High speed pursuit

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Associate Professor Rodrigo Mariño from Melbourne Dental School.
Associate Professor Rodrigo Mariño from Melbourne Dental School.

The data speeds promised by the National Broadband Network is revolutionising tele-dentistry and, as a result the delivery of public healthcare, as a team of researchers at the Melbourne Dental School and the Oral Health Cooperative Research Centre are discovering. By Chris Sheedy

An academic research project that ended late last year provided a fascinating and vital insight into the power of broadband-enabled internet. The idea of the project, which involved researchers from the Melbourne Dental School, the Oral Health Cooperative Research Centre and the Institute for a Broadband Enabled Society (IBES), based within the University of Melbourne, was to figure out whether a remote dental examination using an electric toothbrush-sized camera and a broadband web connection could be as accurate as a face-to-face examination.

“Obviously there was a difference in results,” says Associate Professor Rodrigo Mariño from the Melbourne Dental School. “A face-to-face examination is always going to deliver a better result. But what we discovered, in controlled laboratory conditions, was that the remote examination was accurate to an acceptable degree. It was not as accurate as face-to-face, but it was not far off.”

Assoc Prof Mariño is now running a new research project in more of a real-world situation rather than in laboratory conditions. He and his team are conducting remote examinations of people within nursing homes in order to continue to test results and to discover new uses for, and restrictions of, the web-based technology.

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“A lot of the success of such technology is down to the National Broadband Network (NBN) and its implementation,” Assoc Prof Mariño says. “For example, we have calculated that a file containing a 15-minute remote examination on high-resolution video uses about one gigabyte of data per minute. With pre-NBN data speeds, such a file would take hours to stream to the specialist via online channels, so a 15-minute examination would become an all-day time waster. But with NBN speeds, the file is almost instantaneous. It streams in seconds.”

Remote consultation for remote regions

Assoc Prof Mariño is quick to point out that tele-dentistry will never be a replacement for face-to-face consultations. Much of dentistry is about touch and feel so issues such as soft tissue conditions will never mix well with tele-dentistry in video form. But for many remote areas of Australia where there may be no dental services, or within specific areas of society that tend to experience lower oral health standards, such as nursing homes, tele-dentistry is much better than what patients are offered right now.

Tele-dentistry, in some form, has actually been around for a very long time, Assoc Prof Mariño says. Dentists have sought advice from colleagues or specialists in other territories over the phone, or by email. But broadband internet and its ability to stream high resolution video takes tele-dentistry on a giant leap forward into a new era of real-time consultation and advice.

“We’re currently working with nurses in nursing homes who can manipulate the cameras as we conduct an examination.” – Associate Professor Rodrigo Mariño of Melbourne Dental School

“Our objective is to find out how we can use this technology for various purposes and many beneficial options are revealing themselves,” Assoc Prof Mariño says. “We’re currently working with nurses in nursing homes who can manipulate the cameras as we conduct an examination, for instance. This works very nicely as a form of preventative care as often there might be a condition that is able to be resolved by the nurse, under instruction from a dental specialist, in real time.”

“Also, imagine if somebody is located in a rural area that has a dentist but no specialists. A patient experiences a serious dental problem that requires specialist knowledge and experience. Previously they would have had to travel to the city and endure the expense of accommodation and travel, as well as time away from home and work, in order to have the problem seen to. But if a specialist can do a tele-consultation and offer advice to the local dentist in real time over a broadband connection then it’s possible the issue can be resolved without the need for travel.”

What a remote consultation may look like in the NBN-enabled future.
What a remote consultation may look like in the NBN-enabled future.

“Finally, if a dental specialist must travel to a nursing home to assist a patient or patients with particular types of problems, a tele-consultation conducted before they leave can ensure the right specialist with the right equipment is sent on the job, and that they experience no unexpected surprises when they arrive.”

The technology is moving forward at a rapid pace, Assoc Prof Mariño says. Consider that just 10 years ago such real-time communication and video streaming was not just impossible, it wasn’t even on the radar. While we don’t know what the next decade might bring, as the NBN is completed and the dental industry innovates around such technology, researchers such as Assoc Prof Mariño and those within his faculty are putting the basic building blocks in place to ensure that by the time tele-dentistry becomes commonplace, the industry doesn’t have to learn from its own mistakes. “We’re conducting another project with the Royal Children’s Hospital in Melbourne that is also centred around helping patients based in rural areas to avoid trips to the city for treatment. In the case of people suffering a dental trauma, for example, in the past, if they could not get local treatment, they had to come to the city. But sometimes with high-speed broadband technology and a dental professional at the other end of the web connection, that travel can be avoided and some treatments can be carried out locally under tele-consultation. This doesn’t just save money and hassle for the patient, it frees up resources in city hospitals and clinics, many of which are already experiencing punishing demand and long waiting periods.”

Futuristic solutions for future problems

It’s no secret that the ageing population in Australia, as in many other territories around the globe, is going to place massive pressure on our already-stressed medical system. The IBES says over the next 45 years the number of Australians aged over 65 is expected to double. Social isolation among the elderly is already becoming more prevalent, leading to its own special set of problems. A rise in chronic diseases is already beginning to reveal shortfalls in the health workforce and problems in some areas around access to specialist care. The elderly require greater medical care than any group in society. As the tax-paying worker base shrinks while the pool of retirees expands over the next few decades, new solutions are vital.

Many, including researchers at the IBES, believe one of these solutions will involve tele-care for in-home consultations. The ability to have medical check-ups and monitoring conducted within the home, in consultation with remote specialists, will help to reduce pressure on hospitals which, current research shows, within the next few decades will not have enough beds to take care of chronic patients.

Such bodies as the IBES and the Asia-Pacific Ubiquitous Healthcare Research Centre (APuHC), directed by Professor Pradeep Ray at the University of New South Wales, have been at least partly set up to look into using technology as a solution to develop ways and means of providing health care to people in their homes and in remote regions. The APuHC is also looking into using wireless web technology to provide first-class medical assistance on the ground after a natural disaster such as a tsunami or an earthquake, particularly in less developed nations. It’s important, in this specific case, that the solution is wireless as other web infrastructure is often knocked out during a natural disaster. The dental industry in Australia will require the same types of advanced and innovative solutions to cope with future issues. Once the technology is up and running it is likely to make a genuine difference to many people in various geographical, age and socio-economic regions, groups and sectors.

Two-way web traffic

The NBN won’t just be good for sending information from a patient to a specialist. Assoc Prof Mariño says he and his team are also looking at ways to maximise its effectiveness in sharing knowledge and skills with dental professionals nationally and around the globe.

“This technology won’t just save patients from having to travel in to cities—it will also allow dental experts from around the world to share and gain knowledge through video tutorials and live courses that they are able to attend from anywhere with a broadband web connection,” Assoc Prof Mariño says. “It means that anybody, anywhere in the world can empower themselves with knowledge, and share their own expertise, which should add enormously to the knowledge and skill levels of dental experts globally.”

“This technology won’t just save patients from having to travel in to cities—it will also allow dental experts from around the world to share and gain knowledge.” – Associate Professor Rodrigo Mariño

It’s not just dental experts who stand to gain from such technology and knowledge sharing. Researchers at the IBES say broadband technologies will also help older people maintain their independence and live in their own homes for longer by allowing easier access to health care, helping the elderly to engage socially rather than become isolated, and allowing them access to lifelong learning opportunities.

The dental profession is an important part of the new frontier as the technologies on offer appear to solve several traditional problems. “My specialty is in public health and I see this technology as a possibility to improve the oral health of the entire population,” Assoc Prof Mariño says. “If you improve oral health then you improve quality of life, particularly in remote communities. I can see this happening in the very near future. I think we’re close.”

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