NACCHO Aboriginal #EyeHealth : 10 Recommendations to improve eye health services in remote Aboriginal communities.

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” According to data from the 2016 National Eye Health Survey (NEHS), Aboriginal and Torres Strait Islander adults have a greater burden of eye disease, with three times the rate of blindness and three times the rate of vision loss than the non-Indigenous population.[1] Uncorrected refractive error causes almost two thirds of vision impairment, and cataract is the leading cause of blindness among Aboriginal and Torres Strait Islander people.

Vision 2020 Australia welcomes the opportunity to provide comment to the Productivity Commission (the Commission) regarding its Inquiry into introducing competition and informed user choice into human services (the Inquiry).

Download this full submission here :

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Vision 2020 Australia’s response to the Inquiry predominantly relates to improving outcomes in relation to eye health services provided in remote Aboriginal and Torres Strait Islander communities.

Additionally, almost 40 per cent of Aboriginal and Torres Strait Islander people who need cataract surgery have not accessed specialised treatment services (compared to 13 per cent of non-Indigenous Australians), and approximately half of Aboriginal and Torres Strait Islander participants with diabetes were found not to be having an eye examination at the frequency recommended by the National Health and Medical Research Council (NHMRC).

The eye health and vision care sector supports the principle put forward by the Australian Government that refers to introducing informed user choice in these communities. However, the sector has identified a number of challenges posed by the principle of introducing competition in the provision of eye health services in remote communities; due to issues such as the fragmented or duplicated delivery of these services.

In the following submission, Vision 2020 Australia outlines ten recommendations which, if implemented fully, would ensure that eye health and vision care outcomes for Aboriginal and Torres Strait Islander people are improved through better access to effective and reliable services.

Note all 10 recommendation are in this submissions

Recommendation 8

That ACCHOs are offered fair opportunities to compete with non-Indigenous health organisations during competitive tendering processes.

Vision 2020 Australia notes that, in the context of eye health in remote Aboriginal and Torres Strait Islander communities, reforms intended to introduce greater user choice and competition do not necessarily result in positive outcomes. For example, in remote areas, increased competition when providing outreach services can in some cases lead to fragmented service coordination. Vision 2020 Australia therefore contends that mechanisms and approaches to introduce greater competition, contestability and user choice need to be carefully considered.

In remote Aboriginal and Torres Strait Islander communities delivering services collaboratively and in partnership with ACCHOs, and ensuring that the communities are consulted and involved in the design of policies and programs that impact them, is integral.

Furthermore, Vision 2020 Australia notes that the 2015 Senate Finance and Public Administration References Committee inquiry into the impact on service quality, efficiency and sustainability of the Commonwealth Indigenous Advancement Strategy tendering found that competitive tender processes disadvantage ACCHOs and do not fully take into account their value and expertise.[1] It is therefore vital that Aboriginal and Torres Strait Islander organisations are offered fair opportunities to compete with non-Indigenous organisations.

[1] “Commonwealth Indigenous Advancement Strategy tendering processes,” Parliament of Australia, accessed February 14, 2017. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Finance_and_Public_Administration/Commonwealth_Indigenous.

Vision 2020 Australia

Vision 2020 Australia is the peak body for the eye health and vision care sector, representing around 50 member organisations involved in: local and global eye care; health promotion; low vision support; vision rehabilitation; eye research; professional assistance and community support.

This submission has been developed in collaboration with the Vision 2020 Australia Aboriginal and Torres Strait Islander Committee (the Committee).

The Committee provides a platform for members to collaborate and shape the direction of Vision 2020 Australia’s systemic advocacy related to Aboriginal and Torres Strait Islander eye health and vision care.

The Committee supports and promotes The Roadmap to Close the Gap for Vision (the Roadmap), developed by Indigenous Eye Health at the University of Melbourne, and works closely with the National Aboriginal and Community Controlled Health Organisation (NACCHO) and its affiliates to ensure its strategies are consistent with priorities identified by Aboriginal Medical Services providers in States and Territories.[2]

Vision 2020 Australia supports the submissions put forward by our member organisations, namely Indigenous Eye Health and The Fred Hollows Foundation.

Vision 2020 Australia notes that, in the context of eye health in remote Aboriginal and Torres Strait Islander communities, reforms intended to introduce greater user choice and competition do not necessarily result in positive outcomes

. For example, in remote areas, increased competition when providing outreach services can in some cases lead to fragmented service coordination. Vision 2020 Australia therefore contends that mechanisms and approaches to introduce greater competition, contestability and user choice need to be carefully considered.

In remote Aboriginal and Torres Strait Islander communities delivering services collaboratively and in partnership with ACCHOs, and ensuring that the communities are consulted and involved in the design of policies and programs that impact them, is integral.

Furthermore, Vision 2020 Australia notes that the 2015 Senate Finance and Public Administration References Committee inquiry into the impact on service quality, efficiency and sustainability of the Commonwealth Indigenous Advancement Strategy tendering found that competitive tender processes disadvantage ACCHOs and do not fully take into account their value and expertise.[1] It is therefore vital that Aboriginal and Torres Strait Islander organisations are offered fair opportunities to compete with non-Indigenous organisations.

[1] “Commonwealth Indigenous Advancement Strategy tendering processes,” Parliament of Australia, accessed February 14, 2017. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Finance_and_Public_Administration/Commonwealth_Indigenous.

Summary of recommendations

Vision 2020 Australia has ten recommendations which, if implemented fully, would ensure that eye health and vision care outcomes for Aboriginal and Torres Strait Islander people are improved through the provision of better access to effective and reliable services.

Recommendation 1
That the Australian Government allocates additional funding to address existing barriers to accessing specialist eye health services in rural and remote areas.
Recommendation 2
That the Australian Government undertakes capacity building for ophthalmic telehealth services.
Recommendation 3
That the Australian Government modifies existing IT infrastructure in remote facilities catering to Aboriginal and Torres Strait Islander health to facilitate efficient and effective telehealth services.
Recommendation 4
That the Australian Government facilitates the introduction of electronic patient record systems targeted for use in remote Aboriginal and Torres Strait Islander communities, with linkages to the broader health system.
Recommendation 5
That the Australian Government provides funding for additional staff trained in the provision of eye health services for remote Aboriginal and Torres Strait Islander communities.
Recommendation 6
That the Australian Government regularly reviews and provides ongoing funding to the Visiting Optometrists Scheme (VOS).
Recommendation 7
That Aboriginal Community Controlled Health Organisations (ACCHOs) and Aboriginal and Torres Strait Islander communities are consulted and involved in the design of policies and programs that impact them.
Recommendation 8
That ACCHOs are offered fair opportunities to compete with non-Indigenous health organisations during competitive tendering processes.
Recommendation 9
That governments ensure that the Aboriginal community controlled sector is a key player in the delivery of culturally safe health services.
Recommendation 10
That services provided to remote Aboriginal and Torres Strait Islander communities are integrated and coordinated so as to ensure an effective patient pathway where comorbidities can be effectively assessed and treated.

 

[1] Foreman, J., et al, 2016, The National Eye Health Survey Report 2016, The Centre for Eye Research Australia and Vision 2020 Australia, Melbourne.

[2] Taylor HR, Anjou MD, Boudville AI, McNeil RJ, 2013, The Roadmap to Close the Gap for Vision, Indigenous Eye Health Unit, Melbourne School of Population Health,The University of Melbourne

NACCHO Aboriginal Eye Health Survey : Fred Hollows Foundation’s Indigenous Australia Program (IAP)

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The Fred Hollows Foundation’s Indigenous Australia Program (IAP) is conducting a survey of our partners.

As a valued partner of the IAP , we are keen to understand your views and use these to help us improve.

Completing the survey will take approximately 10 – 15 minutes. The survey is confidential and responses will not be attributed to any individual or organisation.

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The survey is open from Wednesday the 14th of November  to Wednesday the 30th of November 2016.

GO TO SURVEY

The survey consists of four short sections:

  • Section 1 asks you about your relationship with the IAP
  • Section 2 focuses on the IAP’s guiding principles
  • Section 3 asks you about our partnership approach
  • Section 4 focuses on our organisation, processes and people

Your input will be collated in a way that guarantees the anonymity of your responses. The results will help inform the IAP’s continuous improvement process. Depending on the feedback we receive, we expect to make specific program improvements and/or guide specific advocacy messages. Key survey results and how the IAP plans to address them will be disseminated to partners via email early next year.

Please contact myself jbarton@hollows.org  or Alison Rogers arogers@hollows.org if you have any questions.

Completing this survey can helps us make a positive impact on how the IAP works to increase access to eye health services for Aboriginal and Torres Strait Islander Australians.

GO TO SURVEY

Your participation is greatly appreciated.

Kind Regards,

Jaki Adams-Barton

Manager, Indigenous Australia Program | The Fred Hollows Foundation

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NACCHO #WorldDiabetesDay and Aboriginal Health : ACCHO Members IUIH and Apunipima have #EyesonDiabetes

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Type 2 diabetes affects Aboriginal and Torres Strait Islander communities around three times as much as non-indigenous Australians – they also suffer from more complications and are more likely to die as a result of the condition.

By empowering and inspiring people to take control of their own health via creative and innovative ways such as the CGMS system, we can help reduce the toll of this disease on Aboriginal and Torres Strait Islander people.

‘When you screen, people can find out if they are heading towards diabetes and can take steps to prevent it.  Screening can help identify diabetes early and help prevent complications. It is also an important management strategy to maintain good diabetes control.’

This year’s World Diabetes Day theme is Keep Your Eyes on Diabetes – a sentiment echoed Apunipima’s diabetes team on Cape York

 ” We know that untreated eye disease is a key contributor to preventable blindness among our community and is often caused by other diseases that affect our people such as diabetes and hypertension.

This campaign implemented by the Institute for Urban Indigenous Health (IUIH) with funding from The Fred Hollows Foundation will see more people checking in with our optometrists on a regular basis, so we can pick up and treat these diseases early, and close the gap in health outcomes in our community.”

IUIH Chief Executive Officer Adrian Carson says that the program will improve access to preventative eye health services and reduce rates of eye disease : See story 2 Below

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To support World Diabetes Day (November 14)  Apunipima’s Diabetes Educators-  Bernadette Heenan and Cathryn Dowey – presented  at the Lowitja Institute International Indigenous Health and Wellbeing Conference on the benefits of continual glucose monitoring technology (CGMS) which allows Type 2 diabetes clients to ‘see’ when their blood sugar levels change and then alter their behaviour accordingly.

The team (which also includes Diabetes Educator Maureen Toner) is seeing health improvements among their clients thanks to their innovative approach

‘Continuous glucose monitoring involves the person with the disease, enabling them to see (via graphs) what causes their blood sugar to spike beyond a healthy rate,’ said Bernadette.

‘Giving people the power to see what behaviours impact their blood sugar levels gives them the information they need to make healthier choices – we are all about building capacity and supporting the person to make changes that are right for them and their families.’

While this process makes a difference to those suffering from the disease, there is a lot that can be done to prevent people getting diabetes in the first place.

For every person who is diagnosed with diabetes there is one undiagnosed. So the theme this year is screening.

‘When you screen, people can find out if they are heading towards diabetes and can take steps to prevent it.  Screening can help identify diabetes early and help prevent complications. It is also an important management strategy to maintain good diabetes control.’

‘If you are of Aboriginal and Torres Strait Islander descent you are automatically in higher risk category for developing Type 2 diabetes. If you live remotely your chances of developing Type 2 diabetes go up again. It is vital that everyone in remote Cape York communities, kids, pregnant women, everyone get regularly screened.’

‘Getting in early means the disease and impacts – such as amputation, blindness and kidney failure

– can be prevented or managed.’

Eye health targeted in ‘Deadly Urban Eyes’ campaign

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On 21 September, The Fred Hollows Foundation Founding Director Gabi Hollows launched a campaign to reduce rates of untreated eye disease among Aboriginal and Torres Strait Islander people living in South East Queensland.

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Picture above : At the launch IUIH CEO Adrian Carson welcomed Gabi and Jaki to the Deadly Choices team by presenting them with a personalised Deadly Choices shirt with The Fred Hollows Foundation featured in the design saying, “We all know how deadly you have to be to get a deadly choices shirt.”

The campaign encourages community members to have regular eye health checks at their local Aboriginal Medical Service. The initiative is being implemented by the Institute for Urban Indigenous Health (IUIH) with funding from The Fred Hollows Foundation, and builds on their existing partnership across the region.

The initiative adds a new dimension to the hugely successful Deadly Choices social marketing campaign which has seen an average 50% year-on-year increase in the number of preventative health checks performed at IUIH’s 18 member clinics across South East Queensland.

Regular eye health checks play an important role in reducing the rate of untreated eye diseases such as cataract, glaucoma, trachoma, diabetic retinopathy and macular degeneration. People who have their eyes checked as part of the initiative will receive a Deadly Eyes gift pack, including sunglasses, lens cloth and spray, as an incentive.

IUIH Chief Executive Officer Adrian Carson says that the program will improve access to preventative eye health services and reduce rates of eye disease. “Both IUIH and The Fred Hollows Foundation are committed to ensuring that all Aboriginal and Torres Strait Islander peoples can access quality eye health services,” he said.

“We have significantly expanded our frontline eye health services over the past year so that they are now fully integrated across our 18 IUIH member clinics across South East Queensland. Integration of these services into the IUIH Model of Care means we are connected to community and able to refer quickly to specialist services if and when they are needed.”

According to Ms Hollows, the partnership is a successful model for bringing eye health care to communities in South East Queensland, “The Deadly Urban Eyes campaign is a great program that will make a difference in the vital eye health care sector,” she said.

The Foundation’s Indigenous Australia Program Manager, Jaki Adams-Barton, said the Deadly Choices Eye Check for South East Queensland was an important component of the work The Fred Hollows Foundation is doing Australia-wide, “Our program focuses on reducing rates of cataracts, diabetic retinopathy uncorrected refractive error and trachoma in Aboriginal and Torres Strait Islander communities. Getting your eyes checked regularly is key given 94% of vision loss for Aboriginal and Torres Strait Islanders is preventable or treatable if caught early,” said Jaki.

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NACCHO Eye Health News : Fred Hollows Foundation partners with Aboriginal community Controlled Health sector for workforce initiative

TFHF Cadetship_L-R Brian Doolan (TFHF) John Brumby (TFHF) Lauren Hutchinson (student) Gabi Hollows (TFHF) Adrian Carson (IUIH)

We know that 94 per cent of vision loss among Aboriginal and Torres Strait Islander people is preventable or treatable, yet more than one-third of adults have never had an eye exam,

“We think having Aboriginal and Torres Strait Islander people as health professionals will reduce this figure – there really is a point of difference when it’s an Aboriginal or Torres Strait Islander person looking at your eyes, or taking care of your health,”

Jaki Adams-Barton, Manager of the Indigenous Australia Program at The Fred Hollows Foundation, said the new Workforce Initiative is key to filling the gap for Aboriginal health professionals in eye heath

“We have a great team here at IUIH and Lauren will have the ability to connect with a number of health professionals, giving her a more holistic look at the patient journey. She will experience first-hand the eye health conditions that affect our people here in south-east Queensland, including the huge impact diabetes is having on the eyes,”

Adrian Carson, CEO, Institute of Urban Indigenous Health, says Lauren will be able to expand her clinical knowledge during her time with the organisation.

A new $40,000 partnership between The Fred Hollows Foundation and the Institute for Urban Indigenous Health (IUIH) will provide optometry student Lauren Hutchinson with hands-on experience in communities in Brisbane in October, and the chance to visit rural communities in south east Queensland later on.

Photo caption: L-R: Brian Doolan (CEO, The Fred Hollows Foundation), John Brumby (Chair of Board, TFHF), Lauren Hutchinson (student), Gabi Hollows (Board Member, TFHF), Adrian Carson (CEO, IUIH)

Ms Hutchinson holds a Bachelor in Visual Science and is a Masters student in optometry at the Queensland University of Technology. A Wiradjuri woman, she was born in Molong NSW and attended St Joseph’s Primary School and Molong Central School (for High School).

Ms Hutchinson will spend three months training with the Aboriginal Community Controlled Health sector, learning on-the-job and through mentoring with the IUIH Regional Eye Health Unit and optometry clinics, as part of a team working in a multidisciplinary Aboriginal and Torres Strait Islander health organisation.

Optometry is a great career that can really make a difference to people’s lives, Ms Hutchinson said. “I’m really looking forward to working with IUIH. It will be such an invaluable opportunity to get some practical experience working with people in their local areas, as well as chance to work alongside some of the leading professionals in Indigenous eye health,” she said.

The Workforce Initiative will support practical placement across the IUIH’s 17 eye health clinics in optometry services and the ophthalmology clinic. As part of the program, Ms Hutchinson will learn about service delivery in rural and remote parts of Queensland.

 

NACCHO Eye health news: LOOKING GOOD:Puppet film promotes eye health in remote in Aboriginal communities

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A short film starring Aboriginal puppets will be distributed to remote communities across Australia to educate locals about the importance of getting their eyes checked.

Looking Good tells a humorous story about one boy’s journey to help his grandmother on her quest to see clearly. It was produced by Rebel Films in collaboration with The Fred Hollows Foundation and the Anyinginyi Health Aboriginal Corporation,

Maree O’Hara, Eye Health Coordinator with Anyinginyi, says that the DVD production is a new and unique way to communicate important eye health messages to adults and children in remote communities.

“Aboriginal and Torres Strait Islanders have up to six times the rate of vision loss compared to other Australians – and many of those most badly affected live in regional and remote communities,” Ms O’Hara says.

“Whether it’s because you need a simple pair of glasses, or you need an operation to reverse a blinding condition like cataract, the most important message is that if people value their sight, their quality of life can improve.”

“Everyone should also know that if you have a problem with your eyes, more often than not, you’ll be able to treat that problem – and there are people out there who can help.”

Anyinginyi’s original idea to create a DVD became a reality through the support of The Fred Hollows Foundation, who continue to work with local Indigenous organisations to improve Indigenous eye health. Rebel Films was engaged to produce, write and direct the film as they have experience, expertise and a proven track record producing culturally appropriate health education audiovisual material.

The film was shot in Elliott, in the Northern Territory, to ensure it accurately reflected community life and local community members voiced the puppet characters.

Ms O’Hara is confident that Looking Good will encourage more people to visit the health clinic and get their eyes checked.

“We’ve already shown the film in the community and the reaction we got to it was really positive. It’s a good laugh, but above all else it created a dialogue between grandparents, parents and their kids around just how important this issue is.”

The DVD will be distributed to Aboriginal controlled health centres, health services and communities across remote Australia.

If you’d like a copy of the Looking Good DVD please contact

Alison Rogers at arogers@hollows.org by phone 08 8920 1406.

Telehealth initiative that will help remote communities in the NT get better access to healthcare.

Healthier future for remote Northern Territory communities

Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, today launched a telehealth initiative that will help remote communities in the Northern Territory get better access to healthcare.

The Health eTowns TelehealthNT Network project is jointly funded by the Commonwealth and Northern Territory Governments and is part of a $20 million Digital Regions Initiative that will:

  • improve the delivery of health and education services to people in 47 remote towns in the Northern Territory;
  • provide telehealth services to emergency rooms and resuscitation areas in Northern Territory regional hospitals and 17 Territory Growth Towns; and
  • allow doctors based in Darwin to examine, talk to, and diagnose patients in remote areas through the use of high-definition Medicarts and room-based units.

“Telehealth has the potential to save lives. Through high-speed broadband, people in remote areas can get speedy healthcare and clinical attention when they need it. It also removes the burden of travel, helping patients stay in their communities and potentially recover faster”, Senator Conroy said

“Interactive online education and training programs have also been implemented to give students and trainees access to mainstream health education programs that are currently only available to students in larger cities.

“The Health eTowns initiative will help close the healthcare and education gap experienced by remote communities in the Northern Territory”, Senator Conroy said.

Minister for Indigenous Health and Member for Lingiari, Warren Snowdon, said the investment in high-speed broadband will improve access to necessary health care for many remote and Aboriginal communities across the Territory.

“Thousands of people live in remote communities and through telehealth services, like Health eTowns, they will be able to access better care, specialists and more health information closer to home.

“This technology will be a great weight off the mind of many people across the Territory, who know that at times seeing the right doctor at the right time can be difficult. Telehealth means that a consultation, a check-up or out-patient follow up is only a video call away”, Mr Snowdon said.

Minister Vatskalis said the implementation of the Health eTowns project is boosting innovation in healthcare by enabling specialist services.

“I am pleased that since the project started  in 2010, the Australian Government and the Northern Territory Government have boosted their contributions so services can be expanded beyond the initial target of 17 Territory Growth Towns into a further 30 remote communities in the Northern Territory”, Minister Vatskalis said. 

This additional funding is also being used to develop a telehealth connection service. This will make it easier for the states and territories to work together on telehealth, helping them share relevant health information and improve health services.

The Australian Government is co-funding a further 13 projects and three NBN-enabled trials across Australia through the $60 million Digital Regions Initiative. Details can be found at: www.dbcde.gov.au/digitalregions

Joint media release

Senator the Hon Stephen Conroy
Minister for Broadband, Communications and the Digital Economy
Deputy Leader of the Government in the Senate
Minister Assisting the Prime Minister on Digital Productivity

The Hon Warren Snowdon MP
Minister for Indigenous Health
Federal Member for Lingiari

The Hon Kon Vatskalis MLA
Minister for Health
Northern Territory Government

Date: 31 July 2012

Contact:

Adam Sims (Senator Conroy)

0408 258 457

Marcus Butler (Minister Snowdon)

0417 917 796

Maria Billias (Minister Vatskalis)

0411 119 746

Tele-eye health teams up with EHRs for diabetes-related blindness in Aboriginal communities

The University of Melbourne and the Fred Hollows Foundation have launched a $3 million partnership to introduce low-cost eye exams for indigenous Australians using proven telehealth technologies and protocols.

The Telehealth Eye and Associated Medical Services network (TEAMSnet) aims to increase the access of people with diabetes to appropriate eye care to reduce the risk of vision loss and blindness and to improve care for people in remote areas of Australia who are living with other chronic conditions such as heart disease.

While there are several other pilot projects aiming to do similar work, what this program will include is a clinically validated protocol with quality assurance that has proven to work not just for diabetes-related blindness but for age-related macular degeneration, hypertensive retinopathy and glaucoma, according to the project’s lead, Sven-Erik Bursell.

It will also use Associate Professor Bursell’s Chronic Disease Management Program (CDMP), an open source software program that actively incorporates eye care management into mainstream chronic disease management functions such as electronic clinical decision support, risk assessments, collaborative care planning, nutrition counselling and physical activity coaching.

The software can operate in a mobile health environment using CDMP’s patient portal, and the team is in discussions with Communicare, the WA-based clinical software vendor that specialises in Aboriginal healthcare and which was recently acquired by DCA, to set up an interface between Communicare’s electronic health record and CDMP.

A/Prof Bursell heads the Diabetes Telehealth Program at the Telehealth Research Institute, part of the John A. Burns School of Medicine at the University of Hawaii. He also has a faculty appointment as associate professor at the University of Melbourne and will later this year come to Australia to run the program on a permanent basis.

A/Prof Bursell has been involved in telehealth from its earliest days in the US and started a telehealth program for eye care in Native Americans in 1997. His team at the Telehealth Research Institute has a long-standing collaboration with the US Indian Health Service (IHS), which runs a federal health program for American Indians and Native Alaskans.

Called the Joslin Vision Network tele-ophthalmology program and run by Mark Horton, this program has been providing telehealth-enabled eye care to people living in remote areas of the US since 2000. A/Prof Bursell said that over the past four years, 21,000 telemedicine eye exams have been conducted in 17 US states, which has led to a 51 per cent increase in laser treatments to prevent blindness. The results of the program have revealed that this approach cost less and saves significantly more sight than traditional eye care services, he said.

Native Americans have similar problems to indigenous Australians in both a high prevalence of diabetes and heart disease and in geographic remoteness. The Navajo people, for example, have a population of over 210,000 spread over an area of seven million hectares, and one community of American Indians lives at the bottom of the Grand Canyon, accessible only by helicopter.

“The crazy thing is, especially for preventable blindness and diabetes, across the US and also in Australia only 50 per cent of people with diabetes are getting appropriate eye care,” he said. “Diabetes is still the leading cause of adult new blindness today despite the fact that you have an incredibly effective clinical process for preventing blindness, which is pan-retinal photocoagulation, which reduces the risk of vision loss to less than five per cent.

“Diabetes should not be a leading cause of new blindness today, and the use of telehealth really is something that can break that logistic logjam of patients getting to see specialty care at the right time.”

One of the major problems with diabetic retinopathy is that vision loss is asymptomatic, with patients seeing perfectly well until they suddenly go blind. There is no gradual progression of vision loss, so patients are very reluctant to see an eye specialist and undergo uncomfortable procedures such as eye dilation.

“With telehealth, we don’t use bright lights, we don’t have them dilate their pupils, it takes about 10 minutes to get their eyes done, and boom they are out of there,” he said. “They have their bloods drawn, they have their eye images done.”

As part of TEAMSnet project, non-mydriatic retinal cameras will be purchased and sent to participating communities, with Aboriginal health workers taking the images. These will be sent via a secure virtual private network to a team of trained readers at the Centre for Eye Research in Melbourne, who will do a retinal assessment and relay an encrypted PDF report back to the originating site.

“They open it up and the GP or the nurse practitioner has a look at the report and makes the final decision on how to manage that patient, whether they need to be referred to eye care or whether they are doing fine and they just need to come back next year,” A/Prof Bursell said.

One of the benefits for community health centres is cost avoidance. “You don’t have to send every person with diabetes to see an ophthalmologist every year as defined by best practice guidelines, yet at the same time we are sending more people to the ophthalmologist who actually need their care, and we are not clogging up the ophthalmologist’s schedule with people who are doing fine. The wait times for specialty care are then reduced.”

The technology is reasonably simple and there are other projects underway, such as the Remote-i tele-ophthalmology trial being run by the Australian eHealth Research Centre at the University of Queensland, but for A/Prof Bursell, the difference is the clinically validated protocol and the open source, license-free, software for chronic disease management that he will be bringing.

“The real issue that we face with anything in telehealth, be it tele-ophthalmology or tele-dermatology, is that you need to have a clinically validated protocol with quality assurance to support it on the back-end,” he said. “That’s what we have. It is a clinically validated protocol, not only for diabetic retinopathy but for other ocular diseases like age-related macular degeneration, hypertensive retinopathy, glaucoma – we cover the whole gamut.

“The way I look at this is that we use the eye imaging as a foot in the door. It is a very powerful education moment. For the first time, the patient is actually seeing pictures of their own eye on the screen, so our Aboriginal health workers are trained to talk to the patient and discuss with them healthy lifestyles, good eating, good exercise, managing your blood glucose – all of that good stuff, to help them better manage their own diabetes.”

CDMP, which A/Prof Bursell developed himself, will help Aboriginal health workers within the community to manage patients both for cardiovascular disease and diabetes. The CDMP can be integrated with electronic health records to provide a large amount of new data that normally can’t be captured on an EHR.

“Your traditional electronic health record systems have nowhere to put that home or remote monitoring data,” he said. “This is not certified laboratory data – this is a patient saying ‘gee I feel crook today’. There is no way they can put that in a longitudinal health record and if they want to do it, it costs too much money and [the vendors] are just not going to do it.

“The advantage is that Communicare is a small EHR so you’re not going through a whole load of administrative functions just to get to the right person. Something like the CDMP actually provides value because it augments the function of the electronic health record, which is really procedure-based rather than outcome-based.”

A/Prof Bursell believes that where telehealth can really make an impact is in being able to facilitate a move to value-based healthcare. “We can provide the disease registries for all of these different conditions because we are monitoring from the home and in the community. We collect a lot of that information that can be used to assign value to improving clinical outcomes.

“It is not just that the patient does better with their medications – why does the patient do better with their medication? You can start characterising patient populations and medications and symptomology, and figure out what the best way of doing things is.”

The program will initially be trialled in four communities in the Northern Territory, with the hope of rolling it out to more. The TEAMSnet team is currently selecting the sites, after which ethics approval will be sought at each individual community.

“We’ll set the model and this is both the model in the healthcare service delivery as well as the model in data sharing and the model in quality assurance and the model in setting up appropriate referrals to speciality care,” he said. “Once you’ve got that set up, it becomes very easy to translate that model to another community or another hospital. The learning curve time is significantly decreased.”

The University of Melbourne and the Fred Hollows Foundation are working in collaboration with the Aboriginal Medical Services Alliance Northern Territory (AMSANT), the Centre for Eye Research Australia and the University of Sydney Clinical Trials Centre. The participating communities will also be partners in the program. Additional funding has come from the National Health and Medical Research Council.