Technology in healthcare

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.

Telehealth

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

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

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
• falls.

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.

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.

Your opinion

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

Ongoing review

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.

Training

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.