What are the factors that impede the uptake and acceptance of digital technologies for remote health service delivery? By David Murtagh, ACRRM Digital Health Team

Introduction 
With the COVID-19 Pandemic and the new Telehealth Medicare items designed to allow all doctors to deliver their services to remote and isolated patients via telehealth, there is an overwhelming body of evidence isolated people have benefited from Telehealth (references). Since the start of the pandemic until late 2020 the medical profession has, through Medicare, billed about 97% of Telehealth consults using the phone as versus videoconferencing. Over the March to June 2020 period, Polar primary health data from 1000 clinics in Victoria and New South Wales indicated COVID-19 Telehealth items represented 40% of MBS billed GP consultations with only 5% through video-based Telehealth (Pearce et al 2020). This represents a significant change in practice as a response to the pandemic. The approach to opening up Telehealth use in primary care has helped to protect the medical profession as well as the Australian population by enabling health service delivery to isolated people. This has demonstrated an effective method of augmenting healthcare delivery to remote Australian and should continue through supported developments, collaborations and skills improvement both for clinicians and patients. 

Background 
In remote Australia there are many known significant health issues that impact both the individual’s longevity and quality of life. There is a greater burden of disease including diabetes, heart disease, kidney failure, significant eye issues and a high number of hospital presentations through accidents. This contrasts with the metropolitan context where quality of life and life expectancy are higher. Ease of access to medical facilities and treatment is the difference between the two contexts. Many proposed solutions to address this difference in access include the use of communications technologies like telehealth. Research has demonstrated technology can play a significant role in addressing many of the health issues of remote communities (Edmunds et al, 2017; Bradford et al 2016; St Clair et al, 2018). However, there has been a clear lack of uptake of technology in the Australian remote health context.  

Barriers to the uptake of Telehealth in remote Australia are:  

- Telecommunications quality (insert references).  
- Affordable, easy to use and reliable videoconferencing software.  
- Capable clinical staff willing to embrace quality improvement in their work practice.  
- A viable business model that allows for the remuneration of these services.  

With demonstratable improvements in communications services to remote Australia and the world-wide experience of millions of COVID enforced Telehealth consultations creating changes driven by patient demand, Health Minister Hunt has recently confirmed the ongoing funding of Telehealth through Medicare. As a result, these additional questions have become a priority:  

1. Why is there only 3% of COVID MBS items billed for Videoconference based Telehealth?  
2. What are the change and quality improvement strategies needed to support videoconferencing for telehealth uptake?  
3. Can multidisciplinary collaborative advantage be achieved through the development of change processes, workforce support and technology development within and between health industry leadership organisations?