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Wednesday, 21 June 2000
Page: 15321

Senator EGGLESTON (1:30 PM) —Today I would like to talk about telemedicine or telehealth, which has been altering medical practice in this country and has the potential to bring about a revolution in health care, for remote and rural areas especially, that could fundamentally alter the face of medicine as we know it today. Australia is an acknowledged world leader in the area of telemedicine, with a large number of trials already under way. In Queensland, for example, the largest telemedicine network in the world has been established, with more than 120 telemedicine sites across the state.

Senator Boswell —That's out of Networking the Nation—from the sale of Telstra.

Senator EGGLESTON —It is indeed, Senator Boswell, and it just shows us that the benefits of Networking the Nation and the sale of Telstra are flowing through to rural Australia.

Senator Boswell —Working for the bush.

Senator EGGLESTON —Yes, working for the bush, as Senator Boswell says. That is another example of the great focus the Howard government has on improving services in regional and rural Australia. Thank you, Senator Boswell, for calling my attention to that.

The federal government has founded Health Online under the auspices of the National Health Information Management Advisory Council to help coordinate telemedicine trials and develop a national action plan for information management in the health sector. Telemedicine has the potential to bring a large range of benefits to consumers and clinicians alike. In rural medicine, this is particularly the case. The vastness of Australia and the remoteness of many of its communities have always provided a unique challenge for the timely and efficient delivery of both health and other services to the more remote areas of Australia. Telemedicine has the potential to reduce the inequalities of access to general and specialist health services and health information in remote and rural Australia.

Medical consultations and screening procedures can be conducted in real time over vast distances by the use of videoconferencing and Internet technology, reducing the expense and necessity for people to travel to larger centres. Telepsychiatry and teleradiology are two good examples of this. Teleradiology enables the radiologist with appropriate equipment to receive images from anywhere in the country, look at those images, make decisions about patient management and give advice to a doctor a long way away about the management of a patient.

Telepsychiatry has proved very popular in Australia. In Australia we do have a maldistribution of psychiatrists. There are very few psychiatrists in regional areas, very few outside the capital cities. But with teleconferencing, it is possible for a psychiatrist to have a consultation with a patient a very long way away. In Western Australia, the WA Health Department and the North-West Mental Health Services have been involved in a telepsychiatry pilot project involving training and education, clinical consultations and service administration to patients in very remote areas. The project involves videoconferencing and links towns such as Broome, Derby, Kununurra, Karratha and Port Hedland to the Graylands Hospital in Perth, which is the main psychiatric hospital. Some people have thought that people who think their television set talks to them are perhaps suffering from a psychiatric problem but in this case rather than it being an indication that something is seriously wrong, they are in fact receiving appropriate psychiatric help and attention.

A pilot project currently under way in Queensland provides a good example of the use to which technology can be put. The Brisbane Mater Mothers Hospital has been providing real-time obstetric teleultrasound consultations to patients in Townsville, with most clinicians and patients apparently very happy with the outcomes. That could be repeated in many centres around Australia. Were it necessary to have very sophisticated ultrasounds carried out on pregnant ladies or other patients requiring ultrasound and were the equipment available in a regional centre, a very highly specialised clinician could read the ultrasounds and provide advice to the local doctor, wherever that local doctor was, using telemedicine services.

Another advantage of telemedicine is that consumers now have more access to medical information. In late April the Federal government launched HealthInsite, which has links to more than 50 web sites from which some of Australia's leading health organisations provide up-to-date information on a large range of health topics such as heart disease, diabetes, malignancy and many other problems. By giving the public access to these sites, it improves the extent and reach of public health programs and thereby hopefully cuts down the cost of dealing with preventable problems in our health system.

All the information on the HealthInsite is subject to a rigorous quality assurance process and is assessed by medical experts and consumer representatives. Doctors themselves have access to similar information, which provides a solution to the difficulty doctors in isolated areas have of keeping up to date with the latest medical information. It means that doctors living in remote locations can now have access to the very latest views on various conditions and can keep themselves well informed.

A very good example of the way videoconferencing can be used for postgraduate education in medicine is the monthly teleconferences conducted by the Western Australian Centre for Remote and Rural Medicine. The WACRRM service in Western Australia provides a monthly teleconference which goes out to every hospital in Western Australia where the local doctors are interested in participating. The conferences always have a theme—they are about some particular aspect of medicine. The WACRRM providers in Perth have specialists in that field who either present cases or present a video on an issue. Then they have an interactive discussion with the doctors in rural Western Australia, which might go on for several hours. That is a very good practical example of how telemedicine is bringing benefits to doctors in regional areas and improving health services in regional Australia.

There is no doubt that telemedicine is a system which has the potential to deliver major cost savings to consumers and governments in terms of the provision of, and access to, health care. The cost benefits to patients in rural and remote areas are obvious when we think about it, with less need for transport to city hospitals, a reduced need to travel to major centres for specialist consultations with all the expense that entails—the travel costs, accommodation, loss of income and so on. In Western Australia and around Australia there is the patient assisted travel scheme, which is now funded through the state governments but which used to be funded through the federal government. Quite obviously, with telemedicine, the cost of PATS for people in remote areas will be substantially reduced.

If, for example, a patient with some sort of rash can be seated in front of a videoconferencing unit and a dermatologist in Perth can have a look at it and say exactly what the problem is and recommend a treatment program or if a patient, for example, has a foreign body in the eye or some other problem with his eye, there are now slit lamps which can be set up with a small camera in them and the picture of the eye transmitted in direct real-time to an ophthalmologist in a major teaching hospital—in my experience in Perth, but anywhere in Australia—and the condition can be assessed by the ophthalmologist and a decision made as to whether or not that person can be treated locally or needs to go to a metropolitan area.

A doctor in Port Hedland who has a major interest in occupational health has established a telemedicine facility in his practice, which is used very largely to assess workers compensation type injuries arising from the BHP plant in Port Hedland. The potential saving to the mining industry of having telemedicine centres set up in remote mining locations, where it is possible for a patient to be assessed by specialists in various fields at long distance, is enormous. The cost savings to the mining industry have been estimated in the millions and millions of dollars, when one takes into account the saving in lost work time that is involved when a patient is evacuated from a remote mining location and taken to a specialist in the metropolitan area. Often that time need not be lost if a specialist is able to look at the injury or the eye and recommend action to whoever is responsible for the medical treatment of the worker at the mine site, and in that way there are vast savings to be achieved.

A Queensland telemedicine trial under way provides a very concrete example of the sorts of patient cost savings that can be delivered. Since 1997 the Children's Nutritional Research Centre at the Royal Brisbane Hospital has been conducting virtual clinics in Mackay, Townsville, Cairns and Mount Isa. As a result, during the first 200 virtual clinics some 900 kilometres of travel and 13 hours of family dislocation have been saved per patient, as have 20 air transfers and the prevention of a significant loss of income per person. Results of the trials have revealed that some 76 per cent of patients gain access to specialists sooner, with a majority believing the care they received was as good as a face-to-face consultation.

A further possibility offered by telemedicine, which is somewhat controversial, is the possibility of electronic lifetime health records, as envisaged by Health Online. But, of course, there are issues of privacy and confidentiality surrounding electronic health records, and concerns have been expressed that records held in electronic form will not be sufficiently secure. Patient records often contain highly personal and sensitive information and there is a need to ensure that, if this kind of service is provided, patient confidentiality is utterly secure.

Other problems related to the expansion of telemedicine services include, for example, current registration practices, because as things stand medical registration is on a state by state basis. Yet with telemedicine, of course, state boundaries become somewhat irrelevant, in that a person can be assessed in a telemedicine centre, we will say on a remote mining location in the Kimberley, by a doctor in Sydney or Melbourne, yet those doctors will not be registered in Western Australia. That becomes an issue in terms of the legality of any advice given and one presumes any liability arising from any malpractice or a bad outcome. This also raises the question of whether there should be special registration requirements for doctors who intend to incorporate telemedicine in their practices, and that is perhaps something which could be looked at by the council of Australian health ministers. (Time expired)