E-health protocols trump network speed in NBN inquiry

The Australian Medical Association today highlighted a lack of data transfer protocols as one of the chief barriers to effective, electronic healthcare provision.

Addressing a Parliamentary Inquiry on the role and potential of a National Broadband Network, AMA vice president Steven Hambleton said non-network barriers were holding back electronic information transfer.

Despite having an ADSL2 connection that was shared between 15 desktop computers, Hambleton said most communications left his Brisbane office via fax or paper.

Inefficient communication methods could lead to drug prescription errors and a lack of follow-up, he warned.

“At this stage, there are no protocols for us to do that [electronic data transfer] securely,” he told the House Standing Committee on Infrastructure and Communications.

“There are concerns for sending patient information if it’s not encrypted … If you want to save lives the fastest, that’s where we’ll invest the money.”

Describing a three-day internet outage at the clinic during the recent Queensland floods, Hambleton noted that the impact of connectivity was “really quite amazing”.

He highlighted the ability to retrieve and show patients relevant images in real time, and the ability to set up meetings with specialists as examples of the benefits of connectivity.

“If you can’t do it in real time, oftentimes you don’t do it at all,” he said, noting difficulties that rural practices may face.

Liberal MP Paul Fletcher questioned whether a fibre network was specifically required to meet the outcomes that AMA vice president Hambleton described.

“The impression I got from you is there are non-network barriers about the efficient exchange of information … the NBN in and of itself is not going to solve that particular problem,” he said.

Earlier this week, the National E-Health Transition Authority inked a $23.6 million contract with IBM to develop a national authentication service that would facilitate information exchange.

The system was expected to be delivered by 30 June 2012, in time for a July 2012 launch of personally controlled e-health records.

When questioned by the Committee this morning, the Department of Health and Ageing was unable to specify network speed requirements for Australia’s e-health goals.

“To set a minimum speed is unnecessarily fettering things, but it [speed] certainly limits what you can do,” said Richard Bartlett, first assistant secretary of the Department’s Medicare Benefits Division.

Although telehealth services could be delivered by the telephone alone, “the better the speed, the better the outcome”, and poor outcomes would lead to a low uptake of NBN services, he said.

Rural requirements

The National Rural Health Alliance, which also addressed the Committee this morning, said universal broadband access and pricing were its primary concerns.

In accordance with the 2010 NBN Implementation Study (pdf), the Government planned to provide 100 Mbps fibre connectivity to 93 percent of Australian premises.

Fixed wireless services were expected to reach another four percent of premises, while the remaining three percent of premises would connect via satellite.

“For the alliance, the missing three percent – those living in remote or small areas – provide the real test for a National Broadband system,” alliance chair Jenny May said.

Although commercial-grade satellite would be an improvement on current services in remote regions, the alliance said it was “aiming for the best that we can possible get”.

Besides facilitating information transfer and providing telehealth opportunities, May said high speed broadband was needed to attract medical professionals to rural areas.

Citing feedback from the alliance’s student members, she said the next generation of health professionals were unlikely to work in regions where they felt “professionally and socially isolated”.

“Their lives are so inextricably involved in fast communication that they cannot imagine a quality of life, for a long period of time, without high speed internet access,” May said.

Alliance policy advisor Helen Hopkins suggested that NBN Co include specific requirements for services to the health sector in its service level agreements with internet service providers.

The alliance did not directly answer questions about how NBN Co may deliver a uniform price for rural and metropolitan services, noting only that price would affect uptake.

“We’re indifferent as to how it’s delivered as long as we get universality and a uniform price,” said Gordon Gregory, executive director of the alliance.

Applications for e-health

Today’s Committee hearing was the first of the Inquiry, which was established in December last year and expected to report by August 2011(pdf).

The Inquiry aimed to raise awareness of the potential applications of the NBN in areas like health, government services, education, research, and business.

At the Broadband and Beyond conference last month, Monash University professor Michael Georgeff called for the industry, Government and NBN Co to raise awareness of broadband’s potential for healthcare, noting that “the technology alone isn’t going to be enough”.

“There is a fundamental lack of awareness in what is out there and what can be used,” said Georgeff, who was also the CEO of e-health solutions provider Precedence Health Care.

Describing Precedence’s chronic disease management service cdmNet, Georgeff said that blog-like interactions between healthcare providers and user-friendly, shareable care plans had led to a threefold increase in productivity in trials.

“By and large, people are not so much interested in data; they are interested in applications, business processes, solutions,” he said.

“We have to get away from the mentality of thinking about data and data sharing, and into the mentality of thinking about applications.”