sites, using a videoconferencing bridge to simultaneously connect multiple sites. Typical seminar topics include school refusal, childhood anxiety, autism, loss and grief, conduct disorder and depression. Following each seminar a videotape of the session is sent to sites requesting a copy. Participants are also regularly referred to the links section of the Women's and Children's website, to follow up other articles on the seminar topic.

The telehealth network conducted a total of 36 professional development sessions by videoconferencing in 1998, ranging in duration from 45 to 90 minutes and involving a total of 45 different participants who participated an average of four times each. The number of uses per participant ranged from one to 15. The 45 participants came from 11 different health disciplines and Darwin was by far the most frequent far-end location (60 per cent of all sessions), followed by Roxby Downs (17 per cent) and Alice Springs (14 per cent). The volume of usage has increased in 1999 and Coober Pedy has become a major receive site.

The study of the first twelve months of the network reveals positive aspects of Telehealth for professional development, such as the provision of networking and peer support and the achievement of improved efficiency, reduced travel costs and improved health services. Participants considered that the following uses of telehealth had changed their models of the way clinical and educational services can be provided to rural and remote sites: the ability to access second opinions; the ability to access specialists; the ability to book Telehealth consultations from Adelaide; and the ability to access supervision from Adelaide.

Case Study: The Hospital Without Walls - home telecare using vital signs monitoring

Excerpt from an article by LS Wilson, I Sharp, RW Gill, S Heitmann, CF Chen, MJ Dadd, A Kajan, M Gunaratnam

Health care systems are increasingly subject to the burdens of increasing health costs and an aging population. One approach to slowing this trend is to maintain as many potential hospital patients as possible in their own homes rather than in the considerably more expensive hospital system, or even such institutions as nursing homes. There are, of course, social and lifestyle benefits to remaining in familiar surroundings rather than the hospital environment. This project's underlying hypothesis is that the use of telecommunications and other technologies may permit a proportion of patients in certain categories to be treated and monitored in their homes. The potential cost savings are enormous: a recent report suggests that the daily cost of supporting a patient through home telemedicine is $US30, compared with $US74 for home visits, $US100 for nursing home care and $US820 for inpatient hospital care.

Implementation of home telemedicine can take many forms, and some of the possibilities, which have already been explored in other projects, include:

• Round-the-clock monitoring of vital signs such as heart rate, rather than occasional measurements at the bedside or in a doctor's surgery.
• Monitoring of other signs of normal activity, such as use of household appliances.
• Immediate intervention if abnormalities are detected in vital signs.
• Other tests such as spirometry or blood pressure performed either unassisted by the patient (or carer) or by a visiting nurse.
• Automatic integration of information about patient's vital signs into an electronic patient record.
• Tele-consultation to the patient's home.
• Provision of patient-specific health care information.

Recent developments in information technology and telecommunications, including low-cost personal computers, advances in mobile communications, high-bandwidth connections to homes via the cable television networks, and of course, the Iinternet, have hastened the introduction of these technologies to home telecare. CSIRO's Hospital Without Walls Project aims to harness its technical expertise across these areas to demonstrate the efficacy of home telecare. The project is being developed in collaboration with the Distributed Systems Technology Centre (DSTC) and the University of Queensland's Centre for Online Health.

The monitoring of cardiovascular parameters will be the central feature of the system. Reasons for this choice include the desirability of 24-hour monitoring, the unpredictable occurrence of episodes such as arrhythmia or syncope, and the effect of the environment on some parameters (the so-called "white coat effect", due to patient anxiety in the presence of a medical professional).

Older people who fall are an interesting group of individuals who may benefit from such monitoring. Approximately 35 per cent of the over-65 population fall in any year and this is a significant cause of death and disability. As such it is a significant problem for both the individual and public health service. Frequently there may be an unreliable history and retrograde amnesia to syncopal events and it is here that telemonitoring may be ideal. In a collaboration between CSIRO Division of Telecommunications and Industrial Physics and the Ryde Aged Care and Rehabilitation Service, based at Ryde Hospital in Sydney, the Hospital Without Walls Project aims to use telemonitoring techniques to assist in investigating and caring for such patients, and enabling their investigations to take place in a community setting and promote their independence.

Older patients frequently present at Emergency Departments following a fall. Falls tend to be of multifactorial origin and are often a result of a complex blend of extrinsic factors (such as the environment and medications) and intrinsic factors (such as cognitive impairment, neurological or cardiovascular problems). It is these cardiovascular problems, including arrhythmias, orthostatic hypotension and carotid sinus hypersensitivity that may be particularly suited to investigation by telemedicine techniques. Determination of the cause of the fall may involve close monitoring of the patient by a carer or as an inpatient, both of which may be impractical. Home telemedicine may be able to play an important role, particularly if the vital signs are recorded at the time of the fall. These signs include blood pressure and heart rate, but would also involve monitoring whether the patient has fallen, or has possibly momentarily lost balance without falling. As many as possible of these parameters should be monitored continuously, since the relevant episodes tend to be both transient and unpredictable.

• The main design criteria for this technology are
• Easy installation and removal from the home.
• No local technical requirements beyond a telephone line and a source of mains power.
• The equipment interferes minimally with normal lifestyle.
• Vital signs are recorded throughout a home and adjoining garden on a continuous basis.
• Skill level required by the patient should be consistent with people who are elderly and possibly affected by mild dementia.
• The equipment is linked to a hospital information system so that data may be interrogated at any time, and alarms possibly generated, if, for example, a fall is detected or the patient's vital signs fall outside predetermined limits.

The main components of the initially planned system are shown in Figure 1. The patient wears a small module containing all of the electronics. This comprises sensors for heart rate monitoring, accelerometers which sense posture and activity, and an ultra-low low-power radio which transmits data to a small receiver. The receiver is attached to a personal computer, as is a module possibly containing "fixed" sensors for spot measurements such as blood pressure. The PC may also receive data from other sources, an example being notes entered by a visiting health professional, such as a member of a Home Nursing Service.

Figure 1. Simplified block diagram of the "Hospital Without Walls" project implementation in a single home

STRATEGIC DIRECTIONS FOR E-HEALTH

E-health is a new subset of e-commerce. Hence strategic planning in e-commerce can provide guidance for the growth of e-health. Australia's e-commerce Report Card (1999) set out four main priorities and activities for e-commerce, as follows:

1. Establishing the environment conducive to the widespread adoption of e-commerce.
2. Demonstrating the business case.
3. Targeting barriers to the development of e-commerce.
4. Maximising the efficiency dividend from e-commerce for the economy at large.

A similar list of priorities and actions could be used to provide strategic direction for the growth of e-health in Australia. However, strategic e-health initiatives can be more specific and aggressive, given the in-depth findings from this report about the nature of e-health.

Unstoppable e-health

This report has demonstrated that the term e-health is needed to describe practices that have become pronounced over the last twelve months. This report documents instances such as nurses visiting patients in the country, equipped with hand-held computers linked via mobile phones to pharmacists and databases; call centres in mental health and cardiology servicing callers from anywhere in Australia; an entrepreneurial company providing high quality medical services in remote locations, using a ship container and state of the art telecommunications. The report also describes a range of initiatives that use the power and reach of the Internet. E-health has arrived; it will continue to grow; and it will bring benefits to Australians.

In many instances, the e-health initiatives in Australia are equivalent to leading edge activities overseas. Australia's special challenges of distances and the lack of medical practitioners in rural areas are obvious incentives for expanding e-health. Other drivers behind these developments in Australia include the realisation of the clinical benefits of using combinations of information and telecommunication technologies to provide improved or new services; the mounting pressure from consumers that the clinical world take advantage of electronics; and the ubiquitous growth of the Internet.

The identification of these current e-health activities and the presence of these relentless drivers substantiate the title of this report, From Telehealth to E-Health: The Unstoppable Rise of E-Health.

Strategic actions

The following immediate, strategic actions are needed to guide the growth of e-health:

• dissemination of quality information about the rise of e-health.
• promotion of the new business concepts incorporated in e-health.
• removal of barriers to the continued growth of e-health.
• advocacy of the cost benefits of e-health.
• encouragement for e-health in the home and the use of the Internet for health information.
• identification of industry leaders to champion e-health.

Recommendations

It is recommended that:

1. Government, industry and stakeholders (including consumers and health professionals) work together to accelerate the widespread adoption of e-health practices, where it improves access to services and the efficiency and effectiveness of the health system.
   
   Key roles for the Commonwealth Government are the widespread dissemination of this report, the conducting of high profile workshops on the report and the use of the mass media to underline the importance of e-health.
2. Government, industry and stakeholders promote the emerging business cases and models for the development of e-health activities.
   
   The emphasis in these business cases will be on the use of  IT&T to improve the delivery of services to patients. New efficiencies, cost savings and changing business practices need to be highlighted.
3. Government, health professionals and industry partners target barriers to the development of e-health and promote ways to address them.
   
   Many of the barriers to the development of e-health can be removed, through policy changes, business strategies and the innovative use of new and emerging technologies. For instance, barriers that are now being addressed include concerns about privacy of health data; inter-connectivity between different technologies; the need for technical and clinical standards; and the remuneration of health professionals using e-health strategies. Another barrier is the low level of knowledge about information and telecommunications technologies among many health professionals. There is a need for training and development of e-health users and providers in the use of the Internet and other IT&T.
   
   There are many technical and regulatory solutions to overcome current impediments. Government and industry can also work together on industry development initiatives, such as research and development into new technologies and the availability of capital to support emerging Australian technology companies. Key initiatives such as the development of software applications and technical solutions for general practitioners need to be progressed immediately.
4. Federal Government agencies - the Department of Health and Aged Care and the National Office for the Information Economy - work with stakeholders including State Governments to promote the efficiency dividend from e-health for the economy at large. Particular focus should be given to the cost benefits of e-health in the home and the use of the Internet for healthcare.
   
   Cost benefit analyses of e-health can demonstrate the significant savings made possible by the appropriate application of IT&T. The cost benefit analyses can also demonstrate the improved clinical outcomes from e-health.
5. Telehealth and telemedicine advocates promote the integration of telehealth/telemedicine with the broader e-health and health reform agendas.
   
   E-health, as a branch of e-commerce, highlights the rise of customer demand, fuelled by the Internet and the potential applications of IT&T. High quality medical and health information can now be accessed via the Internet, and via IT&T applications, encouraging a surge in self-management and enhanced tools for use by health workers. Medical and health professionals can take advantage of this consumer interest in online information, by providing new services. Advocates of telehealth/telemedicine can promote both telehealth/telemedicine and the broader area of e-health.
6. Key industry groups or leaders provide leadership in the promotion of and strategic direction for e-health.
   
   The Australian Information Industry Association (AIIA) is a national industry organisation that is ideally suited to bring a sharp edge to the growing awareness about the value of combining IT&T for value added business processes in the health sector. NOIE should work with the AIIA to identify key industry stakeholders from the diversity of players who have participated in recent workshops. The AIIA should consider the formation of a permanent industry forum to champion the increased use of e-health and to address issues associated with vendor and customer conflict and distrust. The industry forum would work with Government, health professionals and stakeholders to address the range of regulatory, behavioural, clinical and industry development issues listed above.

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ACKNOWLEDGEMENTS

The generous assistance of the following personnel in providing information for the Australian case studies is greatly appreciated.

Aileen Sprott, Mental Health Information for Rural and Remote Australia

Bob McEvoy, National Heart Foundation

Dale Kendall, Telstra

Dr Alex Disney, The Queen Elizabeth Hospital, Adelaide

Dr Andrew Wilson, High Performance Healthcare

Dr Des Lugg, Australian Antarctic Division, Tasmania

Dr Gary Shanks, DocTel

Dr Merlin Thomas, The Queen Elizabeth Hospital, Adelaide

Dr Tina Hayward, Women's and Children's Hospital, Adelaide

Graham Williamson, Medi-safe Communications

Geoff Wood, Telstra

Gillian Church, Mental Health Information for Rural and Remote Australia

Immanuel Mensik, Johnson & Johnson

Jill Towers, Royal District Nursing Service, Victoria

John Clark, Optus

Jonathan Revitt, National Heart Foundation

Judy Morgan, Med-E-Serv

Laurie Wilson, CSIRO

Lyndie Spurr, Royal District Nursing Service, Victoria

Mike Gregg, Health Communication Network (HCN)

Pat Gallagher, Project Electronic Commerce and Communications for Healthcare (PECC)

Phil Robinson, Women's and Children's Hospital, Adelaide

Professor Ben Freedman, Concord Repatriation General Hospital, University of Sydney

Vicki Sheedy, Queensland Rural Medical Support Agency

• Document ID: 17919 |
• Last modified: 6 February 2008, 10:20am