Medical services take a leap into remote areas

The worldwide convulsions of the Covid pandemic focused attention on health management and health logistics – particularly on the knotty problems of providing for those unable or unwilling to visit health professionals in person. Expanding fast into this field is Glenn McKay’s Medical Rescue Group, which provides a range of medical and evacuation services to Australians (and others) in remote locations, from providing fully-staffed air ambulances to more routine medical services such as vaccinations.

The company was launched in 2010 when McKay, a doctor, perceived a gap in remote area medical services provided by the private sector. “There were a lot of companies expanding into remote places and they were missing that high-level medical care that’s available to everybody in the city,” he says, adding that it was unreasonable for large construction or mining projects in regional areas to rely on a single general practice in a nearby town for their medical needs.

Now employing a fluctuating number of staff, up to as many as 500 depending on requirements, Medical Rescue began by providing medical services with about 60 staff to ski-fields in New Zealand. “We were providing acute medical services to four ski-fields over there and treated several thousand trauma patients a season,” McKay says, adding that his company can mitigate the risks of providing inhouse medical care by providing a complete service.

Specialising in the provision of medical services in austere environments, Medical Rescue leases two jet aircraft based in south-east Queensland to repatriate injured or unwell Australians and other nationals from Pacific nations. Essentially flying intensive care units, these jets can keep patients alive until they can be transferred to a city hospital. Customers include travel insurers and governments – the Japanese government, for example, uses Medical Rescue to assist with evacuations of injured or ill diplomats.

Within Australia, Medical Rescue partners with Toll to provide helicopter rescue services. On the ground, the company has its own resources. “We have a fleet of about 50 response vehicles,” McKay says. “We’ve also developed deployable health units – big trucks, effectively mobile hospitals, which can cater for ICU patients for 24 hours.”

For the past two years, the company has provided ground medical services, including ambulances, paramedics, doctors and nurses, to the Australian defence forces to support defence training around Australia.

McKay says there has been an increased demand for the services Medical Rescue can provide as public health services consider how best to staff the hospitals and clinical outreach programs used by remote communities. The Covid pandemic has stretched health services thin, and hospital staff are tired, he adds.

This exploding demand has pushed the company to expand at speed. “Prior to the pandemic it was like sitting in a tube, floating down a river in Thailand drinking a cocktail and watching the business steadily grow,” McKay says. “Over the last couple years, it’s swimming against the current. We’re growing rapidly, but there’s been no cocktails or tubes in sight.”

Telehealth services in demand

The pandemic also drove rocketing demand for Australian telehealth company Coviu which finalised an expanded platform just months before the illness swept the world.

Chief executive officer Silvia Pfeiffer says at the beginning of the Covid meltdown, the Coviu platform managed about 400 medical consultations a day. Within two to three weeks, after Medicare introduced telehealth rebates, numbers had shot up to about 25,000 consultations a day. “It was a massive, massive increase; it was insane,” she says. “We’ve done eight million consultations since the beginning of the pandemic.”

Coviu grew from a plan in 2012 to improve access to specific aspects of healthcare in rural and remote parts of Australia. It was inspired by news of a speech pathologist group having difficulty providing services to rural and remote parts of far west NSW, particularly schools. The speech pathologists had been using various products, such as Adobe Connect and Teams, and they were unhappy with the quality of the video and audio – so important for connecting with children. CSIRO scientists hoped to smooth the way. “That was the motivation to build Coviu originally,” Pfeiffer says.

The computer technicians got to work and came up with a product that had good video and audio quality, particularly lip sync, she adds. “The clinicians said providing speech pathology through Coviu was almost as good as being there.”

In 2018, Pfeiffer and her colleagues spun Coviu out of CSIRO and as an independent entity it began to provide a platform for other types of health professionals, including dieticians and mental health practitioners – psychologists and psychiatrists.

In 2019, Coviu signed up on a massive digital health collaboration with HealthDirect, a company co-owned by multiple Australian state health departments and the federal health department. The Coviu experts began building a bigger platform to support hospitals’ outpatient clinics and six months later the pandemic hit.

“So, in March 2020 we were there at just the right time in the right place with our platform, providing all these clinicians across hospitals, specialists, GPs, allied health providers, anybody in healthcare, with the possibility to deliver virtual care successfully,” Pfeiffer says.

While certain ailments and conditions, such as appendicitis or a broken elbow, cannot be examined or treated via video links, many illnesses can be assessed. “Plenty of things are possible; a lot more than people actually thought before the pandemic,” Pfeiffer says, noting that Coviu builds clinical tools into the platform to provide health professionals with expanded assessment options.

“Now a lot of virtual emergency departments are using Coviu for a virtual triage point; people can call up that virtual emergency department to work out whether they should go into emergency department,” she says. “Seventy-five per cent of people who call that hotline don’t have to go to hospital, they are redirected to a GP or elsewhere. It provides peace of mind: ‘this can wait’.”

Demand has fallen since the peak of the pandemic, but Pfeiffer says the platform continues to manage 13,999-14,000 consultations every day, and the numbers are slowly increasing.

Coviu has a staff of about 55 people, and the organisation is expanding from digital health into phone telehealth, helping doctors build SMS conversations with their patients. As well as expanding into the US, Coviu is also focused on Canada and New Zealand.

“We want to transform the industry,” Pfeiffer says.  “We want to give clinicians a chance to embrace technology, to really embrace the future of health care, which will absolutely include virtual care. So that’s why we’re building Coviu the way we’re building it. Health care practitioners overall are aware that it is the future and they can’t resist it much longer.”

Hypnosis as a therapeutic tool

The Covid-era boom in demand for remote treatment has also boosted Mindset Health, a rapidly-growing company which markets a range of hypnosis-based digital therapeutics to patients around the world.

Founded by Melbourne-based brothers Alex and Chris Naoumidis, aged 27 and 25, Mindset Health currently offers three digital therapeutic apps – to treat irritable bowel syndrome and menopausal hot flushes and to help users quit smoking.

“In 2017, my brother and I were in Monash university, both commerce-finance students, and we taught ourselves to code,” Alex Naoumidis says. Their first endeavour was a peer-to-peer dress rental start-up, but they wound it up, abandoning fashion to focus on psychology, mental health and behavioural science.

The potential of hypnotherapy caught their attention. “Our dad rated it and has used it in the past,” Naoumidis says. “We thought it was a bit weird, but we decided to look into the science and we found there’s a huge amount of clinical evidence supporting hypnosis as a therapeutic tool.”

The focused attention and absorption engendered improves therapy, he adds, and hypnotherapy works even via a recording heard on a device. “When hypnotherapy is performed, particularly in randomised research settings, the hypnotherapist is just reading from a script,” he says. “It’s transferable – through an app. The outcomes and the effectiveness of hypnotherapy done by an audio recording is very similar to that of in-person hypnotherapy.”

Mindset’s primary product is an app called Nerva, designed to assist people with irritable bowel syndrome to manage their condition without using drugs or staying on a rigid diet. A scientist with a doctorate in gut-directed hypnotherapy and psychophysiology from Monash University, Simone Peters, ran a randomised controlled trial to compare the effectiveness of gut-directed hypnotherapy with the often-recommended low FODMAP diet (which limits certain types of carbohydrates).

She found the hypnotherapy and the diet were equally effective. Her hypnotherapy protocol is now central to the Nerva app, which earns 95 per cent of Mindset’s revenue. More than 300 million people around the world have irritable bowel syndrome and speak English, so there is a large potential customer base. Naoumidis says Mindset was “global from day one”, and most of Nerva’s 27,000 paying members are in the US.

“We get a lot of referrals and recommendations from doctors, dieticians, and gastro-enterologists who recommend Nerva to their patients,” he says, adding that rather than treatment, the company’s apps were self-help tools.

Mindset Health now employs 28 people and expansion is on the agenda. Under consideration are apps for anxiety and depression, insomnia, chronic pain and weight management; with the aim eventually of providing a broad portfolio of digital therapeutic apps. “Our mission is to help empower a billion people to improve their health with their minds,” Naoumidis says.

Digital health monitoring

Another fast-growing company has capitalised on the still burgeoning need for digital health monitoring and management. Developed to link healthcare teams with patients to better manage chronic disease and prevent unnecessary hospitalisations, CareMonitor is the face of healthcare in the future, says founder and chief executive officer Deepak Biswal.

“You can do a lot of things at home to manage and monitor vital signs,” he says, pointing out that this sort of health monitoring can cover long periods of time in the home. “That’s where a patient spends most of the time during the year, rather than in the hospital setting.”

Twenty per cent of patients account for almost 80 per cent of health care costs, and these people typically have complex and chronic conditions, and often a number of ailments simultaneously, requiring treatment from a range of health professionals, from general practitioners to specialists to pharmacists to allied health professionals, he adds. “The challenge for clinicians is how to collaborate with other health providers to manage the patient,” Biswal says.

The CareMonitor platform can maintain a patient’s records to allow for seamless communication between health professionals, he explains, and it offers a patient app and a patient portal, so patients can be reminded of medication schedules and the tests they are required to take at certain intervals. A patient with diabetes, for instance, would be reminded every few months of the importance of taking a HPA1C test to determine their average blood sugar levels, and reminded daily to measure blood sugar levels.

The platform can be linked to other electronic medical records in health systems, and educational material can be sent to patients

Many of CareMonitor’s clients are public health services, such as the Northern Adelaide Health Network which uses the platform to run Hospital in the Home programs. “For some of the sub-acute patients, instead of coming to the hospitals, the services are delivered to them,” Biswal says. “The hospital can effectively keep an eye on them. If you know the patient is doing well, there’s no need to bring them back into the hospital, so you can allocate resources to someone who’s actually falling off a cliff.”

The platform settings can be tailored to suit needs. In January, the CareMonitor platform was being used by Medibank and a large Catholic hospital to manage 100,000 Covid patients in five states: collecting data from them, managing their progression to recovery, escalating care when necessary and discharging them when appropriate.

With a background in digital health care strategy in the Asia-Pacific, Biswal saw the opportunity to develop a comprehensive digital healthcare system. It took his team some time to build the platform and CareMonitor finally began trading about three years ago.

The system is still morphing and evolving, he says, adding the company now employs 23 people and to date nearly 200,000 patients have been managed across the platform, which has been built to deliver care more efficiently in a range of settings.  “This whole space is evolving,” he says. “The surge from Covid has driven understanding that care can be provided remotely.”

Australian Financial Review