NBN 101: How the NBN can change Australian healthcare

Back when he was a far more popular figure among the ALP hierarchy, Kevin Rudd led Labor to victory with the grand promise of a nationwide high-speed broadband network that would provide ubiquitous access for all Australians.

The $43 billion National Broadband Network (NBN) has the potential to enable a host of new and innovative applications and radically change a number of Australian industries.

[This article is part of Computerworld Australia's NBN 101 series, in which we take a look at aspects of Australia's fibre-to-the-home (FTTH) network. The articles are meant to be an overview of the debates surrounding the National Broadband Network (NBN). For in-depth NBN coverage, head to our NBN tracker.]

In the realm of education, it could revolutionise how Australians teach and learn. The effect it stands to have on Australian healthcare is no less dramatic. Although a network on the scale of the NBN is not necessarily a technical precursor to the rollout of many e-health technologies, with its bandwidth and the scale of its deployment it can act as an enabler that eliminates some of the constraints on the implementation of unique healthcare identifiers and personally controlled electronic health records, for example, and enhance access to telehealth and videoconferencing.

Further reading on e-health: Snapshot: The e-health landscape in Australia

Where are we now?

It’s common knowledge that residents in metropolitan areas have a significant advantage over their country cousins in rural Australia when it comes to broadband services. And when it comes to healthcare services the Royal Australian College of General Practitioners (RACGP) e-health spokesperson and former clinical lead at the National E-Health Transition Authority (NEHTA), Dr Nathan Pinskier, says the current environment is hampering the capacity of healthcare providers to provide services as the infrastructure to deliver such services is not up to scratch.

“They’re two interrelated issues; the foundations for e-health are not necessarily broadband-dependent but the mass adoption of e-health is. So we need to be able to build the foundations, deploy them across the health sector and then have the capacity to be able to use those foundation components as part of the messaging processes and other communication requirements.”

According to Deloitte consultant and e-health expert, Craig Smith, the ongoing issues for broadband when it comes to e-health are availability, reliability and coverage.

“Unless we can actually improve reliability for all connected points, we will have challenges in people taking up any kind of healthcare delivered over that infrastructure,” he says.

“Without broadband or the NBN, the key impediments that exist today when we’re trying to deliver e-health would still run rife,” he adds. “Obviously within the health environment on of the key challenges is access to the information, but reliable access to the information is most important.”

Grampians Health Alliance chief information officer, David Ryan, agrees, noting that the uptake of e-health is patchy in rural and regional areas due a lack of connectivity between health services. Specifically he points out the poor take-up of telehealth services in these regions as the communities struggle to attract and retain staff.

“The service of metropolitan specialists travelling into remote regions is becoming more and more difficult for them. So ultimately if you can provide that on a remote basis #8212; as an online consultation service or a telehealth videoconferencing service #8212; that means it’s seen as a way for those services to continue.”

“There have been quite a significant number of failures across Australia in telehealth before and it’s fair to say the reasons for those failures have been sustainability both in terms of funding and sustainability in terms of how the technology companies have contributed to their own downfall,” he says.

“They have basically sold solutions at very low prices, 'get-in prices' and then failed to sustain those prices when the project is completed. Sustainability must be embedded both in terms of ongoing funding but also embedded in the practice of healthcare.”

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Rural and remote areas are often served by a single telecommunications provider, Ryan notes, which has resulted in attempts at bringing clusters of health services together to create Wide Area Networks (WAN), as has been the case for the Grampians region along with the Hunter Valley and Queensland Health.

“What that means is that by bringing some of the health services together, they can now provide additional healthcare services that they might not have been able to do if they didn’t have connectivity in place.

This can be problematic in the long run, "because you get to a point where people are using those wide area networks to pass around electronic health information that is everything from scanned medical records, CT and MRI scans, all the way through to videoconferencing services

“As we get more and more people using things like telehealth services, videoconferencing, remote monitoring or even passing around electronic health records, you get to a point where you saturate those links and you need greater speeds.

To attain those greater speeds, he says, there is really only one technology – optical fibre.

Enter the NBN

Questions still remain over the exact benefits the NBN it will have when it comes to e-health, however.

Ryan describes the NBN as a “crucial” leveller that will provide equity across metropolitan, rural, regional and remote Australia.

“Health is one of those things that people see as important to them, Australians expect their healthcare to be delivered for free and they also expect that no matter where you live you get the same level of care.”

“I think the issue that we face in rural and remote is the perception that it’s your choice to live out there but in reality people don’t necessarily have the choice.”

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Smith echoes this sentiment and adds that unless the network truly does deliver equal access across Australia, “What is the point?”

“I think it comes back to the perception around availability, reliability and coverage," he says. "If we can address those things and mitigate each of those in the NBN infrastructure rollout and service delivery then we will have a medium that can be used for high availability services such as healthcare. If we can’t address those then we obviously will continue to have a challenge around perception and the reality of whether or not we could deliver these services with any guarantee.”

The NBN must provide a platform via which health services can be delivered in a different way than they were previously, Ryan says, because of the ageing population and the greater demand placed on hospitals and general practices.

“E-health is starting to be seen as much broader; it’s about the whole e-health ecosystem which incorporates all levels of government.

“We’ve got to do things differently; e-health has to be seen as much broader than the hospital system because the hospital system hasn’t solved any issues to date and I don’t see it solving them into the future.

“I see it as all providers and all disciplines getting in there and discussing it and coming up with new ways of delivering the service.”

According to Pinskier, the use of videoconferencing and telehealth are set to climb with the rollout of the NBN, particularly in remote and rural areas which are currently using satellite technology.

“Satellite technology is slow and unreliable so once you have a solid terrestrial connection it means you can start to have certainty around service level agreements and around the data speeds, it really brings the bush into the city,” he said.

Ryan, too, questions the ability of satellite to deliver the healthcare services that remote Australians require but is optimistic.

“It’s an open question as to whether [satellite] can provide those that are truly remote with the same level of access speeds as our rural, regional and metropolitan counterparts,” he said. “It’s fair to say the current environment could probably be supported on satellite but as we grow more and more complex in the way we deliver our telehealth and e-health services, particularly video, it may mean that even the satellite links get saturated and the bandwidth provided by satellites may not be enough.”

Privacy, security and the NBN

Although widescale deployment of e-health initiatives can increase the efficiency of delivering health services, it also raises issues of patient privacy and security.

Ryan says that the current paper-based system should be given more credit than it is and somewhat replicated in terms of the way it deals with privacy.

“At the moment, the gold standard is you ask the patient and if the patient wants a certain practitioner to be involved in their care and they grant it.

“This currently works in the paper environment and it should be replicated in the electronic world and, in fact, it should be easier in the electronic world.”

“I think generally people accept that when they sign up to an agreement if they get the convenience of it being online they access an element of risk," Ryan says. But they also expect that the service provider is building in the appropriate levels of security and privacy into those infrastructures.”

Pinskier advocates the establishment of a “robust” privacy and security policy or security access framework that can be put in place with the relevant authentication to support the rollout of the NBN.

“The network is essentially a highway by it provides capacity and provides a carriage of information. The framework that underpins it and the way in which you transmit information or access information is currently being developed but it will all augment each other.”

Smith agrees, describing them as two separate, unrelated entities, with the NBN as the medium that will be used to deliver services while privacy remains the responsibility of the e-health service deliverer.

“Certainly there is a responsibility for the NBN to be a secure network just like any other communications provider, however there is a broader responsibility on the healthcare solutions and systems service providers.”

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He says that current privacy frameworks like the Health Identifiers Bill 2010 should assist the shift from paper-based healthcare systems to electronic systems and ease fears about the security of personal information.

“I understand the existing privacy constraints, but I believe that by changing to electronic we are not changing those constraints, we’re simply changing the medium," Smith says. "The trouble is that the perception is causing a lot more confusion than is necessary.”

NBN and e-health: But what about the applications?

A June 2010 report #8212; Telemedicine in the context of the National Broadband Network #8212; prepared by National ICT Australia (NICTA) for the Department of Broadband, Communications and the Digital Economy argues: "There is no doubt that health care systems will undergo fundamental transformations over the next several decades. Pervasive broadband access will be genuinely disruptive. We have the opportunity to use the NBN as a catalyst to advance Australia into a leading position in telehealth-care as an integral part of healthcare more broadly."

Telemedicine is defined by NICTA as "that subset of e-health that deals with medical diagnostic and treatment services, at a distance… Tele-medicine provides health care, decision support services, and information management, with an anywhere, anytime access model"

The report identifies a number of aspects of telehealth services that the NBN stands to affect, such as videoconferencing for remote diagnosis and the increased speed of data transfer.

A submission by the Medical Technology Association of Australia (MTAA) to the parliamentary inquiry into the NBN notes that many of these services can be delivered even without a near-ubiquitous high-bandwidth network like the NBN. However, it adds that the NBN can offer greater access and decreased costs, and make telehealth services faster and more efficient.

In addition to better access to staples of telehealth such as patient record storage and retrieval, including bandwidth-hogging MRI and CAT scan results, for example, and enhanced remote diagnosis and teaching through tools such as videoconferencing, the MTAA submission argues that the NBN is perhaps capable of changing the fundamental nature of healthcare delivery in Australia.

The role of remote consultation with specialists through videoconferencing is a fairly obvious tool that can be enhanced through a network like the NBN. However, it can be easy to miss just how significant this can be in a country with such a dispersed population such as Australia. The Royal Australasian College of Physicians' submission to the same inquiry identified some of the social and personal impacts that the NBN could have on patients, their families and their communities through technologies such as this.

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