The Remote Outback Satellite Infrastructure Enablement for Health (ROSIE-eH) is a remote infrastructure initiative of the Kimberley Pilbara Medicare Local (KPML). AHCSA is collaborating with KPML to aid three of our member services who have expressed their intent to participate in the ROSIE project.
The problem is simply that internet based services (ehealth, PCEHR, telehealth) to improve access and service delivery of health and related care are only of any use if the providers actually have reliable access to the internet.
Experience is showing that “domestic grade” satellite connections (e.g. Broadband for Health) do not have sustainable viability for health critical applications, including the current NBN satellite option. Experience shows that commercial grade services are functional but very expensive, up to $1,600 per site per month, for a 10 site system $16,000 per month – $192,000 per annum; faster connections with access to greater bandwidth in the cities are about $7,200 per annum. MBS Item numbers payments are the same as in cities.
Input into the design and deployment of components of the ROSIE project has been provided by a number of ehealth and telehealth experts including:
a. Health services and clinical staff within the three communities of the Kakarrara Wilurrara Health Alliance (KWHA)
b. Medicare Locals covering predominantly remote outback areas,
c. Aboriginal Community Controlled Health Services’ communications infrastructure and telecoms experts,
d. GPs, Remote Area Nurses, Pharmacists, Allied, mental health and aged care providers,
e. St John’s Ambulance volunteers and
f. current and retired remote health service exponents.
Objective: enable cost viable access to commercial grade satellite internet connections for primary, allied, mental health and substance misuse services and aged care, delivered by non-government providers across remote WA, NT and SA. Any solution must be optionally extensible to remote Queensland, New South Wales and Victoria.
Filling a gap: ROSIE is being established for a limited time i.e. until the National Broadband Network (NBN) satellites are commissioned and appropriate Usage Plans are anticipated to be in place in 2015-16.
Ethic: participants in the ROSIE project are committed to connecting health and related services for people in Remote Outback areas, by using the internet to improve access to quality joined up health care in a timely manner. We are doing what we can for the patient/client to have the right information available, to the right provider, at the right place in a timely manner to provide continuity of care.
There is a collective push for action now to include remote service delivery locations in connected care networks, to end their isolation. A platform for change is required now there is a critical mass of expertise and commitment to “just do it”.
Coordination: ROSIE is a collaborative initiative that will be administered by the Kimberley Pilbara Medicare Local (KPML), with consultation and input from other collaborating organisations including Country North South Australia Medicare Local (CNSAML) and AHCSA.
Sponsorship: ROSIE-eH is sponsored by telecommunications, resource and related companies. The arrangement, accessing reserved bandwidth for the limited period, enables Network Plans to be offered with a 75% reduction in price. The value of the arrangement is up to $1,000,000 per annum.
The ROSIE project has secured partial funding from the Department of Health and Ageing, and the Australian Medicare Local Alliance. AHCSA would like to extend its thanks to CNSAML and NACCHO for partially funding the KWHA alliance communities.
Discounts: equipment suppliers are also supporting ROSIE. A shared procurement process is being established for standardised packages of components to assure consistent quality while minimising training and support costs.
Target beneficiaries are all residents, as well as fly-in, fly-out workers, travellers and tourists through:
1. General Practitioners;
2. Aboriginal Community Controlled and related health services including residential and respite aged care, substance misuse facilities and mental health/well-being services;
3. mine site, community and camp health and related services;
4. fly-in, fly-out health and related specialists;
5. community dialysis initiatives;
6. community-based palliative care;
7. volunteer emergency services;
8. emergency deployments e.g. infectious disease outbreak, suicide prevention.
a. National eHealth Record
b. secure medical messaging
c. clinical and allied health patient information systems
d. telehealth, telepsychiatry and video case conferencing
e. emergency triage
g. remote monitoring and
h. emerging technologies.
ROSIE will be made available to technology companies wishing to test internet enabled point-of-care equipment and procedures.
Quality of Service (QOS):A standard set of access and priority Policies will be loaded into the system management and QOS module based on Agreements that will be established to determine the priority for different applications and their use of the internet connection; non-business applications will be blocked during clinic business hours; other content e.g. movie streaming will be blocked 24/7. A Technical Team will determine the Policies.
Network Node Plan: a number of service provider locations will be connected over a symmetrical 2/2 Mbps (Megabits per second) link. A Node Plan will be tuned to obtain agreed practical performance metrics. When one Node is optimised another 2/2 Node will be established. Based on current systems in operation in the Kimberley and East Pilbara it is anticipated that a Node Plan will support 10-15 service provider locations (dishes). The service will not be data volume limited but will be speed limited depending on available bandwidth.
Dedicated telehealth connection: An additional video service is to enable participants to book one hour time slots for 1/1Mb dedicated links for telehealth, case and other video conferences.
Antenna and electronics: 1.8metre dishes with 4 watt BUC, LLM and LNB components, satellite modem, performance tuning module (SkyWire Imp) and system management and Quality of Service module (WatchGuard).
Additional costs: Transport, installation (including mounting pole or ground mount) and commissioning (locking onto the satellite) are separate costs and are not included in any of the other estimates.
Training and support: support will only be for the satellite connections, not any applications or uses of the connections. Application support for eHealth, telehealth etc. will continue being provided by methodologies currently in place (e.g. AHCSA eHealth team, ACCRM telehealth facilities, etc. )
KPML eHealth Cluster Hub members KPML, Northern Territory ML, Goldfields Midwest ML and South West ML
Partial funding from the Department of Health and Ageing, and the Australian Medicare Local Alliance.
Partial funding for KWHA members from CNSAML.
Thanks for private contributions from many individuals dedicated to equalising access to health
service availability for residents and visitors to Remote Outback Australia.
Note: There are opportunities for ROSIE-eH to impact on health service delivery in the context of the community at large in terms of jobs, demand at local stores, encouragement for education, environmental health. If sponsorship can be obtained it is proposed that a community internet might be made available outside the operating hours of health and related service providers.
The vision for ROSIE-eH is to provide part of the critical infrastructure for ehealth and telehealth required for inclusion of those living and working in or travelling through remote outback Australia. The aims are to improve access to services, service delivery and outcomes for patients/clients and reduce hospital Emergency Department presentations and general admissions as well as patient assisted transport. With this critical infrastructure in place there is the platform for better models of care enabling all health and related professionals to link the steps for the patient’s journey through internet-accessible shared patient/client records, including the PCEHR.