Telehealth doesn't need fibre, the technology already exists: Experts

Telehealth doesn't need fibre, the technology already exists: Experts

Summary: The fundamental problem with telehealth is not a lack of NBN connectivity; it's culture, intransigence, and needing to change the way the health sector does business, said CSIRO chief scientist professor Branko Celler.


One of the core principles of belief in why Australia needs to deploy a full fibre-to-the-premises (FttP) National Broadband Network (NBN) across the country is telehealth. However, in a panel session that should give FttP proponents nightmares, a quartet of health experts have identified the issues with increasing the use of telehealth as being cultural and operational, not bound by the speed of a data connection.

Speaking at the Connect conference in Melbourne on Thursday, a panel consisting of professor Branko Celler, chief scientist at the CSIRO; Lyn Davies, managing director of Tunstall Healthcare; Stephen Leeder, professor of public health and community medicine, University of Sydney; and Dr Elaine Saunders, managing director, Blamey Saunders agreed that telehealth could start saving governments money today, if only the will existed to implement it.

"Telehealth is a solution, the technology is here, the patients have never been the problem ... but we have some quite overwhelming organisational, workplace culture issues that are really hard to overcome — plus the absence of a proper funding model to scale up nationally telehealth," said Celler.

The panel was in agreement that telehealth, if implemented properly, is not a technical issue, but one that changes the entire delivery method of health service.

"When you are looking at technologies most effectively to solve the health problems we have, that doesn't necessarily mean doing things the old way but with an internet connection," said Saunders. "It means that you've got the latitude to do things quite, quite differently. That means we need our leaders in government to be open to suggestions about solutions, not about specific products."

"I think the real barrier [to widespread telehealth adoption] is thinking about things in the old way," she said.

Without proper incentives and general practitioner engagement, Davies said that any telehealth program is doomed, and it isn't a cure-all for issues in the health sector.

"[Telehealth] is not the only answer, and everybody knows that we can't sustain the Medicare system by just adding more onto it," she said.

"We have to realise those cost savings, first in some ways, so it's the chicken and egg ... before telehealth has some mainstream capability."

Professor Leeder said it is important for Australia to realise that many aspects of telehealth are being done in other places around the world.

"My estimate is that we are 20 years behind," he said.

"The problems of connectivity of patients to their professional careers, whether they be 100 metres down the road or 1,000 kilometres away, have been dealt with.

"You don't need a whole bunch of new technology to do that, it's there, it's working ... it's a question of implementing it."

Leeder said successful enterprises spend as much on change management as they do on IT hardware and software, and that was what changed the mind of every stakeholder in the health sector.

"It's got to be done sensibly, carefully, thoroughly, and professionally — otherwise, the IT device is not worth it."

For places where IT is needed immediately in health delivery, Leeder listed three areas where IT could help: Medical research; using big data to predict health issues, rather than explain what has already happened; and using IT in the clinical care of patients.

"We've mastered the art of providing health care using pieces of paper and telephones and ignoring IT — it's unbelievable," he said.

"All we need is the money to do it. My proposition is this country be contemplating the next big IT spend, equivalent to what we put into the NBN, on health IT."

Topics: NBN, Government AU, Health


Chris started his journalistic adventure in 2006 as the Editor of Builder AU after originally joining CBS as a programmer. After a Canadian sojourn, he returned in 2011 as the Editor of TechRepublic Australia, and is now the Australian Editor of ZDNet.

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  • Fibre Not Required?

    In that case perhaps we can get Telstra to replace all the failing copper that presently struggles to connect or provide even audible voice traffic when calling 000 during wet weather?
    Not to mention that long term it will cost even more than doing it properly in the first place with cheaper, reliable, future proof, low maintenance fibre.
  • It is the Quality of Service needed for Telehealth that is the issue

    Any copper network, where you are doing things that the copper was never designed for, and
    is in a significantly bad state, will never provide the required relibility.

    My ADSL2+ connection drops off up to 37 times a day. Just started monitoring it because it was so bad.

    My speed drops from 19,511 kbps to 1500 kbps. That is down to less than 10%, and re-transmission go through the roof decreasing speed further.

    You can not base anything with this inherent reliability of our copper network on anything that needs
    reliability, you would obviously provide a 3G or 4G backup, but this adds cost and complexity, Bill shock.

    The most critical time, during natural disasters, floods etc, the node cabinets will likely fail, or the power will fail. Fibre nodes have no power requirement and being purely optical will likely keep working, or return to service themselves or will little effort and cost.

    Replacing 1000's of nodes during a flood is going to be costly.

    The power requirement for the 60,000 estimated nodes and the power for all the modems in houses will easily be over $10 billion per decade, Fibre has maybe $120 Million for the home equipment only per decade.

    So these assumptions are only a subset of the real issues.
  • Only 5% of medical consultations are eligible for Medicare.....

    Over at gp2u we deliver more telehealth than anyone in the country, so this is my special subject. Here are a few brief comments:


    The current copper network is very marginally adequate, but what we need first is better backbone rather than fibre to home. Copper for the last X m is a perfectly viable solution, that can deliver results in the sort term.

    We run copper from the MTU in the basement and the reality is that almost all end users will run copper from the fibre endpoint to their devices. The key bit is to recognise that the fibre termination endpoint does not need to be in the premises for the system to work, and work well.

    The delivered speed depends on choke points. If you distribute your connectivity by wireless you have installed the choke point. If you have enough length of copper that will be where it is, but once you get past that you hit the backbone and that is the first place attention should be directed.


    We have had the NBN outside our door for a year, but can't get connected because we are in what the NBN call a multi tennancy unit, that would be an office building to the rest of us.


    When the Federal government talks about their desire for Telehealth it is worth reflecting on the fact that out of the 130 million Medicare funded medical consults that occur in Australia each year less than 7 million are eligible for Medicare funding if delivered by Telehealth.

    Or to put it another way Medicare currently says 95% of all medical consults can't be delivered by Telehealth.
    Dr James Freeman
    • Adequate? Only in some places

      Copper is unreliable. It is subject to corrosion and fails due to water ingress. This is all a totally irrelevant point anyway. The copper network is in many places in need of replacement for the last leg to the customer, either in premises or between the premises and where the node will be or both.

      The saving in using copper is in using what is there - in which case if the copper needs replacing the saving doessn't exist.

      Copper from the basement in an MDU is a completely different issue to copper to a house. To pretend they are the same issue is disingenuous.

      I have also run copper in an MDU situation for providing internet and other services. I did this about 10 years ago. To hear this sort of installation misused to pretend that a phone line is a high speed netowrk cable is galling to say the least. Different conditions, different cable, 4 wire not 2 etc.

      You can't get NBN cause you are in an MDU? Well every talked to an MDU resident who can't get HFC?

      Or maybe talk to an MDU resident who can't get decent ADSL where those around him can?

      MDUs are a problem for a multitude of reasons. Using existing copper in an MDU is often not possible. Running any kind of new cabilng in an MDU can be a nightmare for tecnhical or for reasons of gaining access to common property. Optus won't touch MDUs for HFC to run the copper.

      So many years of this debate and it's still full of misinfo and spin.