e-health to explode - great article

Medicine-To-Go: Stand By For the e-Health Revolution
Published: April 07, 2010 in Knowledge@Australian School of Business




Health care is undergoing a silent revolution in which science fiction is becoming science fact. As the global population ages and chronic disease cases occupy more hospital beds, generating astronomical costs, governments in the United Kingdom, the United States, Australia and beyond are turning to technology as a remedy.

European studies estimate the cost of providing telemedicine, aka e-health, at one-third that of face-to-face care, according to Pradeep Ray, director of the Asia-Pacific Ubiquitous Healthcare Research Centre at the Australian School of Business at the University of New South Wales.

Health now accounts for 9% of Australias gross domestic product, he says. Health care is one of the worlds largest business sectors, costing trillions. According to the NSW Auditor-Generals Office, by 2033 the entire NSW state budget could be consumed by health. So we have to do something drastic.

Despite a slow rollout for e-health in Australia, the sector is forecast to explode, with a profit-making agenda already set by the private sector overseas and public-sector infrastructure and policy struggling to catch up. Demand is being driven by the need to cut high travel costs for patients in a vast continent, by chronic disease suffered by a sizeable indigenous population, by the promises of the national broadband network (NBN) and by impressive emerging local research and development. Innovative Australian trials in e-data, virtual psychiatry, mobile phone health (m-health) and telehealth (telephone and video-conferencing consultations) are underway.

Growth in information technology in the Australian health care sector has been limited in the past decade due to heavy regulation and tight government control, Ray says, but we expect this to grow rapidly. This is because technologies and applications such as video-conferencing using Skype on mobile devices are easier to use. Australia has been a very good trial location for products in the past, not only because Australia is far away from the rest of the world, but also because the population is very accepting of new technologies, so the level of tech-savviness is higher here.

Australias e-health platform hinges on broadband deployment. The federal government finally set up a new company, NBN Co., in 2009 to invest A$43 billion over eight years to deliver broadband up to 100 times faster than at present. In February 2010, the federal government introduced legislation for individual 16-digit identifiers for patients and providers to standardise e-health records nationally. The National E-Health Transition Authority has released a 2009-12 strategy and, in the wake of a 2009 National Health and Hospitals Reform Commission report that recommended spending of up to A$1.9 billion on e-health, the government announced A$218 million support to fund the authority to 2012.

Overseas, the US unveiled grants of US$1.2 billion in April 2009 to help hospitals and health providers set up and use e-health records. And the UK is rolling out its huge STG12 billion National Health Service program for IT. (Scotland alone will spend STG1 million on telecare in 2009-10 to help the elderly stay at home.)

Vital Signs Offshore

Australias private sector is playing a pivotal role in the global health e-revolution. One of the worlds largest healthcare IT companies, iSOFT, which specialises in providing e-health records, is based in Sydney but earns most of its revenue offshore. Chief Executive Gary Cohen says 57% of its A$500 million annual revenue is earned in the UK, where the company has an office, but only 10% in Australia, which is lagging up to five years behind. Australia has been very slow, Cohen says. Compared to investment going into health IT in countries of a similar size, Australia has a very poor level of funding. The UK has a population of 60 million, three times that of Australia, yet our company does only about half the value we should be doing here. Swift action is needed. Probably the biggest single thing missing in Australia is a key decision by governments to build a national strategy on e-health.

Another Sydney-based telehealth company, TeleMedCare, also has a big exposure to the UK, where it has an office. Director Branko Celler Visiting Professor in Systems and Control at the Biomedical Systems Laboratory at the University of New South Wales says the UK generates 75% of its annual revenue compared with 25% in Australia. We do a lot more work in the UK than Australia because they are far more telehealth-ready than we are.

TeleMedCare supplies devices to monitor chronic disease and vital signs and to manage medication. Clients are nursing homes, GPs, community agencies and home patients. We know from international research that there are fantastic results being obtained from telehealth, Celler says. One study carried out by the company in Norfolk, England, reduced emergency admissions and bed days by 70%.

Mobile phones are being used increasingly for guided remote self-care in Australia and overseas by chronic disease patients with diabetes and cardiac complaints as well as by health professionals in developing nations for remote monitoring, managing electronic patient records, training rural professionals and tracking epidemics. In December 2009, Australias dominant telecommunications carrier, Telstra, launched a mobile diabetes project with US-based Entra Health Systems to replace patient logbooks. Diabetes Australia estimates the disease affects 1.5 million Australians and the World Diabetes Foundation predicts that by 2025, 80% of new cases will originate in developing nations.

Entra Health, with its Asia-Pacific headquarters established in Sydney in 2009, supplies MyGlucoHealth blood-glucose monitors, which collect blood-test results that are relayed by Bluetooth to mobile phones then to a portal and approved carers. If a patient fails to test for two days, a reminder is sent. Telstra and Diabetes Australia carried out a study of 100 patients and 80% are keeping the new system, the Solution Owner at Telstra Industry Health Solutions, Izaak du Plooy, says. One participant was a 14-year-old boy whose parents struggled to get him to record anything. But now that he can do it on his mobile, he absolutely loves it, he says.

Entra Health is targeting sales of 5 million glucometers in the Asia-Pacific region by the end of 2010 and about 100,000 in Australia over two years, chairman John Hendel says. I envision that in 10 to 12 years time, Sydney will be one of the global leaders in e-health technology, the Silicon Valley of e-health if you like. This is because Australia has in the public and private sectors technologies in e-health that are complementary to our own. I was quite impressed with the systems and data that universities in Australia are working on. So we are looking to a good source of future knowledge transfer. It will be our strategy to acquire companies in this region.

Another Australian mobile health trial being carried out by the Commonwealth Scientific and Industrial Research Organisation has seen Nokia provide 80 mobile phones to remotely monitor cardiac rehabilitation patients at Brisbanes Prince Charles Hospital. The E-health Theme Leader at the Queensland CSIRO, David Hansen, says early results are outstanding. We are seeing a greater drop-out rate from the normal program than with the new remote monitoring program. The phone-based model will deliver help to more people for the same amount of funding.

Mobile Care Factor

Ray says mobile health care is critical to developing nations. Vodafone Foundation statistics show that only 5% of the worlds population have personal computers, but mobile-phone penetration is 40%. So obviously, the mobile phone is the way to go to provide e-health, he says.

Vodafone will launch a business unit of 10 staff in the UK in early 2010 to deliver m-health technology into markets including India and China. It also formed a global alliance with the Rockefeller Foundation of the US and the United Nations Foundation in 2009 and produced a report outlining 50 m-health development projects.

Project Masiluleke in Africa uses mobile phones for text messaging in HIV/AIDS education. In Thailand and in a South African pilot study, medicine compliance reached 90% when tuberculosis patients were given mobile phones to receive daily reminders. Disease and epidemic m-health applications are being used in Peru, Rwanda and India. And the University of Melbourne is creating tools including a mobile drug-dosage calculator for health workers in Mozambique.

The report estimates that by 2012, half of all people in remote regions of the world will have access to mobile phones. In 2009, 4 billion mobile devices were in use globally, 64% in emerging economies. There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve health care services, Ray says.

Nokia is also active in emerging markets, launching its Nokia Data Gathering software in 2008. The software, which speeds up the reporting of disease outbreak data, has been used by hundreds of Brazilian health workers to fight dengue fever, the companys director of community involvement, Gregory Elphinston, says.

In Dhaka, Bangladesh, a telehealth call centre has been operating since 2006, with 65 doctors offering phone consultations. The Head of the Telemedicine Reference Center, Dr Sikder Zakir, says 8000 calls a day are serviced. In our experience, 60% to 65% of the patients wont need any medical visit, only 30% to 35% need referrals and only 5% to 6% end up in hospital. A pilot program is being rolled out at up to seven rural centres where up to 15 rural doctors will network with the Dhaka centre using mobile phones. In Bangladesh, we have only 40,000 doctors for 150 million people, he says.

Entra Healths mobile phone-based intensive diabetes management solution has also been launched in association with the Bangledash Diabetes Association to service 1.5 million registered diabetic patients. The diabetes solution a few years ago cost US$200, but now costs US$40, so at least some of my patients can now afford it, Zakir says.

Going the Distance

In Australia, the vast continent means travel costs can be high for patients needing specialist care in cities. So in Victoria, the Loddon Mallee Rural Health Alliance is trialling a bedside video-conferencing system connecting three hospitals and Melbourne specialists. The Virtual Trauma and Critical Care Unit was used in about 750 incidents in 2009, including 100 trauma cases such as road accidents as well as emergency care, staff training and stroke management, says Bruce Winzar, the alliances chief information officer.

Trial results and a business case will be finalised by June 2010, but Winzar says the new system can cut the cost of patient travel by 10% or more. A helicopter lift to Melbourne can cost more than $10,000. If you are sending one of those a week, it doesnt take long to look at the business case and say how do we do this smarter? he says. The business case will address remuneration for specialists because their video-conference consultations are not recognised under the Australias universal health- care system, Medicare.

Winzar, who inspected telehealth systems for dermatology and stroke patients in Canada in 2009, says: I think telehealth is going to explode in Australia. Telehealth is very strong in Canada and our system is similar in terms of size and all the issues we face. Canada has had telehealth since the mid-90s. Given our large regional areas in Australia, telehealth here is an absolute must in the next five years, particularly with the NBN, as eventually bandwidth will need to be far greater if we are to do a lot more with ultra-high definition video-conferencing, images and data.

Telstra supplied technical services for the project. Telstra Health Industry general manager Bernadette Gibbons sees health as a huge growth area around unified communications and networking. We see the health industry for Telstra as actually growing at a faster rate than any of the other sectors. Thats because it hasnt grown in such a long time. Its coming from that lower end, where regional health care is still on paper. New government policy will drive Telstra forward, she says. The unique health identifier is being launched by June 2010 with the release of the new Medicare card, then e-referral is next. So theres a great opportunity for Telstra there.

One legendary Australian service, the non-profit Royal Flying Doctor Service, will also roll out a new centralised electronic medical record in early 2010. It will manage better follow-up for chronic conditions such as diabetes, which heavily affects the large outback Aboriginal population, says Sue Zeckendorf, project manager for the Electronic Health for Remote Australia project.

A new briefcasing facility will allow patient histories to be downloaded from the internet onto the laptops of 250 of the Flying Doctor clinicians. About 40% of the services patients are Aboriginal. n the year to June 30, 2009, it conducted 145,000 face-to-face consultations and 85,000 telehealth consultations (usually nurses consulting doctors by phone, although 200 used video-conferencing). A total of 37,500 emergency retrievals were carried out using 53 aircraft. A number of our clinics are run on homesteads out on the verandah where theres no net connection, Zeckendorf says. So in these situations, we are likely to use briefcasing.

Another powerful application for e-health is psychiatry. Sydneys VirtualClinic, run by the University of New South Wales and St Vincents Hospital, is trying out online self-help courses for patients suffering depression, social phobia and anxiety. VirtualClinic director Nick Titov, of the School of Psychiatry at the university, says 1200 patients have completed courses, with up to one-fifth living outside cities. Trial results show that online treatment, popular due to its convenience, is achieving similar outcomes to that of face-to-face therapy, with up to 70% of sufferers treated moving to a healthy group. These are quite large shifts, Titov says. The findings are surprising, but at the same time really exciting and encouraging. Some people after the online program said they gave a talk in front of 200 people or did things that they had never before had the confidence to do.

The possibilities for e-health appear limited only by imagination and technological know-how. Remote surgery is still rare, but is becoming more common as robotic functions improve in operating theatres. As early as 2001, a New York surgeon performed remote gallbladder surgery on a patient in France. Remote laproscopic procedures have also been performed in Canada. Such remarkable innovations will be key to further advances in global e-health.