Talking HealthTech: 299 – Building the capability for greater digital health participation. Robert Hardie, nbn

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Virtual care, telehealth, telemedicine, connected care, and other terms refer to the delivery of healthcare when the patient and clinician are not physically present in the same room. It occurs via telephone and internet infrastructure.

As a result, having a strong communications infrastructure in place is a must if more individuals are to have access to digital healthcare services. And in Australia, the nbn plays a significant part in that communications infrastructure. 

Where do you think digital health sits on the radar for the nbn? 

Pete is joined in this episode by nbn’s Robert Hardie. They will be addressing the present state of the nbn when it comes to digital capabilities and infrastructure, which will drive healthcare delivery in the future. Pete and Rob will also explore the role nbn will play in enabling digital health, telehealth, and other virtual care services across Australia, including metro, regional, rural and remote areas.

Meet Rob Hardie

Rob Hardie is nbn’s executive manager for health and agriculture. He joined nbn in April 2020 as head of a segment for agriculture, and on May 22, Rob added health to the role. He has more than fifteen years of public policy background in a variety of fields, including defense and veteran affairs, agriculture, and telecommunications.

Rob’s interest in politics led him to Canberra, where he studied at the Australian National University. He began working in Parliament House when he was twenty years old, and he left at the age of thirty-one as deputy chief of staff to a minister. When Rob left parliament, he went to work for the New South Wales Farmers’ Association, where he worked with farmers to further their interests.

The Agriculture and Health Combination in nbn

There is still a significant information gap, and it is not anyone’s fault. The nbn is investigating challenging issues of how to deliver services to those who require them. So, in agriculture, the objective is to assist farmers to be as productive as possible and to bring connectivity into the places where they generate money. 

So, how can they help farmers to connect and comprehend the opportunity that exists in the healthcare business due to connectivity in their paddocks?

This is quite similar for the healthcare industry, where there are multiple players.  In the same manner that a doctor must be outfitted with technology to give virtual care via whatever platform they are utilising or wherever they are physically located, you must also ensure that the patient has access to services that allow them to connect. It’s the same kind of activity; only there are many players- clinicians and patients.

It is about identifying common platforms that clinicians and patients can use to converse in a visual virtual telehealth sense. However, it is also important to ensure that clinicians are equally versed in the digital environment into which they are venturing. 

Similarly, in agriculture, hundreds of individuals work every day as stock agents and agronomists to assist farmers. If a doctor is equally technologically skilled and can demonstrate to a patient that “this is how we can have a telehealth visit in between the times when I want to see you,” then everyone will be more capable and, ideally, more confident in how they utilise it.

About nbn

The nbn is a valuable national resource. It’s difficult to believe that the nbn didn’t exist just over a decade ago. A prior Commonwealth government established it intending to improve Australia’s telecommunications infrastructure. The nbn network has had its fits and starts and modifications along the road, but the result is that more than 17 million people are now served by it in some form.

The nbn network is powered by a multi-technology mix of existing copper wire lines and optic fibre (known as fixed line), fixed wireless and satellite. In regional Australia, fixed line connectivity serves 75% of the population. 16% of the population is linked via fixed wireless technology. Fixed wireless is a network of around 2200 base stations spread across the country that is similar design to a mobile phone tower but slightly different in the manner it delivers connections.

There is a $750 million investment to boost speeds across the fixed wireless network, which will provide access to speeds up to 250 megabits per second to 85% of the footprint.

For satellite users, from July 2022 the off-peak period has been extended (the period when data is not required, when it is being utilised or consumed through the satellite network). It is currently open sixteen hours a day, from midnight to 4:00 PM. 

When Rob joined the company, the network roll-out was nearing completion, making it one of the largest and most complicated infrastructure projects Australia has ever undertaken. And the company is now considering ways to ensure that the network is used in a way that continues to provide value to the community.

“How do you get into the nbn network?” someone once enquired. Because the company is a wholesaler, you do not purchase services directly from nbn; they are purchased via a third party known as a Retail Service Provider (RSP). There are many nbn service providers available.

The nbn is available throughout the country. It may just take a little research and a visit to the company’s website, nbnco.com.au. Users can find out about the technology that is available to them in their area. It can then present them with a list of suppliers to contact as well.

The role of nbn enabling digital health

It is important for surgeries, allied health clinics, pharmacists and regional hospitals to be connected so that the medical staff in those facilities can have access to the records and services they need to deliver quality healthcare.

It is also important that consumers of digital health services feel confident and capable in accessing the services in the first place. There is perhaps a need to refocus the discussion around telehealth so that telehealth fits the needs of the patient, in terms of the care that they require for the condition that’s being managed. This means there’ll be instances where telehealth makes sense because it may be a check-in, but where a face-to-face consultation is required, how can that be facilitated? There is a need to strike the right balance when it comes to telehealth.

Telehealth also allows the monitoring of people with chronic health conditions in their homes. This is important because we want to make sure people trust how their information is handled and feel confident that they can seek help if they need it.

The nbn created a tool called OSCAR to help people improve their digital skills. OSCAR stands for Online Skills Check And Resources. It provides users with a quick assessment of their knowledge, device usage, data, and e-safety skills. By taking the assessment, users can identify areas where they need improvement.

The nbn also has staff around the country who are helping reach out to local communities in regional areas in particular to help them bridge that digital divide and narrow the gap that we know exists in digital capability between metropolitan and regional Australia. The key here is making sure that we remove the barriers that are preventing participation in the first place.

During Covid, we all learned how to do things that we never thought would need to happen. Now how do we then leverage the ability to be able to do that into helping more people feel comfortable receiving care delivered in a virtual way.

By measuring people’s digital capability to understand where the gaps are, steps can be taken to improve that capability

Confidence and capability

There’s no shortage of apps and devices and wearables to use to monitor your health. The challenge isn’t lack of technology. The challenge is which one are you going to pick? As a provider which platform do you choose? Do I want to be locked into a particular technology ecosystem? Does it prevent me from making further investments or what opportunities does it open up going forward as well? These digital platform decisions for any business are significant decisions and everything has a trade off, so getting that decision right is fundamental. 

Quality internet infrastructure has potential to remove a barrier of connectivity to enable more technology adoption to happen. It’s one less thing that a practitioner has to worry about, and equally, a consumer has to worry about because they know that the network that they’re operating on is capable of supporting whatever decision the clinicians made. 

Something that technology vendors should consider, is often they will be building their solutions from within a metro area where they have fast fiber internet connections and reliable network. But when you move out onto remote areas where satellite is the predominant source of connectivity,  there are different challenges that exist in the way that these communications technologies work which might create new unforeseen challenges in the technology.

So it is important to design for the capability that exists rather than the capability we might like to exist.

Opportunities in virtual care enabled by improved communications

A key role virtual care can play is helping manage chronic conditions more effectively. The cost of delivering health in this country continues to climb, and as people live longer they need more healthcare, which gives rise to increasing costs.

Technology can enable more cost effective methods of monitoring chronic health conditions within a patients home.  A common question is – does monitoring healthcare at home consume lots of data? And the answer is no.  

The way that home monitoring will be adopted more widely is if it works behind the scenes while we live our lives day to day.  It is also vital that data is transmitted in a secure fashion. It is also important that data is captured in a central record like My Health Record to ensure healthcare could be delivered to somebody appropriately in the event of an emergency.  

Removing barriers and providing choices

What kind of healthcare should be delivered by telehealth vs in person? The answer to that question really comes down to the system having the flexibility and choice to give patients and clinicians options to determine the best pathway for care under the circumstance for each patient.

Sometimes its necessary for people living in rural and remote locations to travel 3 or 4 hours or longer for a medical appointment.  If we could remove the barriers that could allow the patient to remain in their own home, and say be connected to their clinician via telehealth and remote monitoring devices powered by the internet then this is not only more cost effective and convenient for everyone, but also potentially improve care as patients could be treated faster or identified any issues earlier using continuous monitoring.  

5G and satellites 

Mobile connectivity has a key role to play when it comes to network infrastructure in Australia. The mobile network and the nbn broadband are different, however nbn is leveraging advances in 5G technology in the upgrade of the fixed wireless network so more data can be sent further. 

nbn is also leveraging science and learning more every day about how to best move information around.  They use two satellites orbiting earth, which are delivering connectivity in real time to places in very remote parts of Australia and ensuring that people, no matter where they are located, can get access to the quality healthcare services that they need in real time and manage conditions so that people can live longer and healthier.

Future focus for nbn in healthcare

The main priority is keeping talking to communities to understand their needs.  There will continue to be a lot of focus on the challenges and opportunities in rural and remote Australia.  

_{Source talkinghealthtech.com}