In a state as large and diverse as Queensland, the provision of healthcare isn’t always straight forward.
The work of the Royal Flying Doctor Service — founded and created in Queensland’s outback — laid the groundwork for advances in both physical and mental health delivery for medical practitioners the world over.
But as the state grows — and our geography remains expansive — the need for more innovative health delivery and improvement in patient outcomes is a prerequisite to life in Queensland.
Professor Anthony Smith has been delivering telehealth opportunities in under-served communities in regional and remote Queensland for nearly 20 years.
Born and raised in Brisbane, he’s now the Director of The University of Queensland’s Centre for Online Health (COH) — a research leader in planning, implementing and evaluating telemedicine.
“I enjoy living in Queensland and can appreciate the challenges of delivering health services — especially when the distances are extensive,” Professor Smith said.
“Queensland is the perfect place for telehealth. With the large distances, widely distributed population — with about a third living in rural and remote towns — and centralisation of specialist services in city locations.
“With most specialist health services also situated in city locations, access to these service for country families is much more challenging. In extreme cases, some people elect not to travel to see a specialist because of the burden of the physical and mental stress associated with travel.
“What motivates me is the need to see greater equality in the way health services are provided — and where appropriate, telehealth should be used as the first option when dealing with patients in remote locations.”
While telehealth is not a new concept, the uptake has been slow in Australia — something Professor Smith has devoted his career to changing within Queensland.
“Telehealth can help with the provision of a service in a timely manner and it reduces the need for travel. It’s such a valuable method for supporting clinicians in rural and remote areas and may also assist with earlier diagnosis and/or clinical decisions during emergency or acute presentations,” Professor Smith said.
“Telehealth also improves responsiveness of services, especially in cases where patients would normally have to travel large distances to see a specialist.
“A great example is in paediatric cardiology. A paediatric cardiologist can examine in ‘real-time’ an echocardiogram via videoconference, to diagnose a potential cardiac defect in a young child.
“During the videoconference, the specialist can offer instructions to the technician operating the ultrasound equipment, form an assessment and discuss the case and management plan directly with the local clinicians caring for the child.
“Instead of being automatically transferred to the specialist hospital in Brisbane, in most cases, the child and family can remain in the community with the support of local services.”
Professor Smith takes the responsibility of keeping up with the latest technology and learning how to best adapt the technology in a clinical and cost-effective manner very seriously.
“The Centre for Online Health is internationally recognised for its work in this area — done in partnership with the health service and other commercial organisations,” he said.
“Doing telehealth implies a change in the way we are normally accustomed to providing services with in- person appointments. System changes take time, and these include the availability of suitable infrastructure such as facilities and telecommunications, revised referral processes, changing roles and responsibilities, documentation requirements, clinician time and service coordination.
“Change management is very important — telehealth is a process which forces all of us to think carefully about the way we provide health services.
“It can be a challenging field also in awareness raising efforts. For example, until now most medical, nursing and allied health training programs did not specifically teach students about telehealth. Our centre at UQ has been providing education and training for more than 15 years, and we are now contributing to the development of a new digital health curriculum at the university.
“It’s important that we start moving towards a community awareness that telehealth is for everybody — not just people living in distant locations. People living in metropolitan may experience difficulties travelling for a specialist appointment; perhaps due to frailty, the travel costs, work requirements, or absence of family support.
“If clinically appropriate, telehealth should be used for all patients irrespective of where they live.”
While the hopes for the future in more populated areas will be supported through the COH, it’s Professor Smith’s work in the small town of Cherbourg in central Queensland that has made incredible change in recent years.
“About 10 years ago, we worked with the health service in Cherbourg to develop a mobile health screening service for Aboriginal and Torres Strait Islander children at risk of ear disease and preventable hearing loss. We converted a van into a mobile screening unit, which is now used to visit schools in the region,” Professor Smith said.
“During a school visit, senior Aboriginal health worker, Mr Cecil ‘Pickle’ Brown conducts basic hearing tests and collect information, including digital images of the inner ear.
“If a child fails the hearing test, then the information is referred back to the local service. Doctors in Cherbourg, are then able to assess the child and if necessary, refer to the specialist hospital in Brisbane if further assessment or potential surgery is required.
“This model demonstrates the importance of community engagement, and leadership amongst community stakeholders. Key results included an improvement in the overall screening rates of eligible children from around 40% to more than 80%, and an efficient community-led service — where children with suspected ear health problems could be assessed by local medical services or a specialist in Brisbane.
“The aim of telehealth is to provide health services as close to home as possible. It makes sense to build services in community settings and to use telehealth as a means of supporting remote communities in terms of professional support, service delivery and training.
“From the Indigenous perspective, ensuring services are designed and delivered in a culturally appropriate manner is very important. In this program, the COH provided ‘behind the scenes’ support needed to operate the program, and the health service in Cherbourg managed the service on a day to day basis. The Cherbourg health service have done a remarkable job and continue to run the service for Indigenous children living throughout the region.”
For Professor Smith and his team, the future is bright, and they’re working hard to ensure their hopes for the next 10 years in Queensland come to fruition.
“We would love to see continued expansion of telehealth services within the entire health system, with routine telehealth services being delivered in hospitals, general practice medical centres, nursing homes, aboriginal medical centres, and in the home,” Professor Smith said.
“Ideally, telehealth would be fully integrated within every specialist service and the processes would be in place to permit easy referral, and consultation in a timely and convenient manner. I would hope that access to telehealth services are not defined always and only by geography, and that these services are provided to people living in nearby communities as well.
“Of course, to have this made possible appropriate funding models have to be in place to support the delivery of all clinical services, regardless of whether it’s in person consultations or telehealth.
“The key piece of the puzzle moving in to the future though is working towards interoperability between different systems — from videoconferencing, to billing, to medical records, to pathology, and beyond.
“Although there has been excellent progress in some health services with the digitisation of hospitals, there is still a heavy reliance on paper records. Access to health information during a telehealth consultation is very important, as is the need to document health service events following the use of telehealth.
“With the emergence of the digital hospitals, a vast amount of clinical information is becoming available for research and quality assurance. These extensive clinical datasets are going to be a valuable opportunity for the development of more responsive treatments and service planning.
“Examining information and identifying patterns in healthcare data will be helpful for clinical decision-making and health service planning and will help to ensure that our scarce health resources are being used in the most efficient manner.”
For the man responsible for guiding Queensland Health’s journey in to a more digitised environment to harness the power of data, the foresight of people like Professor Smith is music to his ears.
Professor Keith McNeil was appointed as the state’s first Chief Clinical Information Officer in late 2017 and has been working to transform Queensland healthcare, one piece of data at a time.
Professor McNeil is the first to admit that the transition from paper-based recording in hospitals to a digital platform is confronting at first.
He’s a man with a lot of experience in the field. He was the Chief Executive at Cambridge University Hospitals National Health Service (NHS) Foundation Trust during its electronic patient record implementation and held the Chief Clinical Information Officer role with NHS, and now he’s back home in Brisbane to implement and develop similar systems throughout Queensland.
“Shortly after we had implemented the electronic medical record (eMR) in Cambridge after practicing in Queensland in a paper based system for much of my career, I popped in to see a patient, and as was my habit of lifetime I reached for the clipboard at the end of the bed — but for the first time in my 30-year career there wasn’t one there,” Prof. McNeil recalled.
“Instead of reading through handwritten notes and adding my own manually, I had to go to a computer instead. It was a change and a challenge, but now I can’t think of any other way of doing it.”
“There is no doubt that putting these digital systems in place can be incredibly arduous,” Professor McNeil said.
“Doing it properly from a technical perspective and funding it sufficiently is a big job. An even bigger hurdle however is the adaptive challenge — to get healthcare providers to understand how to change the way they work to maximise the potential of these digital systems.
“Changing habits is hard work and moving in to a digitally savvy environment for nurses and doctors who have been working with the same system for decades is understandably confronting.
“But the young medicos we have coming through the ranks now think it’s absolutely archaic to have paper records! What I’m working on with the roll out and subsequent developments is not to simply digitise an old way of working but give us the platform to enable a whole new way of working.
“Digitising hospitals has been sold as a ‘tech solution’ but it’s really not. It’s just an enabler to generate high quality data and knowledge to make better decisions. The tech solution is most definitely not the end game, and it takes a while for people to go through that journey of understanding of what role tech plays.
“We’ve always utilised the power of information in clinical medicine. The great early physicians would talk to patients, ask questions and record (write down) the answers, and then aggregate and analyse the data collected to look for patterns that would inform a diagnosis.
“Today we have the ability to collect data in unprecedented ways and we are able to generate more and more information and knowledge from that data. We can do things faster and medical professionals can access real time data and information every time they sit down with a patient.”
Professor McNeil says one of Queensland’s star examples of digital transformation is the Princess Alexandra Hospital in Brisbane.
“Here they’ve successfully implemented clinical information dashboards,” he said.
“This offers real time data in a way not available to hospitals before. For example, at any hour of any given day you can see the exact number of people in the hospital who have diabetes or are on blood thinning (anticoagulant) medication.
“That sort of information has huge positive impacts on a whole range of functions of the hospital, from staffing, to medical supplies to bed availability, but most importantly it plays a critical role in improving patient safety.”
Professor McNeil said other hospitals in the state have now successfully implemented a fully integrated electronic Medical Record, and many others are on their way to doing so.
By 2020 nearly 30 Queensland hospitals will have the system in place, covering over 80% of the healthcare delivered in our hospital system.
“This will dramatically improve patient outcomes and help to improve workflows, hospital efficiency and productivity in every corner of Queensland,” Professor McNeil said.
“One brilliant example is the benefits for hospital pharmacists. Prescribing on a digital platform improves medication safety in a spectacular fashion. For one, they no longer must try to read doctors handwriting! This alone reduces medication error by eliminating the human error in misinterpretation of handwriting.
“Digitising medical records also means we stop giving stuff to people that they’re allergic to — because even if they forget they can’t have a particular drug, it will be stored on the digital record and automatically flagged via electronic prescribing ensuring nothing falls through the cracks.
“These are just some of the things — and the tip of the iceberg really — that a digital healthcare system makes possible.
“You can’t deliver modern healthcare without hospitals, and in a similar vein, in this day and age you just can’t deliver safe, high quality healthcare without digital systems.
“It’s an expensive process for the Queensland government to commit to, but we simply cannot afford not to make this is investment. The return on investment will be beyond anything we can imagine today. It might not be a specific dollar figure — but we will improve patient outcomes in ways that simply cannot be fathomed as we roll the process out.
“In another ten years we will have achieved a population health data set that is linked to every single patient and every member of Queensland’s population.
“We will be able to accurately characterise every individual at multiple levels — from social indicators of their health right through to their unique molecular make-up.
“This is the holy grail of preventative health care — we’ll be able to intervene before a health issue starts and have the ability to administer precisely the right treatment. We all want to be healthy and happy and that’s what digitising Queensland’s healthcare system will deliver — in spades.”
Read the Advance Queensland Strategy to find out more about how the Queensland Government is Building Our Innovation Economy.