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Let telemedicine come in from the cold, says expert

The Age, 28th April 1998

Medical insurance or Medicare rebates for telemedicine consultation may not necessarily result in wider use of communications technology by health-care professionals, says a study of the fledgling $36-million industry in Australia.

South Australian video-conferencing consultant John Mitchell, in a report to the Commonwealth Department of Industry, Science and Tourism, said reimbursement for teleconsulting was not the panacea the industry required.

A House of Representatives standing committee claimed in its Health Online report last year that the restriction of the Medicare Benefits Schedule to face-to-face consultations was a major barrier to the use of telehealth. Another report, Telehealth in Rural and Remote Australia, made a similar conclusion.

Mitchell's study identified a remuneration plan undertaken in California, which showed little significant increase in the use of teleconsulting despite insurance refunds. He said while the funding of telehealth sites was an important issue, the major barriers to the industry in Australia included a limited telecommunications infrastructure and the lack of dialogue between equipment vendors and buyers.

He recommended an industry association for telemedicine be formed to deal with industry development, infrastructure needs, national coordination and to monitor technology advances.

"Telemedicine is currently a fragmented, immature industry in Australia," Mitchell said. "If it is to develop and to influence the delivery of health care services … and to live up to its potential it will need to be integrated effectively with mainstream, healthcare."

The Department of Industry, Science and Tourism said the report is due soon for public release.

While there are about 250 videoconferencing-based telemedicine sites in Australia, the definition of telemedicine for the purpose of the study covered the delivery of health care in clinical, educational and administrative services, with doctors not the only key users.

Cheaper video-conferencing systems have dramatically widened the availability and application of the technology in the past few years, but Mitchell stressed, interactive video transmission was not the only telemedicine technology.

Telehealth also includes e-mail, fax and voice telephony, Web-based access to archived information, call centres and teleradiology.

His report identified some leading edge telemedicine applications in Australia, including a research project at the University of New South Wales, to develop a device to record clinical measurements for use in hospitals and in a patient's home.

A spokesman for Dr. Michael Wooldridge, the Minister for Health, said the Australian Health Minister Advisory Council (AHMAC) was considering the issues behind structuring Medicare rebates for telehealth.

A number of topics, such as the usage of teleconsultation as a clinical measure or as a cost-cutting exercise, have been raised. The Government is also holding discussions with the Malaysian Government on international telehealth projects.