Project for Rural Health Communication and Information Technology (PRHCIT)

Project Brief

Investigate the use of Technology for Education and Service Delivery in Rural Health Service

Project Team

• Australian Rural Health Research Institute
• Monash University School of Rural Health
• Queensland University of Technology
• Monash University Centre of Medical Informatics
• Campbell Research & Consulting

Funding

Australian Government Department of Human Services and Health

Further information

Below is a summary of the project proposal as accepted by the Australian Government Department of Human Services and Health. The final report Telehealth in Rural and Remote Australia is available on-line.

Project Summary

Introduction

On Friday, February 3, 1995, the Federal Health Minister Carmen Lawrence announced at the 3rd National Rural Health Conference, the commencement of a Project to Investigate the Use of Technology for Education and Service Delivery in Rural Health Service.

Two organisations, Australian Rural Health Research Institute (ARHRI) and Queensland University of Technology (QUT) were jointly appointed to provide the consultancy. The outcome of this joint project will be a comprehensive document that meets the aims of the project brief, based on the strengths in rural health and information technology of ARHRI complemented by with the strengths of education, communication technology and strategic planning offered by QUT.

Aims

This project was to:

• investigate the need for and use of interactive technology by health workers in rural and remote areas of Australia
• consolidate the experiences of a variety of Communication and Information Technology (CIT) projects and
• provide a framework and develop guidelines (including benchmarks) for future applications for CIT in rural and remote area health services.

Objectives

To produce a report that was to:

• describe aspects of rural and remote health practice which would be improved or enhanced by greater application of CIT. This includes both health service delivery and support, education and training of the rural health workforces;
• provide guidelines and a methodology for the future introduction of interactive technology for education and training of the rural health workforce, and for service delivery purposes over the next five years, outlining reasons why certain delivery options are chosen;
• review the technologies themselves and their possibilities, cost implications and likely near to medium term developments; detail the availability and effectiveness of existing medical and allied health education and training activities/programs/courseware for delivery via the various modes;
• provide an assessment of the existing level of access by health workers to communications and information technologies, with particular emphasis on the rural and remote areas;
• detail strategies for effective use of whatever level of access is available; detail the support infrastructures available for health workers at the local, state and national levels;
• identify the need for and level of training required for these technologies to be adopted and used efficiently. This covers issues of interface development as well as training structures that will work in a variety of settings;
• assess the potential for partnerships/strategic alliances of health education and services to share infrastructures with the tertiary sector, government agencies, commercial interests, business sector and across systems;
• detail current trends and their most likely development over the next five years;
• develop strategies for achieving that program, providing a framework for future orderly evaluation and implementation of CIT in rural and remote health service settings;
• and develop a framework for technology applications for health service delivery and options for public health surveillance.

Project Strategies and Methodology

A four part strategy, involving a number of different methodologies, is proposed to meet the aims of the project brief and the objectives detailed above. The first and second parts of the strategy will run concurrently.

1. Identifying the needs of Rural and Remote Health Workers

The key to the success of this proposal will be comprehensive, detailed and widespread consultation with health providers in all rural and remote areas of Australia to identify what they perceive their needs for CIT are, and therefore how these needs can, or cannot, be met. This will include health care providers with experience in using technology.

The following strategies are proposed to achieve the level of consultation required:

A. Qualitative and Quantitative Surveys of Rural Health Providers Extensive qualitative and quantitative research will be undertaken. Ramis Corporation (please note: this was later undertaken by Steven Campbell of Campbell Research & Consulting), which has extensive experience in conducting survey research, will undertake the survey work required. Five key categories of Rural and Remote Health Workers (medical practitioners, nurses, allied health workers, aboriginal health workers and health service executives) will be surveyed to identify major differences between these groups. The telephone survey should be no more than 15 minutes in length and there will be 5 open ended questions.

B. Direct consultation with key stakeholders. There will be consultation undertaken with key stakeholders identified by or from the relevant national bodies representing rural health workers and consumers - Rural Health Policy Forum, Rural Doctors Association of Australia (RDAA), Association for Australian Rural Nurse Inc. (AARN), Council for Remote Area Nurses of Australia (CRANA), the National Association of Community Controlled Health Organisations (NACCHO), the National Rural Health Alliance (NRHA) and the Australian Rural and Remote Allied Health Professionals Taskforce (ARRAHT), or its successor body. This process will be undertaken by the project team leaders and research assistants in association with the local nodes of ARHRI in Victoria, SA, NSW, SA, NT and WA. The resources of the QUT will be used in Queensland. In Tasmania, contact with key stakeholders will be coordinated by the Monash University School of Rural Health.

C. Use of CIT for and by rural health providers - Review and analysis of CIT needs of Rural Health Workers. A comprehensive review will be undertaken of all relevant existing Australian and overseas CIT projects to acquire data to develop both a national overview - ie State by State, and where appropriate a regional and local view, within States (eg North Queensland c/f South Queensland).

A functional view - ie the current access and use of CIT by rural health workers and the potential for how rural health workers desire to implement CIT in the future to meet their particular needs - will be developed from qualitative and quantitative surveys.

Establishment of a list server and a World Wide Web (WWW) site on AARNet (and Internet). This will enable the project team to solicit comments in a structured way from all interested parties on the use of technologies for health care workers in rural and remote areas. These facilities are planned to run for the duration of the project is proposed.

2. CIT Technology Review

The CIT process involves the gathering and analysis of information regarding the technologies themselves as well as reviewing the documented experiences to date both nationally and in the international community. The experiences of the users of CIT in the rural sector gathered under 'Review and analysis of CIT needs of Rural Health Workers' will undergo closer analysis with regard to the technologies themselves and the results of their use in rural or remote settings. A number of organisations that will be contacted during the above process have spent significant time and effort to date in examining and developing planning, implementation and evaluation structures for CIT in health care.

3. CIT Expert Panel

From the analyses of the data collection in the two components above, it is expected that it will be possible to identify the best technology options to suit various purposes and provide positive factors for strategic development and a migration pathway for standardisation to ensure interoperability at a national level, and provide an adequate level of service to the rural and remote areas. This may involve potential partnerships/strategic alliances with a range of stakeholders both within and outside the health sector. That is, once an infrastructure is in place, it can be used by any group. This makes it more viable in the first instance and provides avenues for cost efficiencies. An expert panel will be formed composed of project team members, auspiced by Monash Medical Informatics, and invited representatives from Industry, Government, Academic and Health sectors. A number of the organisations contacted to date who have agreed to participation in aspects of this process include:

• BHP IT
• Communications Engineering
• Telecom Research Laboratories
• Siemens Laboratories
• Menzies School of Health Sciences
• Monash University School of Rural Health
• Programs for Health Group Pty Ltd (Ex Nursing Solutions)
• Charles Sturt University, School of Environmental and Information Science

This panel will seek input from a number of individuals and organisations who have been undertaking significant work in specific technological areas (Eg satellite services, electronic communications via voice networks, HCN, rural communications etc). The outcomes of this panel will be incorporate the findings of the first two stages to form a cohesive fusion of CIT options/management with regard to user expectations and experiences.

4. Strategic Directions

The analysis of the results from the previous components will continue in terms of providing the basis of the strategic directions and final report. Client issues, including concerns, incentives and barriers relating to the adoption of new methods of learning and working will be outlined and strategies suggested for addressing these. The strategic directions will outline a vision, mission statement, goals, specific strategies and resources implications of these. Directions will be set for the short (one year), medium (two to five years) and long term horizons. The directions will also outline the following criteria for choosing delivery options: needs of the health care workers; the purpose and nature of the activity; the wishes/needs of the providers of education, training and services; and the feasibility of the options; desirable directions for interoperability of technology and economies of scale across regional boundaries. Resource implications will be outlined, including a number of optional scenarios. Further, the implications of the lack of action at the national level will be outlined.

Project Supervision

Day to day coordination, supervision of the project officers and implementation of the strategies will be the responsibility of the project team leaders. The Project Management Group will be responsible for ensuring the overall integration of the project. Membership of the group, in addition to the project leaders, will be:

• Patricia Buckley, Director, ARHRI
• Associate Professor Branko Cesnik, Director, Monash Medical Informatics
• Professor Pamela Bell, Chair, IT Standing Committee, ARHRI
• Ernst Van Oeveren, IT Coordinator, ARHRI

Dissemination of Results of the Project to Appropriate Target Groups

The presentation and dissemination of the final report will represent a significant marker in the development of policy for and implementation of CIT for rural and remote health workers in Australia. It would therefore be appropriate to ensure that the final report is made available to all the recognised key stakeholders, including those bodies, and by other methods of promotion, as listed below:

• RHSET,
• other interested government and professional bodies
• presentations to relevant conferences relating to Rural/Remote Health and Information Technology/Informatics
• publication of articles in relevant journals.

Evaluation/Quality Assurance

By working closely with the nominated steering committee, there will be an ongoing process of feedback and evaluation. A reporting process, regular and stepwise, is integral to the timeframe.

External evaluation will also be provided by the involvement of key stakeholder bodies and groups eg RDAA, AARN, CRANA, plus relevant communication and information technology organisations.