Closing the gap

Closing the gap

One of the greatest benefits of the digital health industry will be unprecedented equity in the services and level of patient care available.

One of the greatest benefits of the digital health industry will be unprecedented equity in the services and level of patient care available.


Digital health doesn't mean losing the human touch


In small towns across Australia, the cycle of ever-diminishing services threatens to irrevocably change the face of our country.

However, a growing digital health industry, riding the broadband wave, has the potential to take advantage of Australia's expanding communications network, evolving to meet the challenge of providing quality care to the entire population.

This complex beast goes by many names, digital health, telehealth, ehealth, but it is first and foremost a technological enabler according to Professor Rod McClure, Dean of the University of New England Faculty of Medicine and Health.

From transferring patient records to digital imaging, Professor McClure believes one of the greatest benefits of the digital health industry will be unprecedented equity in the services and level of patient care available.

"We have an existential crisis in Australia in that we have a large area and dispersed population and yet medicine is at a point where there is a concentration of high-end services, expensive services, where dense population allows those services to be optimally utilised," he said.

"Digital health and telemedicine overcome the problems of access for people who aren't just down the road from those high-end services.

"It overcomes the problem of low density populations still getting access to high-end services and in doing so it makes for equitable opportunity in a country which geographically defines opportunity on the basis of access."

Surprisingly we have been using elements of digital and telehealth for a long time, probably as long as we have had telephones, without even realising it.

The Alcolock, which prevents drivers from getting behind the wheel if they are over the blood alcohol limit, is an example of preventative digital health based on high technology and information exchange.

The uptake of ehealth solutions and practices has been strong.

The uptake of ehealth solutions and practices has been strong.

Despite being hours apart, doctors can download real-time data from a patient's in-built pacemaker, instantly identifying areas of concern while ultrasounds and other imaging can be undertaken by non-specialists in distant clinics and read by specialists in city labs who can diagnose the patient and decide what next in the treatment phase.

Professor McClure believes this remote, real-time monitoring could allow doctors to monitor hundreds of patients for parameters like blood sugar, far more efficiently in terms of patient outcomes than a quarterly check-up.

In this age of seemingly endless possibility, it's easy to let imaginations run wild, but this must be restrained by boundaries like effectiveness and value.

McClure also stresses ehealth isn't an alternative to normal health, it will require some delicate splicing of existing services and new technologies to produce an effective hybrid which could give people in small towns and isolated stations health care to rival city dwellers.

Read more: Time to treat the cause of the rural doctor shortage

For example, in the ehealth era, a small-town paramedic may be supported by a high-end cardiologist working via an online telehealth model with the paramedic administering medication to a patient on the scene before a three-hour drive to hospital.

"You can get a better scope of practice in those towns by using digital health rather than if you just relied on the fact you need a doctor in every town, which you are not going to get.

"The pathways of care are much easier than the old system."

Australia certainly has an advantage when it comes to maximising the ehealth evolution with high-speed internet access a "critical" element.

Read more:Case study: Making the right connections

However, Professor McClure emphasised that social infrastructure was equally important in this process.

"Health is health ... it's human beings," he said.

"You need to have somebody at the end to receive and manage the information and work with the end-user or the patient so that you can broker some sort of decision process.

"Human interactions are a mechanism for helping people come to the best decision and I think human interactions are enabled by ehealth because it brings to that conversation a much more sophisticated level of information that two people can discuss and make decisions about."

Interestingly the limitations and risks of this system also have their roots in the human condition.

"Modes of practice is the real limitation. If you have been brought up practising a certain way and technology changes, some of us are not so attuned to technology and maximising the benefit of it."

Despite this, data show the uptake of ehealth solutions and practices has been strong - fastest in the areas of surgery where cutting-edge technology is fervently pursued. However, it has been slower in the areas that rely on a high level of human interaction.

Medical technology doesn't save money, it improves value. - Professor Rod McClure

The risks of the ehealth system are akin to many associated with traditional medical practice but may be ameliorated in some ways by new technologies.

"These aren't bogeyman risks," McClure said.

"They are risks of practising medicine and engaging in health.

"Checks and balances need to be examined and interpretations need to be checked, data needs to be quality data, you need to weigh up all the range of other factors that might be involved and not jump to conclusions.

"These are the skills that clinicians would normally have in any kind of sphere.

"We can find ways that this new technology helps overcome human error, but we don't want to lose some of that human element either otherwise you lose some of the value of the exchange."

So how much is all this going to cost and will it come at the expense of conventional health services?

"Medical technology doesn't save money, it improves value," McClure said.

"This doesn't necessarily need new money but it does need some ...we just need to make sure we distribute the funds available in the most efficient, effective way.

"There is a tendency to sit with the processes we've got and try and use those to produce the outcomes we're after.

"Now is a bit of a moment as everyone is starting to talk about service failure. You can't keep doing the same thing and expect to get a different outcome.

"Now's the time people are going to have to be brave enough to say let's use a different hammer."

Lyndell Whyte is a journalist with Australian Community Media, based in Tasmania. UNE is a partner in the Future Focus project.

The story Closing the gap first appeared on Future Focus.


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