Telemedicine could transform Australia’s health services – but overcoming resistance from patients and healthcare professionals will require strong change management skills.
In a children’s ward at Mount Isa Hospital, Dr Eliza and her team are taking part in one of the regular ‘ward rounds’. They check the condition of each of the young patients and then contact any other specialists involved to discuss their progress.
It’s a routine that happens in every hospital – except that Eliza is a robot. As part of a telemedicine project, she connects children and staff in Mount Isa via a video link to specialists at the Royal Children’s Hospital in Brisbane 2,500km away.
Telehealth offers enormous potential to improve access to healthcare for millions of Australians – particularly those in remote or indigenous communities, elderly or disabled patients unable to travel and children who may otherwise have to be treated at a specialist centre far away from home. It is also a cost-effective way to deliver services at a time when resources are limited.
So why then are doctors and patients so reluctant to use it? Very few clinicians practice telemedicine. Even with the introduction of
Medicare funding, uptake has been limited and, where investment has been made in equipment, often it is hardly used.Dr Eliza title
While technical limitations such as slow broadband speed are in part to blame, as well as a poor roll-out across the country, it’s clear that there are more subtle factors at play. The situation will strike a cord with managers who have been involved in implementing major IT projects. A high proportion of such projects fall by the wayside because the company fails to overcome resistance and persuade staff to use the system.
Dr Nicole Gillespie, a management specialist with UQ Business School, says change management is a key issue. She is a Chief Investigator of the $2.5m government-funded Centre for Research Excellence in Telehealth at UQ and is leading on research projects examining how to overcome the barriers to telehealth. “Telemedicine involves significant change for everyone involved,” says Dr Gillespie.
“Resistance and distrust are common reactions to organisational change like this. Patients and their families may question whether telehealth will deliver the same quality of care. Clinical staff may worry there is inadequate training, or resist change because it will upset the status quo. Successful implementation will require careful attention to management processes and effective engagement of all parties involved.”
Dr Gillespie and her team are working alongside experts from UQ’s Centre for Online Health, a leading authority on telemedicine, Inala Indigenous Health Service and the Griffith Health Institute at Griffith University.
The government believes that, with the rollout of the National Broadband Network (NBN), advances in cloud-based computing and
electronic patient records, it’s time that telehealth was more widely adopted.
Teegan Green, a PhD student working in Dr Gillespie’s team, says there is huge scope to provide remote virtual services in rural hospitals and clinics, in residential aged care facilities and patients’ homes, particularly to treat conditions such as dementia and diabetes – two of the country’s major health problems. Currently 1% of population consumes 30% of healthcare budget, most of that being used to treat chronic diseases.
Teegan says Australia is behind countries such as Canada, parts of Europe and Japan where telemedicine is much more widely used. Remote surgery – where surgeons use robots to carry out operations at a distance – is relatively commonplace in the USA and Japan. The team is trying to understand why Australians are more reluctant to adopt such technologies. Teegan admits that practical issues do play a part.
“Video conferencing is commonly used but can be poor quality and unreliable,” she says. “Consultations can be interrupted because the Wi-Fi connection needs to be reset when robots are moved. Image quality can also be a problem, for example in dermatology cases where consultants are using photographs taken by GPs to make their diagnoses, and to some extent they are reliant on GPs having sufficient knowledge to pass on the appropriate information. It can also be harder to put patients at ease – trust cues are conveyed by direct eye contact and physical touch. In some cases, the consultant ends up having to do a physical examination anyway.”
However Teegan echoes the view of Dr Gillespie that two key factors are getting the processes right and building trust in the system. “Telemedicine requires a different business model, and one that is sustainable and scalable. The current model is based on face to face contact. So for example, how many virtual consultations can be carried out in a day? How do we develop a billing model that encourages doctors to offer telemedicine services?
“We also need to overcome resistance. People initially distrust new technology but over time they build trust. Gradually innovations become more widely accepted and eventually part of everyday life. The question is, can doctors trust telemedicine enough to be confident in making a diagnosis? And will patients trust the diagnosis? To some extent it depends on the patient, the type of illness and the perceived risks.
“Some patients may be more reluctant to change to a virtual service, while others may try it because their choices are limited and it offers them a better mode of care. Where a child has cancer, telemedicine may allow parents to care for them at home. Elderly diabetic patients can be monitored from home until an acute episode arises, minimizing their time in hospital.
“Patients and doctors in situations like this, who become early adopters, are influential in changing attitudes. When you get a few lead users, an idea can spread and become mainstream.”
Teegan says telemedicine could transform the way healthcare is delivered. She adds: “There is the potential to reengineer the whole service offering and improve patient wellbeing. With any new technology though, there is resistance – the more innovative and disruptive the technology, the greater the resistance. In this case, I believe the slow take-up is significant. Telemedicine has the potential to create a healthcare revolution.”