NBN Co needs to do more in the delivery of broadband services to the bush, especially as broadband shortfalls still massively limit the care rural patients receive, according to the Royal Flying Doctor Service of Australia CEO Dr Martin Laverty. 
Laverty told HITNA that whilst NBN Co and other platforms have broadband access in the bush and serve some areas, they “simply don't serve everywhere”.
“The perception is that, because we've got NBN, it works everywhere. You can’t just tie two tin cans together with a bit of string. Even satellite connections to the NBN are not yet reliable enough for our clinicians to have confidence in supervising patients or supervising other clinicians in the field from a base location,” he said. 
As the Royal Flying Doctor Service of Australia (RFDS) provides emergency and primary health care services for those living in rural, remote and regional areas of Australia, Laverty said a clinical-grade reliability of broadband is necessary for the organisation to properly utilise telehealth around the nation. 
RFDS currently uses broadband where available in country Australia for delivering telehealth, managing patient records and keeping medical teams in contact with patients, hospitals, and back-to-base operations.
“There’s a difference between consumer and clinical-grade. For Netflix, for example, if it’s interrupted, it's inconvenient. But if a surgical procedure is interrupted, it's life or death. We haven't achieved clinical-grade, even if we've got patchy consumer-grade broadband access across remote areas today,” Laverty said.  
“In remote Australia, it's not even possible to have a fully functional electronic medical record (EMR) when you don't have a fully functional broadband system. 
“We’ve got a Band-aid around our EMR at present. We download records, we fly them out to location and manage them there. They're manually uploaded when we get back because that’s when we get access to broadband and cloud systems. If the pipe doesn't work between city and bush, you don't have information flowing through it, therefore, you don't have a functional EMR,” he said. 
In 2017, RFDS and NBN Co inked a partnership to have 300 of its remote area clinics and 24 RFDS bases, which previously had limited internet connectivity, benefit from broadband supplied by Sky Muster satellites.
In addition, 14 remote RFDS clinics were expected to use telehealth services as a result of this partnership, allowing patients to video conference with RFDS’ clinicians.
However, the demand for remote services is high, with an RFDS report identifying that one in six remote patients are waiting at least two days to see a doctor for urgent medical care. 
“We’re a healthcare organisation, not a broadband provider. We just want it to work. We don't have the tech expertise to be specific about what we need. We just know it doesn't work today, and we're looking to the suppliers to deliver it soon,” Laverty said. 
According to Laverty, the next layers of development in broadband delivery will solve the clinical-grade reliability challenge that currently exists with the existing satellite and mobile reach of broadband connectivity. 
“We're heading in that direction and when NBN gets there, it changes the dynamic, particularly as artificial intelligence is likely to jump ahead and make telehealth even more customer-responsive. But you've got to have the nuts and bolts in place – the broadband has got to work before you can even think about a greater reliance on telehealth,” he said. 
“With the last few hundred miles' connectivity issue, we’ll be able to deliver the pipe into remote areas. The worst thing we could do would be to invest in the hardware or the training of clinicians and patients and for the pipe to continue to be too thin or incomplete because we wouldn't be delivering the point-of-care health outcomes.” 
Laverty also said that only with NBN efficiencies and upgrades is the RFDS able to deliver on some of its future goals. 
“When the pipe is fixed, we'll add more to [our services]. We've had a telehealth infrastructure that has evolved over 90 years, and it's going to continue to evolve as the capacity of broadband doing more is proven,” he said.  
“Our barrier to future expansion is broadband reliability in remote areas at a clinical-grade level. And when it gets to that level, we will have less reliance on telephone. And as we shift to broadband, we're able to put more share of diagnostic information from patient to clinician, making RFDS more reliable. 
“Today, we can't do that because we can't trust broadband to be at this efficient bandwidth 24 hours a day. When it gets to that, we will invest more and be able to deliver more,” he added. 
An NBN Co spokesperson told HITNA that the company is "committed to regional and remote Australia and helping to ensure the NBN network enables social and economic prosperity" in these regions.
"Our team is currently working with retailers to launch a new business-grade satellite service, which will be available later this year. The service is designed for businesses with complex networking requirements including wide-area network connections to multiple locations and those requiring more broadband data, higher speeds and business-grade service levels," the spokesperson said.  



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