The CSIRO today released a paper called Caring for the last 3 per cent: telehealth potential broadband implications for remote Australia which is intended as a framework to help clinicians determine which telehealth applications can be safely deployed in which areas after giving due consideration to bandwidth and latency issues.
The key issue is latency. According to Dr Sarah Dods, research leader for health services at CSIRO, (pictured above) there is a latency of about a quarter of a second involved when using satellite enabled broadband services which was about the same as the human reaction time. This could make it challenging to achieve satisfying communications she said.
“If you have a deeply distressed patient in a tele-psychiatry session then a quarter of a second delay could cause harm,” she warned. In addition “You are not going to be doing telesurgery over satellites,” because of latency and bandwidth issues.
The report notes that by comparison; “Fibre and wireless broadband have latencies much smaller than human reaction times so latency does not pose a problem.” So a wide variety of telehealth services will be possible for the 97 per cent of Australians with fibre or wireless NBN connections.
According to Dr Dods; “People need to think from a clinical perspective about the purpose of the telehealth application,” before deploying it in remote Australia. While she said telehealth had a tremendous potential to deliver benefits, it was important to consider the broadband infrastructure that would underpin telehealth services before rolling them out.
The remote Australians who will be largely served by satellite communications are already struggling to access health services, and have a life expectancy four years lower than urban Australians according to Dr Dods. She said that around 600,000 Australians would under the NBN plans be served by satellites.
The challenge for health services she said was to determine; “How do we design services that are going to be satellite proof?” She said that there were many work-arounds which could allow a combination of on the ground services and telehealth services to be provided to remote areas.
Dr Dods said she had been involved in a trial in the Pilbara for example which had allowed people at risk of glaucoma or with diabetes to have a health professional perform tests and collect data, and then send that to a Perth based ophthalmologist, who could then review the information and provide expert advice back for the patient.
While it might not have been possible for the ophthalmologist to remotely collect the data themselves given network constraints, it was possible to have a “store-and-forward” approach that allowed information to be collected remotely, relayed over the internet and then analysed.