Current State and Future Vision
As the ehealthinfo.gov.au website highlights, Australia is not alone among OECD countries in projecting unsustainable growth in expenditure on health services. As such, it is essential to find ways to increase efficiencies in the healthcare system, to reduce costs without compromising on the quality of the services delivered.
Like many other sectors, the health sector in the region is frustrated by the current telecommunications infrastructure in the Far West NSW region. For example, this is encapsulated by the Dentist’s clinic which when constructed 10 years ago was fully fitted out and networked for fibre optic cable. The dentist’s current ISP provides a service which is little better than dial-up and there is no alternative service available to the dentist.
Across the Far West NSW region, the lack of adequate technology capacity and speed is holding our region back. In this video below, the Chair of the Far West Local Health District board explains the general aspirations of the regional health services, and highlights how attainment of health standards are being impeded by declining technology services:
We visited an aged care facility in Broken Hill which does not currently offer internet connectivity to individual residents due to infrastructure service constraints. In the next video, you can gain a sense of how quality of life for our older residents is impacted by lack of technology services:
High speed broadband will enable the delivery of electronic services to improve upon existing paper-based systems. The electronic management of health information has the potential to transform the way health is delivered now, by improving the quality and safety of our healthcare system. It’s been estimated by Deloitte Consulting that for every dollar invested in eHealth in Australia, we’ll see more than two dollars back.
To maintain the region’s position of being at the forefront of the delivery of health services to regional communities and to continue to improve the healthcare services being provided to everyone in the Far West NSW region.
Notwithstanding the current frustrations, the Far West NSW region has a real opportunity to become a leader in e-Health by building on the skills, expertise, processes and infrastructure already being put in place by some of the leading health providers in the region, namely:
- The NSW Health and its telehealth and e-Medical records program
- The Royal Flying Doctor Service and its skills, traditions and culture of innovation and adoption of the latest technologies
- The Broken Hill University Department of Rural Health (BHUDRH) and its community of care program
- Maari Ma Health Aboriginal Corporation
Health and Education Equity
Technology should prevent development of the urban/rural health divide. In the following video, hear about health equity. Australia, as a nation, strives to provide the same quality health care in the rural and remote locations as is provided in well populated metropolitan areas. Technology is the critical enabler for the prevention of an urban/rural health divide. Listen to Dr Steve Flecknoe-Brown talk about health equity for the Far West NSW region:
Evidence shows that students learn more effectively in the training programs offered by the BHUDRH. They have more impressive results, and they are more likely to want to work in remote and rural locations. Interactions are real, practical and create long-lasting learning experiences. But without high speed broadband, there are ongoing frustrations. Listen to the story behind the professional development of more than 400 students per year, the future doctors and other medical professionals, who come to our region for this specialist practical learning:
NSW Health has been rolling out an e-Medical record system in select regional areas over the past two years. Broken Hill is one of the areas where the pilot has been conducted. Doctors, nurses and health staff in Broken Hill are already involved in the pilot (along with four other sites) and are building and testing a system suited to rural needs.
The benefits of the e-Medical records include:
- fast access to patient information for clinicians
- reduction in paperwork which allow nurses and doctors to have more time with patients
- alert notification of patient issues
- fewer errors due to issues such as illegible handwriting
- prompting for safer care – ie if the clinician forgets to perform a certain procedure
- better coordination of resources such as operating theatre time
NSW Health has been trialling telehealth services in the region for some time.
NSW Health has begun trialling telehealth videoconferencing services into regional areas. The benefits to date include
- Consultations being delivered via video-conferencing
- Specialists that were previously inaccessible are now available to the rural community
- Broadens clinical options access to the rural public
- Rural patients have taken to the technology very quickly. They see immediate benefits such as quick access to specialists (rather than having to wait months for a consultation) and not having to travel many hours to larger towns for consultations
Lack of bandwidth means the services can only be rolled out to a small number of rural townships at the moment. The NBN will allow telehealth for all.
Broken Hill University Department of Rural Health (BHUDRH)
This campus was established to improve health care in far western NSW by providing high quality support, education and training for rural and remote health workers.
Its focus is to establish relevant teaching and support environments, promote opportunities for student placements in the region, encourage experienced academic staff to spend time in the bush and foster partnerships to improve the quality of health care for rural Australians.
BHUDRH has works closely with the Far West Local Health District, Maari Ma Health Aboriginal Corporation, the Royal Flying Doctor Service (South Eastern Section) and Divisions of General Practice to deliver a successful rural attachment program for medical, nursing and allied health students. It also provides comprehensive training for Indigenous health workers, research training for general practitioners and primary health care workers, and professional development support for local health professionals.
More recently BHUDRH joined forces with the Population Health Division of the Far West Local Health District to operate the Broken Hill Centre for Remote Health Research. The centre aims to enhance national expertise in rural and remote health research and translate research into policy and practice.
The initiative is seen as world’s best practice in clinical education and the University has delivered papers around the world on its effectiveness.
The program has been a great success and has the potential to rejuvenate the health sector in rural communities. As then Prime Minister, Kevin Rudd stated on a visit to Broken Hill in March 2010 to announce $1.9 million funding for the initiative:
“These funds will help ensure that students undertaking rural training have access to top quality facilities and encourage them to consider future careers in rural health. Doctors and health professionals who spend time training and learning in regional and rural centres often establishes strong links with the local community.”
The Rural Health Campus is considered world’s best practice and the academics running the course have collected evidence and presented papers internationally on the campus.
Some of the key benefits are:
- Hands on experience for students
- Unlike in the city they get to see patients first hand – they are not at the back of the queue to see patients as often happens in the larger cities
- Often they get to treat patients on their own
- This hands-on experience means the students become better doctors and medical professionals
- Students contribute to the economy by spending money in the region (estimated at $10m per annum in Broken Hill)
- Students contribute their expertise to the community
High-speed broadband will enable:
- More efficient delivery of the service
- Improved collaboration with participating universities
- Improved connectedness with the outside world – ability to access world’s best practice lectures and webinars
- Ability to deliver webinars on areas of rural expertise (such as aboriginal cultural awareness training)
- Talk to people in real time in rural communities
The Rural Health Campus initiative has been so successful that the region is now looking to take the medical model and move it to other sectors such as law, business, engineering and design. See video below and education section of this report.
Royal Flying Doctor Service
Australia has long been at the forefront of the delivery of health to regional communities ever since the days of the Rev John Flynn in the 1920s. He saw firsthand the health concerns of communities living in remote areas where two doctors provided the only medical care for an area of almost 2 million square kilometres. His vision was to provide a ‘mantle of safety’ for these people and on 15 May 1928, his dream had become a reality with the opening of the Australian Inland Mission Aerial Medical Service (later renamed the Royal Flying Doctor Service (RFDS)). While the RFDS began in Cloncurry, Queensland its NSW section has operated since 1936 when it opened its Broken Hill base. In the 1950s, the RFDS was acknowledged by former Prime Minister Sir Robert Menzies as “perhaps the single greatest contribution to the effective settlement of the far distant country that we have witnessed in our time.” Today, it has a fleet of 53 aircraft, 21 bases around Australia and looks after over 270,000 patients.
The RFDS has always applied the latest technology to deliver health services to the challenging environment of remote Australia. It has a track record of overcoming the tyranny of distance and the barriers of communication. The organisation has successfully utilised technology in the past including:
- the use of flight and other transport means
- the utilisation of telephone and radio
In recent times it has embraced satellite and web based communication technologies both of which will improve with the advent of the NBN. This successful track record in adopting technology and the culture of embracing technology to solve real health issues is a key strength. The Far West region can harness this strength as it enters the digital economy age to provide better health services to all its residents.
|What do we want to do||Why||Who will do it||When||Resources|
|Health EquityThe key aspiration of the Far West NSW health sector is to provide similar health services to the people in our region as are provided to people in large city environments. The only way to achieve this is by having clever use of e-diagnostic and clinical services. Without technology enablers, the urban/rural divide will continue to worsen.||Health indicators deteriorate the further distance you are from cities, e.g. 20 years shorter life for an Indigenous person and 10 years shorter life for non Indigenous; death rates for cancer are higher. The digital divide is increasingly manifested in Australia through such trends.||Far West Local Health DistrictBHUDRH, Maari Ma, Royal Flying Doctor, the region’s Medicare Local, local medical practices and health care specialists||Ongoing||Govt funds.Donations and grants.|
|Health System Management(a) Telehealth
Continue to roll out health services to Broken Hill and our Far West NSW rural communities. Contrary to opinion, patients don’t mind telehealth video. But high definition services are key to having an effective consultation between doctor and patient.(b) e-Medical Records
Continue to improve data management, data sharing, security, storage, access, integration with related services.
|Road travel is dangerous for patients and health professionals alike. Air travel is largely out of reach for many, or not available. It makes sense to let technology offer convenient, efficient services. Current impediments are poor quality picture and unreliable data transmission. Data management efficiencies can increase exponentially over a large geographic area.||All the key medical professionals in the region have a part to play, see above.||ongoing||Govt funds.Far West Local Health District would like to be a trial site for national health e-medical records.|
|Professional DevelopmentContinue to refine the rural health campus initiative and promote its benefits to the world. Broken Hill is transitioning from its past as a working class town to a vibrant, innovative university town. In this new future, people relate to each other differently. A successful transition is the key to our future economic development (reference sites are the former predominantly steel cities of Newcastle, Wollongong).(a) Students bring diversity to rural communities and offer intellect, and vibrancy and innovation.(a) e-Learning blend
Mix up learning methods, e.g. interactions with local mentors, businesses, video, other students.
|Education levels and good health increase. Community learns and grows. Better educated people take better care of themselves. Lifestyle expectations change. People are driven by learning, professional clusters, networks, ability to access quality lifestyles, information and recreational activities. Technology and face to face interactions are critical.The economic impacts attributed to current student learning activities in Far West NSW are estimated at $10m per year.||All the key medical professionals in the region have a part to play, see above. Various national, international partnerships and arrangements enabled with high speed broadband. Medicare Local has prioritised the setup of education programs in next 12 months.||ongoing||BHUDRH, FWLHDStudents from universities.Various grants.Federal funds.|