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THE significant cost-savings generated by a north Queensland telemedicine initiative for remote oncology patients have been roundly welcomed by telehealth experts across a range of specialties.
Professor John Wilson, leader of the Monash Alliance telemedicine collaborative program, described the results from the initiative as “fabulous” and said advances in technology meant savings delivered by such telemedicine programs would only increase.
The retrospective analysis, published online today by the MJA, evaluated the teleoncology services provided by the Townsville Cancer Centre and its six rural satellite centres, finding net saving of more than $320 000. (1)
The project’s 605 teleoncology consultations with 147 patients cost a total of $442 276, including establishment costs, and staff, equipment and maintenance costs in the 4 years and 8 months to 2011.
The researchers estimated that $762 394 in travel and accommodation costs were saved by providing these services remotely, a net saving of $320 118.
Professor Wilson, who heads a cystic fibrosis telemedicine program in Victoria, said cost benefit was one of three components required to ensure acceptance of telemedicine in Australia. The other two components were clinical excellence, which could only be demonstrated in longer term studies, and social acceptance, said Professor Wilson.
He said the Queensland study was of high quality, but only evaluated site-to-site telemedicine. Further savings could be made in the future with site-to-home models.
He said while many homes in rural Australia currently did not have adequate bandwidth to access site-to-home care, this would improve with time. “More homes will be equipped with high-speed internet and more applications will become available that use lower bandwidth capacity”, he said.
The study authors noted that since July 2011, more than 80% of the consultations provided in the teleoncology service were eligible for a Medicare rebate, which was not included in the cost analysis and would provide further financial benefits to the hospital and health services.
A spokesperson for the federal Department of Health said that by June 2013 there had been 97 395 Medicare-funded telehealth services provided to 40 689 patients in Australia. Practitioners using telehealth services included 2904 specialists, 5365 GPs and 29 midwives or nurse practitioners, the spokesperson said.
Vicki Sheedy, the Australian College of Rural and Remote Medicine (ACRRM) e-health strategic programs manager, described the Queensland project as a “shining star” in telemedicine. She said that evidence of such cost savings would help to encourage bureaucracies to endorse telemedicine in health care delivery, especially in rural areas.
“There is [also] an education element to [the Queensland teleoncology model] and the remote area staff are being upskilled by virtue of their relationship with the distant end consultant”, she said.
Ms Sheedy said telemedicine programs also contributed to work satisfaction for remote clinicians, allowing them to broaden their scope of practice, and the benefits to rural and regional families were “amazing”. “The last thing you want to do when you are that sick is to have to travel all those kilometres for chemo”, she said.
ACRRM’s directory of telehealth providers was “growing every day” and included 1000 practices, but barriers to telehealth delivery in rural Australia remained. (2)
Professor Christopher Bladin, lead researcher for the Victorian Stroke Telemedicine (VST) program, said demonstrating a cost benefit in telemedicine was an important step in “embracing [telemedicine] as the model of health in the 21st century”.
Professor Bladin said the VST program, which connected a “virtual roster” of metropolitan-based neurologists with Bendigo hospital, had successfully increased the thrombolysis rate for ischaemic stroke at the regional hospital. A pilot project is being rolled out, with long-term plans for a statewide program.
He said while some services were better suited to telemedicine than others, a cultural change was needed to accept telehealth as a routine health delivery model.
“At the moment, too many people see it as a novelty”, he said. “As a specialist, I work in the public health system and my expertise needs to be used not only in the hospital in which I work, but … across every other aspect of the health care system”.
If you think health care is expensive now, wait until you see what it costs when it’s free!
P.J. O’Rourke
This article is a furfy, the costs of $442,276 for 605 tele-consultations, are only the costs of equipment, maintainance, technical IT, and one full time nurse in Mt Isa. It equates to $731.03 per consultation, exclusive of the doctors wages, typing, and postage ect.
A more cost effective way of providing consultations to Mt Isa would be to have regular visiting oncologist or SR, consult in Mt Isa every three weeks, as the bulk of the patients came from Mt Isa. This would provide a better quality service as physical examination is also done. Mt Isa consultations make up 516 of the total 605 consultations. The Mt Isa patients account for $619,200 of the calculated total $762,394 costs.
The costs of Specialist /Registrar travel every three weeks are $47,634
If we subtract $566,800 ($619,200 less $52,400 urgent review costs) from the total cost of $762,394 = $195,594 and add costs of Specialist travel $47634=$243,228, much less than $442,276 the cost of tele-consultations, with better hands on quality.
Introducing telehealth is not the same as taking a standard clinical service and then delivering the same thing by video consulting. It always involves developing a new model of care, and very often this involves greater communication and integration between the specialist and generalist services. Video consultations have the obvious limitation of the clinician at a distance not being able to do a physical examination, however the clinician with the patient can compensate for that. This is only effective, however, if the distant clinician trusts the skills and experience of the person with the patient. So telehealth is often not suited to those who like to have total control over all aspects of their work. However, there are also rewards to be gained by taking a more team-oriented approach, such as incidental or intentional upskilling of the generalist from the specialist at a distance, which also helps the patient who is seeing the generalist for most of their care anyway. When psychological therapies are being provided, there is academic evidence that patient outcomes are similar and the patients did not feel that the therapeutic alliance was affected. When qualitiative research is done with patients, they sometimes prefer video consulting because they find it less intimidating, and it is more difficult for the clinician to interrupt what they are saying. This is not the case with all patients of course; some prefer in-person, although most prefer a video consultation to having to wait or having to travel. My opinion is that doing telehealth is a new form of delivering care which should be regarded as a potentially valuable addition or supplement to what is already available, not a “second rate substitute” for business as usual.
Ian has it nailed … whilst there are very likely some places that telehealth can really help, my fear is when we stop importing doctors from Asia (where they are needed more) but import their services = export medical dollars, because (where is Ouyen??) never mind Ouyen to Manila, worry about Mumbai to Sydney/Bourke/Adelaide/Canberra … or, of course, we could just drop rebates to Sydney doctors to match their Mumbai counterparts ….
Always nice to read of clinicians advocating a measure for its cost savings.
Once the naive research pioneers have demonstrated that it can be done, and that clinical examination of patients is irrelevant in the 21st century, the pragmatist politicians will realise that if it can be done from Ouyen to Melbourne, or Tilpa to Sydney, it can be done from Ouyen to Manila or Tilpa to Mumbai.
“advances in technology meant savings delivered by such telemedicine programs would only increase” – yes indeed, just ask Telstra how it increased savings in its call centres. This phase 2 (for ‘Hollowmen’ fans) will be implemented by the federal government realising that states are cost-shifting, and cracking down on medicare rebates, while state governments fail to fund tele-health for hospitals treating ‘out of area’ patients.
Phase 3, of course, comes when a wily politician quotes all the researchers, and if the Ouyen oncology service can be as good over NBN as “live” treatment in Melbourne, then it is only logical to replace the Melbourne oncologists with cheaper (oops, sorry, equally good but better value for taxpayers’ dollar), distant end consultants.
I’m glad I’m a surgeon, and the haptic feedback won’t be good enough in my lifetime to unemploy (sorry, tele-upgrade) me.
So, whilst some specialties will need it more, or make do with it better, there are also those consultations for which it is a serious impedance. The discussion is also very subject to the failures of science, with hidden agendas and confabulations and confounders so that we need to read such ‘science’, or reports, very carefully. The dollars mentioned in the original report should make that very clear – there is much to be gained by some over others in the transition from personal interview to distance assessments.
What is more, the efforts assessed when one deals with staff we have once dealt with, and formed in-person trust with, may differ greatly when we provide a service to an ‘unknown’ team in a new place – assumptions in regard to the team’s ability to understand and implement our intended plan can fail, where there is no prior base of mutual understanding.
I think there is a lot more to this new field than many are actually paying attention to.
Whilst agreeing with the above – the opinions are beyond my own experience to judge – I have had a much worse experience of telehealth.
As an Addiction Specialist, providing services for a regional hospital with fly-in needs, telehealth was not very well received by patients or myself, though it was the darling of some administrators and nurses (but not those who were actually involved in the consultations). The report (local to my situation) stated that patients “liked it” and even that they felt “safer” than with in-person consults, but this is diametrically opposed to what patients have told me, and my own assessments.
For consultations such as are needed for D&A, being in the room, feeling the emotional context, seeing mjore than the camera can deliver, facing the patient eye-to-eye … gives a much greater perception of what is really true, than a tv can possibly do. One cannot (at either end) give the camera AND the screen full attention. Newsreaders and actors learn to play to the camera, so do politicians, but one cannot give warm confidence to the viewer at the other end whilst paying adequate attention to their image on the screen in front of you … it is simply not geometrically possible.
I used teleconference in Bathurst – it was great, especially for psychiatric evaluations & followup. Medicare rebates for this service are unavailable here in Katoomba NSW, yet are available in Blackheath, 12 minutes drive west. A great pity, as the nearest appropriate specialist centres are at least one hour’s drive east.
I may be old fashioned, but surely medicine requires a careful clinical examination of the patient, even in the 21st Century. As a consultant physician, I never gave an opinion until I personally took a careful history and then personally examined the patient before reviewing the pathology and radiology. Telemedicine may be cheaper, and can cut costs, but the quality of the advice must be limited as there is no way that the patient can be examined by the consultant. There is also a great deal more to medicine than cutting costs….
Great study by rural Queensland- this is another positive for Telehealth and should reassure policy makers to support this initiative . Telehealth could be utilised by other heath professionals such as allied health , pharmacists and others to create ‘virtual ‘ teams who can deliver quality care in the community . The acceptance by patients is important and the professions and health systems – both public and private need to promote these aspects as part of the solution to the health cahllenges of incresaed demand and reduced resources .