Guest Editorial

This edition of Healthcare and Informatics Review Online is dedicated to telehealth in New Zealand. There are clinical, administrative and educational applications for telehealth currently being used in New Zealand. A 2003 survey found 22 telehealth projects active in 2003 compared with 12 in 2000.^{[ 1 ]} A further survey undertaken earlier this year^{[ 2 ]} shows an increase in telehealth activities in New Zealand in the last 12 to 18 months, primarily due to the addition of new sites on the New Zealand Telepaediatric Services Network,^{[ 3 ]} increased uptake of its services (primarily educational), the outputs of the Mobile Surgical Services bus,^{[ 4 ]} and the efforts of the Mental Health Workforce Development Programme Telepsychiatry Project.^{[ 5 ]} the latter reported on in this edition. 

Teleradiology and telepsychiatry services in acute hospitals are the most popular clinical examples and telehealth applications have their highest concentration in the North Island around Auckland. Two articles in this edition highlight recent projects in these specialities.

Telehealth is viewed as one of several "delivery channels" for health services and has four independent infrastructure components:

• client provider and clinical services infrastructure. Includes referral nodes, range of clinical services, provider network, local community readiness, telehealth CME.
• governance infrastructure, including accountability, standards, leveraging other investments, strategic planning framework, policy framework, and evaluation framework. 
• management and operations infrastructure including financial management, scheduling/resource management, site facility administration, site coordination, management, marketing, promotion and 24/7 technical support
• technology infrastructure including architecture, broadband network, telecommunications network, security, hardware and software, maintenance and integration with electronic health records (EHR).

There are significant overlaps between these components and all need to be addressed coherently to ensure a high quality telehealth service is available and usable by the clinician and administrator. Professor Yellowlees provides us with an interesting overview of the challenges in developing a commercial telehealth product, including the above components. Products must evolve with the health sector and the IT market to meet constantly changing requirements.

It is acknowledged that secure broadband presents a significant opportunity to extend the reach of traditional health care capabilities and support the delivery of more equitable health care in remote communities by enabling a range of telehealth services. There are many Government projects under development that are aimed at using ICT to improve the delivery of government services to citizens, particularly in education, including PROBE (Provincial Broadband Extension Project) and the implementation of the Next Generation Internet . At present these projects do not specifically meet the needs of health, but may provide opportunities for expanding the geographical access to broadband networks thereby reducing the cost of access for the user organisation. The digital strategy from the Ministry of Economic Development discusses providing access to a minimum of 10mb broadband by 2008 for 95% of health and disability facilities. This would be more than adequate for the delivery of video-conferencing services.

Any telehealth delivery model should be "future-proofed", not only in terms of technology and network capability, but also to allow for integration with other health care and health information components such as clinical pathways, electronic health records, administration systems, provider qualifications and consumer information. This approach will support and complement the overall objectives of the Health Information Strategy for New Zealand (HIS-NZ) .

A key enabler will be establishing collective requirements on a national level across clinical services and then taking an aggregated approach to procurement of bandwidth, hardware and other resources common to all or most telehealth services. The networking aspects of any telehealth model and an aggregated approach to procurement will need to be developed in close collaboration with steps being taken within the National Connectivity Action Zone of HIS-NZ.

Given the considerable activity around ICT in the New Zealand health sector, it is not surprising that telehealth continues to increasingly be used as a tool to deliver health care services and professional education.

References

1. Kerr, K. Norris, T. 2004. A Review of Telehealth and its Relevance to New Zealand. ISBN 0-478-28229-X.
2. Kerr, P. 2005. Stocktake of Telehealth in New Zealand. Report for the Ministerial Telehealth Working Group.
3. New Zealand Telepediatrics Service
4. Mobile Surgical Services
5. Mental Health Workforce Development Programme