National Health Strategy

4 December 2015

The New Zealand Telehealth Forum provided a submission to the Ministry of Health's consultation on the draft National Health Strategy. Below is a web copy of the submission with contact details and letterhead and signatures removed.

Introduction

The New Zealand Telehealth Forum (NZTF or “the Forum”) welcomes the opportunity to make this submission to the consultation on the National Health Strategy.

The Forum is sponsored by the National Health IT Board to promote the use of telehealth in healthcare delivery and to address the barriers that stand in the way of its wider adoption. It further aims to maximise the benefits of the Government’s broadband programme, and recognises that telehealth can – and should – be a significant contributor to the shifts that are taking place, in New Zealand and globally, in the delivery of healthcare.

The Forum is clinically led; its national Telehealth Leadership Group includes clinicians who are experienced in the practice of telehealth as well as clinicians and others in various health management and health informatics and technology roles.

“Telehealth” in its broadest sense is the term for the use of information and communication technologies (ICT) to deliver healthcare when patients and care providers are not in the same physical location. The various types of telehealth describe the ways of delivering services, rather than services in themselves. The Forum’s focus is primarily on three types of telehealth:

  • telemedicine, includes interactive sessions using video conferencing e.g. for consultations with patients, multidisciplinary meetings and education or store and forward for applications like transmission of radiology images
  • telemonitoring, i.e. remotely collecting and sending patient data so that it can be interpreted and then contribute to the patient's ongoing management, and
  • mHealth, i.e. the use of mobile communications technologies in medical and public health practice, including the delivery of health information, health services and healthy lifestyle support programmes. The use of telephone and call centre-based facilities such as the National Telehealth Service can also be included under the overall “telehealth” umbrella.1

 

Comment on the Draft National Health Strategy

The Forum welcomes the recognition of the importance of ICT technologies in the draft strategy and in particular the mention of telehealth in the Smart System theme2 along with the Central Otago example.

However, telehealth technologies can enable almost all of the themes in the Strategy. For example in People Powered, mobile and home-based technologies and devices can enable people to be more involved in their health. In Closer to Home, telehealth technologies can provide better, sooner, more convenient access for patients and caregivers alike. In Value and High Performance, telehealth technologies – if effectively and sustainably deployed, along with appropriate funding and reimbursement policies – can improve efficiency and productivity for service providers and patients. In One Team, the use of telehealth technologies can greatly improve collaboration amongst clinicians, support a more cohesive team approach in shared care, and enable upskilling of the workforce.

Comment on the Roadmap of Actions

While there is no explicit mention of telehealth in the Roadmap actions, it appears to be implicit. We recommend the following amendments be made in Roadmaps Section 5 Smart System:

a) that the section “What do we want in 5 years” be amended by adding the following bullet point:

“Regulations, professional bodies and policies relating to infrastructure investment, funding and reimbursement support and encourage both innovation and the sustainable uptake of ICT technologies, including telehealth, with a strong evidence base for the benefits.“

b) that the wording of Smart System Action 20 be amended to include a reference to telehealth. The following is suggested (amendment in bold):

“This action area seeks to improve the health system’s service effectiveness, reduce cost, improve engagement with people who access health services, promote healthy behaviours and self-management and aid people-led design. It includes use of new technologies (medicines, medical devices from dressings to robotics, cell and tissue therapies), service design/models of care, and information and communications technologies (e.g. eHealth and telehealth).

Note – the interpretation of this statement from a telehealth perspective would be that telehealth technologies should be considered in the design and delivery of hospital, primary and community services, and it would support the Forum’s work in addressing the barriers to uptake. Telehealth can then be a viable enabler for improving the effectiveness of the health system.

c) that the second bullet point under Action 20 be amended as follows (amendment in bold):

“Continue to develop and implement the regulatory scheme to support the assessment and uptake of medical devices, therapeutic products and telehealth technologies.

Note – an example of the need for this amendment is the current regulation regarding prescribing, which can be an inhibitor to the uptake of telehealth for patient consultations.

d) that a fourth bullet point be added under Action 20 that signals national leadership in support of technology uptake:

“Support the implementation of tools and the operational environment necessary to ensure effective and increased uptake of new technologies.”

Note – telehealth examples in the above bullet point include the need for a Health Videoconferencing Directory and a seamless environment for videoconferencing interoperability and interconnectivity.

Conclusion

Telehealth technologies provide the opportunity at a very basic level to reconstruct the way healthcare is delivered. There is some progress being made in New Zealand, but much more needs to be done to deliver significant benefits. We look forward to further developing and carrying out the Forum’s Work Programme in conjunction with the Ministry and other government agencies and in support of the National Health Strategy.

 

Yours sincerely,

Dr John Garrett, ChairDr Ruth Large, Deputy Chair