ICT as an enabler of Health Care to Indigenous

Communitieshttps://sites.google.com/site/crauchlethesis/documents/MDCD2012presentation%20outline.pptx?attredirects=0&d=1

Slide 1 of 15

Student: Christopher RauchleSupervisor: Stephen CassidySnum: 41958209

Past Promises of ICT to Indigenous Communities

Telephone – Most Indigenous Population was more than 40km from the main road. This was Telstra’s cutoff (when they were the Post Master General’s Dept)

Aussat –A gold plated system that was supposed to provide telephone and television to remote Australia.

One of the key drivers of the system was Indigneous and outback access and telehealth – did cause the Indigenous media movement in remote (but not very remote) areas but was not a big telehealth success

Radio – simple two way radios have been used world wide to communicate between distant remote regions

Current ICT uses in Indigenous HealthRegular PSTN with a service such as

Skype

Telephone consultations, prescriptions

High quality x-rays, MRI and CT scans being sent as images

Live linking to remote x-rays and sensors (ultrasound etc)

Checking eye health with remote examinations

Checking Blood Sugar, blood pressure

Decision support in the GP office, Health department

Queensland telehealth, Royal Children’s Hospital Brisbane(8)

Service Innovations allowing eHealthGovernment payments for

eHealth consultations

Allowing consultations without physical attendance

iPad field records of community consultations with uploads back in the office or when in range of a mobile service area (and much cheaper and faster than paper or film records)

Medicare payments – where there is a chemist it is usually linked via satellite if there is no telephone line

Future ICT Health platformsIntel ‘Shimmer’ platform of wearable

monitors to tell if the elderly have stopped moving or are moving abnormally in their homes – very useful for an aging Indigenous population1

More integrated e-health systems

Full robotic surgery (already a reality where fibre is available) means specialist surgeons can ‘teleport’ all over the regional parts of Australia without having to travel hours or days to operate. This surgery, using smaller instruments means faster operations, faster healing, fewer complications with specialists in some surgeries ‘working’ only from a few large city hosptials.2

Problems with the basicsCommunications links are never

good enough – mobile service in particular has been quickly overwhelmed by usage

Satellite bandwidth is insufficient for the number of users – this is a problem worldwide and most satellite downloads are limited to around 10Gb/month

NBN is required to deliver similar experience in remote and very remote areas and no matter what party is in power, the NBN satellites will be deployed to provide internet access in very remote areas

Baumol’s Cost Disease and HealthCertain tasks cannot be sped up by IT –

concerts still take several hours to be performed. Health care exams still take several minutes of face to face time. Surgery still requires several hours. Lecturing to students is still done in hour blocks.

Service roles that cannot be done in anything other than human time are ‘stagnant services’ and even if the salaries of the people doing them do not increase over time they get more expensive relative to the cost of other services that are not ‘stagnant’ – Teaching is increasing in cost faster than healthcare.

Even if the cost of a doctor visit doesn’t rise its cost relative to other, non-stagnant services, does

Cato Institute – Price trends for stagnant services9

Baumol’s Cost Disease and HealthIT’s role in reducing cost disease is to compress

the time taken by health workers to process workers and if possible increase the consultation and decision making process

eHealth records, networked CAT scans and MRIs, computers on the doctors desk instead of index card files are all evidence of technology designed to mitigate cost disease.

No surprise that IBM’s Watson is being employed on Health problems now…this is a long shot that health decisions can be made in a clinical setting with IT, which is not subject to cost disease

Increasing reliance on internet based services such as webMD and even Google threaten the health care professional in stagnant services.

Jevons Paradox in HealthThis should be good news then? Cost disease can be mitigated so more people can be served more cheaply.

There is a second Paradox involved to do with the coal industry.

Jevons was hired to research coal consumption by the coal industry. The theory was that coal consumption would fall because new, efficient, steam engines meant that much less coal was going to be burned for the same work output – coal industry feared a price collapse

The opposite is true…cheaper energy meant more steam engines and coal consumption skyrocketed

Jevons Paradox and IT Health CareIT is the same. Faster processes/processors

using chips that consume fewer resources does not result in fewer computers to do the same job. These more efficient systems are able to address markets that had previously been too expensive for IT – IT processors proliferate and service to those markets skyrockets.

Where it was formerly too expensive to offer service to an area, with cheaper IT, more people can be visited and areas that once had a cost to serve that was too high are opened up.

Also, when treatment becomes possible through this effect it replaces non-treatment for a new population of sick people. Therefore something that used to be free now costs something.

Productivity - 1990 v 2040 from Baumol

Can Health Care ever fall in priceAlthough new treatments almost always

cost more than the ones they replace, the amount spent on Health care per capita seems to be falling internationally.

It may be because everyone is using more and more IT to compress or eliminate the various tasks involved in the process

It may be due to superior treatments that are being developed, often with the aid of massive research projects driven by super computers that develop and simulate drugs such as immunosuppressants, anti-viral and anti-cancer drugs and therapies.

Indigenous Specific Commonwealth expenditure

Indigenous expenditure as a percentage of GDP has remained static at one third of a percent of GDP.

Even in periods of budget surplus, spending on Indigenous programs remained static with funding redistributed to other govt programs during the GFC

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Cost to serve Indigenous clients2011 – $123B total health care with $4.5B spent on Indigenous Health (5% for the 2%)

2012 - Government Health care costs for Indigenous people are twice as high per capita as for non-Indigenous people ($8190/Indigenous v $4054/Non)3

The cost to deliver health care to remote and very remote Indigenous Australians can be four times the cost to deliver to a non-Indigenous Urban client.

Government costs to deliver health care to a very remote Indigenous family of four could therefore cost $64,000 so anything that can reduce the cost to serve is welcome

Since Urban Indigenous people access the same Health Services as non Indigenous people, with most going to remote and very remote clients

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Market attractivenessDelivering services is not profitable but

policing the delivery of services, administering the delivery of services and planning the delivery of services is.

Well people are not as lucrative as sick people needing complex medical procedures and assistance with chronic illnesses but Indigenous Health programs are well funded and so this segment is attractive.

Most expenditure on Indigenous Health remains in the planning areas of government departments with a tiny proportion making its way to the front line.

Attempts to control expenditure result in more planning and oversight which perpetuates the problem.

Social MediaResearch institutes have begun to

use social media to distribute their materials.

NACHO – National Aboritingal Community Controlled Health Organisation is on twitter and reports their documents are downloaded more now.

“Just for a Chat” social media campaign in the Torres Strait to deal with sexual health (funded by Queensland Health)

No Smokes campaign by the Menzies School

TelehhealthFlying Doctor transformation from a physical

delivery service to IT delivered one – 85,000 telehealth consultations per year including video calls – one third of their patients are Indigenous7

Patient e-records – sometimes patients can’t remember when they were treated for things and in an Itinerant population it is valuable for any doctor or chemist to be able to look these up

Closing the Gap program – making it easier to make claims without medicare documentation

E-Health system relies on MyAccount with fed.gov. This system has already changed since last year. I cannot log into the account I created and I cannot reset it without talking to a call centre. Not the sort of UX a very remote Indigenous person would be able to use.

ConclusionsIndigenous Health consistently fails to hit its KPIs and Millenium

Development Goals for improving health outcomes.

Australia has rates of glaucoma, trachomoa and hearing loss related illnesses that aren’t seen outside of Sub-Saharan Africa – when sight, breathing and hearing are affected it causes ‘disease burden’

External cause (injuries) are up to three times higher for Indigenous males between 25 and 44 years of age. Endocrine, metabolic and nutritional mortality 6 to 7 times higher than non-Indigenous rates.6

Much of the money and time devoted to Indigenous Health is in administration and rather than focusing on high tech solutions in the field, cheaper solutions based around social networks would be more effective.

References1 http://www.ted.com/talks/eric_dishman_take_health_care_off_the_mainframe.html

2 Monte Malach • William J. Baumol, Opportunities for Cost Reduction of Medical Care: Part 3, p891

3 2012 Indigenous Expenditure Report, Indigenous expenditure in all states, http://www.pc.gov.au/__data/assets/pdf_file/0017/119303/01-ier-2012-factsheet-allstates.pdf

4 Commonwealth Indigenous-specific expenditure 1968–2012, 28/9/2012, p10

5 Commonwealth Indigenous-specific expenditure 1968–2012, 28/9/2012, p43

6 http://www.aihw.gov.au/indigenous-observatory-health-and-welfare/

7 http://yourhealth.flyingdoctor.org.au/health-services/telehealth/

8 http://www.uq.edu.au/coh/telepaediatrics

9 http://www.cato.org/blog/cost-government