Technology in healthcare
Technology has revolutionised the way we work, changed the way people manage their health and improved access to healthcare services.
Why is it important?
Using technology in healthcare can:
- increase timely access to appropriate interventions
- provide access to services not otherwise available
- reduce financial barriers and costs associated with travel
- reduce the burden of travel on health and wellbeing
- extend hours of service and provide consistent, continuous care
- extend the scope of practice for rural and remote clinicians through consultation and shared care with specialists
- provide tools to help people understand and manage their health condition
- empower people to self-manage their health condition
- improve communication and collaboration between local and remote healthcare professionals.
Types of technology in healthcare
Telehealth allows you to deliver healthcare remotely, using technology such as video conferencing, home monitoring (using special equipment or apps), remote education, and store and forward (collecting data and sending it to another site for evaluation).
While electronic medical records and self-guided consumer education, such as therapy apps, are an important part of using technology in healthcare, they are not considered telehealth.
Using telehealth can:
- connect clinicians to patients and their family, carers or guardians
- support assessment, intervention, consultation, therapy and supervision
- improve communication and collaboration between health professionals.
Telehealth is used across the health system by ambulance services, community health services, emergency departments and hospital units including intensive care, mental health, maternity, paediatrics, medical and surgical units.
Videoconferencing is used by many services in NSW, particularly for specialist consultations. Some videoconference consultations are supported through the Medicare Benefits Schedule.1
It can be used for:
- individual consultations
- group consultations with clinicians, families, carers or interpreters
- group therapy, peer support, education or exercise sessions
- psychiatric and behavioural assessments and therapy
- allied health assessments and therapy
- monitoring and management of chronic conditions
- case conferencing with clinicians across multiple sites
- accessing resources from home, school or the local community.
Store and forward
Store and forward is where clinical information (including data, images, sound and video) is collected and stored in a secure system, then forwarded to a health professional at another site for evaluation, intervention and management.
Remote monitoring uses technology to collect and send medical and healthcare data to an app, device or service outside the traditional clinical setting. This may include:
- wearable devices such as wristbands
- smartphone apps
- devices used at home
- online portals
- email communication.
The information collected is then sent to a person’s electronic medical record or healthcare professional for assessment and advice.
Remote monitoring can be passive (where measurements are sent from a device automatically) or active (where people collect their own clinical readings and send them to their healthcare provider). It can also involve an alert or alarm in high-risk situations where immediate action is required.
Remote monitoring devices can be used to measure:
- blood glucose
- blood pressure
- heart rate
- respiratory function
- oxygen saturation
- body temperature
- body weight
Remote monitoring improves access to healthcare services and provides more timely care, so people have a better quality of life and stay out of hospital.2
Multipurpose devices that take different clinical readings can be useful for people with more than one chronic condition, and be less overwhelming than having a number of devices.
Healthcare and wellbeing apps
With so many health and wellbeing apps available, it can be hard to know which ones are useful. When reviewing apps, consider:
- whether the app is made by a reputable company
- the cost of the app to purchase (both up-front and subscription costs)
- whether data is stored on the app, who owns this data and whether it can be sold to third parties
- reviews for the app by people who have downloaded and used it.
Apps can be useful for some people, but should be used to complement treatment or management rather than replace it.
Things to consider
The extent to which someone can use technology to actively participate in shared decision making and self-management of their condition will vary. However, the technology should always be clinically appropriate. Before recommending it, you should consider the following factors.
If you think someone is less willing or able to use technology than they actually are, they can be less willing to try it. Consider whether your opinion of the technology is influencing the other person’s decision to participate.
Information technology literacy
While information technology (IT) literacy can affect whether someone is willing to try using technology in healthcare, age and experience are often not a barrier.3 4. Try to be open-minded and not underestimate their ability to learn new technology.
Instead, discuss the options and address their fears or concerns. Make sure instructions are clear and they have easy access to technical support and training.
Individual needs and preferences
It is important to assess people on a case-by-case basis, to understand their needs, abilities and preferences in relation to technology. The level of involvement also needs to be considered for people with cognitive, visual or physical disability.
Some people find it easier to engage via technology, such as those with autism spectrum disorders or attention deficit hyperactivity disorder.5 It may also be useful for people who are embarrassed about their health condition and feel more comfortable asking for help and discussing it online or remotely.6
Technology should be regularly reviewed and customised to suit the needs and preferences of the individual. There should also be a process in place to make sure the person’s outcomes are being met and maintained.
You may like to develop a toolkit for staff and patients with information about what they need to do, how to use the technology, how it is different to usual care and basic troubleshooting tips. This can reduce any disruption and confusion in the early stages of implementation.
Costs and resources
Consider the equipment you will need, such as mobile phones, computers, software and devices. You will also need to consider the costs of electricity and internet, as well as the speed and reliability of connections at both locations.
There are a number of devices available in NSW Health facilities that can be used to support access.
People may also need space to store equipment in their home. To address these barriers, you can provide people with access to the technology from a local general practice clinic or health service, rather than their home.
Quality of care
Technology should provide care that is at least equivalent to the clinical care you currently provide. It is most effective when it is patient-centred, clinician-led and complements face-to-face services rather than replaces them.7 8
When using new technology with limited evidence, make sure you evaluate the new service against standard clinical care.
- Commonwealth of Australia: Dept of Health. MBS online. Canberra: Dept of Health; 2018.
- CSIRO. Home monitoring of chronic diseases. Canberra: CSIRO; 2017.
- Crotty M, Killington M, van den Berg M, et al. Telerehabilitation for older people using off-the-shelf applications: acceptability and feasibility. Journal of Telemedicine and Telecare. 2014;20(7):370-6.
- Cimperman M, Brenčič MM, Trkman P, et al. Older Adults' Perceptions of Home Telehealth Services. Telemedicine and e-Health. 2013;19(10):786-90.
- Hilty DM, Ferrer DC, Parish MB, et al. The Effectiveness of Telemental Health: A 2013 Review. Telemedicine and e-Health. 2013;19(6):444-54.
- Gottlieb L, Hessler D, Long D, et al. A randomized trial on screening for social determinants of health: the iScreen study. Pediatrics. 2014;134(6):e1611-e8.
- NSW Ministry of Health. NSW Health Telehealth Framework and Implementation Strategy: 2016-2021. North Sydney: NSW Ministry of Health; 2016.
- García-Lizana F, Muñoz-Mayorga I. What about telepsychiatry? A systematic review. Primary care companion to the Journal of Clinical Psychiatry. 2010;12(2).
- Thinksulin - A Clinical Decision Support AppOrganisationAgency for Clinical InnovationDescriptionA point of care app for Junior Medical Officers and nursing staff that provides information and decision support on blood glucose level targets, hypoglycaemia management, blood glucose monitoring, basal-bolus calculations, and charting and reviewing doses.URLLicensing/Cost--
Digital health records
- Australian Digital Health AgencyOrganisationAustralian Digital Health AgencyDescriptionInformation about My Health Record including registration, set up and training; evidence review and Australia's National Digital Health strategy.Licensing/Cost--
- My Health Record: For you & your familyOrganisationAustralian Digital Health AgencyDescriptionInformation for consumers about My Health RecordLicensing/Cost--
- My Health Record Online TrainingOrganisationAustralian Digital Health AgencyDescriptionThis training introduces My Health Record and outlines its benefits, features and functionalities.URLLicensing/Cost--
- My Health Record ResourcesOrganisationRACGPDescriptionResources to assist general practice in their use of My Health RecordURLLicensing/Cost--
- My Health Record VideosOrganisationRACGPDescriptionCase studies and video content from My Health Record workshops held in 2018URLLicensing/Cost--
Innovation and the future of healthcare
- Future Health: ??Seven visions of the future of healthcareOrganisationThe Telegraph (UK)DescriptionArticle about the future of healthcare.Licensing/Cost--
- Case study: Home monitoring of chronic diseasesOrganisationCSIRODescriptionCase study of a national telehealth trial of home monitoring of chronic disease for aged care.Licensing/Cost--
Store and forward
- Tele-DermOrganisationAustralian College of Rural and Remote MedicineDescriptionTele-Derm is an internationally recognised online resource, designed to provide practical advice to rural doctors for diagnosis and management of skin disease in general practice.Licensing/Cost--
- Telehealth - Agency for Clinical InnovationOrganisationAgency for Clinical InnovationDescriptionComprehensive information about telehealth, links to resources and the Telehealth Capability Interest Group.Licensing/Cost--
- Tele-psychiatryOrganisationAgency for Clinical Innovation Aged Health NetworkDescriptionTele-psychiatry is access to a specialist mental health clinical input via telehealth to supplement face-to-face services.URLLicensing/Cost--
- Telehealth consultations with Aboriginal people for pain managementOrganisationAgency for Clinical Innovation Pain Management NetworkDescriptionGuide for clinicians on providing chronic pain management services to Aboriginal people via telehealth.URLLicensing/Cost--
- NSW Telehealth Framework and Implementation Strategy: 2016-2021OrganisationNSW HealthDescriptionA framework for telehealth activity in NSW.Licensing/Cost--
- Rural eHealth StrategyOrganisationNSW HealthDescriptionThe Rural eHealth Program will deliver a new approach to the way healthcare is delivered across rural areas of NSW.Licensing/Cost--
- The Health Wide Area Network (HWAN)OrganisationNSW HealthDescriptionThe HWAN will provide a network which will support remote access, multimedia applications and services, data exchange voice and video services as well as wireless access across NSW Health laying the foundation for the successful delivery of clinical programs.Licensing/Cost--
- Telehealth - The Department of HealthOrganisationThe Department of HealthDescriptionInformation about telehealth and links to resourcesLicensing/Cost--
- Consumer information: Better Access Telehealth Services for people in rural and remote areasOrganisationThe Department of HealthDescriptionThe Australian Government is improving mental health support for people who live in rural and regional Australia by investing in Better Access services via video conferencing. Web page includes telehealth guidelines and FAQ about the Better Access telehealth services delivered by psychologists, occupational therapists and social workers.Licensing/Cost--
- Telehealth: Specialist video consultations under MedicareOrganisationThe Department of HealthDescriptionPeople in telehealth eligible areas of Australia have access to specialist video consultations under Medicare. This web page provides information and links to resources.Licensing/Cost--
- Telehealth - RACGPOrganisationRACGPDescriptionA range of telehealth resources for GPs including implementation and tech guidance and templates and fact sheets for patients.Licensing/Cost--
- Telehealth in psychiatryOrganisationRANZCPDescriptionResources for psychiatrists using telepsychiatry in their practice, including information on setting up a telepsychiatry system.Licensing/Cost--
- eHealth and telehealthOrganisationAustralian College of Rural and Remote MedicineDescriptionA range of telehealth resources including Handbook forTeleHealth online education module, and link to an online portal of telehealth and ehealth resources.Licensing/Cost--
- Guidelines for technology-based patient consultationsOrganisationMedical Board of AustraliaDescriptionThe guidelines aim to inform registered medical practitioners and the community about the Board’s expectations of medical practitioners who participate in technology-based patient consultations.URLLicensing/Cost--
- Telehealth training and toolsOrganisationFlinders UniversityDescriptionLinks to a range of telehealth resources including guidelines, tools, education and training, and profession-specific information for doctors, nurses and midwives.Licensing/Cost--
- Adopting Telemedicine in PracticeOrganisationAmerican Medical AssociationDescriptionLearning module for implementing telemedicine. Some information is specific to the American context.Licensing/Cost--
- Video CallOrganisationHealthdirectDescriptionVideo Call has been developed by Healthdirect Australia to make it easy for healthcare providers to offer their services via video consultation. **Note: Healthdirect is no longer used by NSW Health but is still available for Commonwealth funded health services. **Licensing/Cost--
- Healthdirect Video Call Resource CentreOrganisationHealthdirectDescriptionThe Healthdirect Video Call Resource Centre contains activities, resources, and materials to help you offer video call access to your health care services as a normal part of day-to-day operations. **Note Healthdirect is no longer used by NSW Health but is still available for Commonwealth funded health services. **Licensing/Cost--