Telemedicine (part the second)

So Nick Ross from ABC Tech  disagrees with my opinion in the last post.  No problems, I’m happy to stand by my position.  My “continue to spout crap” reference comes from the fact that Nick has posted a number of times about the potential health benefits of the NBN.  See his articles here and here.

From the first of of those links, Nick says:

I’ve a hypothesis which I’m in the process of testing. It’s that the entire NBN will be paid for in the medical benefits alone. Seriously. I’m working on getting the figures. If you can help, please get in touch.

So, as I think I mentioned,  I certainly agree that NBN will have benefits for health.  But in terms of the advantages listed in the rest of that link.

1. Remote diagnosis and check ups. Sending an ambulance to a rural town, according to telehealth specialists at Melbourne’s Alfred Hospital, costs $6,500. Diagnosis by contacting a specialist at a major metropolitan hospital (or anywhere in the world) using an iPad app costs… $200. How many ambulance call outs can be avoided? What’s the total cost of that in Australia?

Fair call.  This is particularly the case for a large, decentralised state like Queensland.   The PA Hospital runs a geriatric outreach service to regional Queensland like this  (see grant application here, the annual report from PA’s link is broken).  As I mentioned, having done a teleconferenced outpatients clinic, it is not without its disadvantages, but there is certainly a cost saving to be had in patient transport costs.

 

Also in that point:

One demonstration at Melbourne’s Alfred hospital showed how a quick, remote, diagnosis of suspected meningitis in a baby meant that potentially life-saving first aid was administered straight away and that the hospital was waiting for the patient when they arrived

Hospitals have Triage nurses, who make an assessment of the potential severity of the illness very early in a patient’s presentation to the hospital.  Patients with potentially life-threatening conditions get given urgent treatment and bypass the waiting room in the current system;  if patients from rural areas are transferred to large hospitals this is done by the Ambulance service – who can provide urgent assessment and treatment and warn the receiving hospital of the likely condition, so the hospitals are primed for rural arrivals as well.

 

2. By not sending out nearly as many ambulances, ambulance crews can react faster to real emergencies

Possibly true.  Pre-booked elective outpatient appointments are done by the Ambulance service in patient transport vehicles;  often they are not ambulances from the acute pool.

 

3. With fewer people not having to queue up in hospitals, waiting times in emergency rooms plummet. Conroy cited a case in America where queuing in emergency rooms had reduced by 70 per cent. There are few Australian’s who wouldn’t be willing to pay for that. Fewer patients means better care from medical professionals too.

Ahh, an anecdote from Stephen Conroy… well, that nails it then.  Maybe the waiting room has been cleared of all the child pornographers who oppose the internet filter.

 

Less flippantly, emergency department waiting times are far more complicated than just numbers of GP-type patients in the waiting room.  Research from the ACEM and others have consistently found that emergency department waiting times are caused by access block – which is caused by a lack of  available inpatient beds (see the point below) and hospitals being 100% full rather than running with a buffer for efficiency.  The number of low-acuity patients presenting are a relatively minor contribution to the problem of ED waiting times.

 

4. Monitoring patients in a hospital, along with feeding them, cleaning them and generally administering them, costs a fortune (I’m working on the exact figures – please help if you can). In many cases, with the NBN, patients can be monitored at home. This saves heaps of money AND patients get better quicker.

Do you have some figures on patients who are just being “monitored” in hospital?  There’s not that many of them really.  Patients who are otherwise healthy with infections requiring outpatient antibiotics and don’t otherwise need hospitalisation are already being discharged onto hospital in the home programs.  Many acute beds are being taken up by people who do not need acute care but are unable to return home.  The NBN will fix neither of these problems.  Often people are in hospital because they need care – good nursing and medical attention.  What else do you think actually happens in hospitals?

5. The cost benefits and efficiency gains are so high that the health service – get this – is already building its own fibre-based mini NBNs in many places. But the rest of us can’t use them. This is still being paid for with tax payers’ money. Madness!

Here’s the link for that http://www.abc.net.au/am/content/2011/s3181312.htm

 

6. If a child is ill or if a worker is ill, then time needs to be taken off work to take them to a doctor (most of us can relate to this). If remote diagnosis was available to everyone, then far fewer people would need to go to the doctor. I’d be interested to know how many work hours are lost to the Australian economy each year through going to the doctor. There is also the knock on effect that with fewer people going to the doctor, then those that are really sick will be diagnosed and treated sooner (again). There’s an enormous cost-saving element to all of this. If only I had the figures.

Remote diagnosis is fine for some things, but it really isn’t the panacea you seem to be making it out to be.  From that previous link:

 

PETER RYAN: Based on the symptoms seen and heard down the line, the specialist decides to take no chances.

So symptoms are heard, not seen – symptoms are what the patient reports.  Signs are seen by the doctor.   A listless, irritable baby with an elevated white cell count may well have meningococcus.  That could be diagnosed over the phone, visual clues would add very little to the diagnosis.  At the end of the day, people are going to be more cautious in their diagnostics if they are unable to examine the child themself and may well err on the side of referring them in anyway.

 

What advantage are you proposing of remote diagnosis for children?  If your child is sick enough to need to tele-consult a doctor, then they are probably too sick to be at daycare or be at home by themselves.  So instead of staying at home and taking your unwell child to the doctor, are you going to stay at home with them and look after them, or tell them to harden up and watch DVDs while you stay at work.   And if you’re sick enough to want to consult a doctor, why would you be doing this in your lunch-hour on your iPad instead of staying at home.  Coming to work while you’re unwell runs the risk of spreading a communicable disease (like influenza) to your work-mates.  Everyone loves a mucous trooper.

 

And then, once you’ve had your teleconsult, what about the other hands on parts of the consultation?  Assuming you need antibiotics (which is unlikely, to be fair) and that the wonder of the NBN allows your doctor to electronically send the prescription to the pharmacy (requires a major change in the Poisons Act) are you going to have your antibiotics printed on your 3D printer?  No?  You still need to leave the house?  My goodness.  How efficient.  (Although this scenario would at least protect everyone else in the surgery waiting room from being exposed).

 

 

So a message directly for Nick – please don’t think I don’t agree with you about the benefits of the NBN in general or that I have a vendetta against you.  But to complain that people don’t have a full understanding of the technology and then talk about its benefits in an area that with respect, I don’t think you have a full understanding of is not helpful to the debate.

I hope you do manage to find some figures that support massive cost savings in the area of health.  I’m also very happy to admit that we have no idea what might happen with technology in 10 years time, so I may well be completely wrong in the long term.  But talking about pie-in-the-sky health benefits that are not grounded in reality really isn’t helping.

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  1. February 23, 2013

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