In January 2015, the ACS Telecommunications Board published a white paper on digital service models for Australia's residential aged care. Among the issues it raises is one that cuts across all aspects of telehealth.

"The ability to charge for (or be paid for) the delivery of a service electronically when we have traditionally expected such a service [to] be delivered in person ... represents a major change for health care in Australia," the paper said.

The Board saw the results of a variety of projects - including NBN telehealth trials and emerging clinical programs - as important to building evidence of sustainably-funded business models for telehealth in Australia.

Susan Jury, telehealth program manager at The Royal Children's Hospital (RCH) in Melbourne, delivered a presentation on current and potential funding models to the Successes and Failures in Telehealth conference in Adelaide late last year.

Jury has first-hand experience with the economics of telehealth: she's in the final year of a three-year program to make telehealth part of RCH's business-as-usual operation.

"As a public hospital, we don't bill patients," Jury told Information Age. "We capitalise on Medicare item numbers."

Medicare introduced rebates and incentives for telehealth video consultations in July 2011. Though the incentive scheme has finished, the rebates remain - "There's a 50 percent loading if you provide the encounter by telehealth compared to face-to-face," Jury said.

"However, I wouldn't say telehealth is what the hospital would consider a massive money-making venture."

RCH's director of neurology, Associate Professor Andrew Kornberg, said the hospital would see its $500,000 investment in telehealth as a success if the program contributed money, broke even and/or made a difference to patients' and their families' lives.

One of the main ways telehealth can improve lives is by reducing the need for patients living in regional or rural areas to travel to and from a hospital for an assessment or for review appointments after receiving treatment.

The cost of travel for face-to-face appointments is picked up either by the patient, their family or by a government-run transport assistance scheme.

Jury's team calculated ballpark cost savings for nephrology - kidney - patients in 2013. A telehealth consultation was on average $602 cheaper than having a patient travel to and from RCH for a physical appointment.

The savings increased to over $4000 for one patient across 10 consultations, and more than $26,000 for 25 patients over 16 months.

The Centre of Research Excellence in Telehealth at the University of Queensland is also presently conducting research on patients' willingness to pay.

Lowering technology barriers

While much has been reported about telehealth trials over the National Broadband Network, researchers are also exploring alternative connectivity options, including the capability of 4G networks.

RES-e-CARE is a virtual health clinic for aged care facilities designed by the University of Queensland's Centre for Research in Geriatric Medicine and the Centre for Online Health. Though it began as academic research, it is now run as a commercial telehealth provider.

Dr Liam Caffery, telehealth technology director and senior research fellow at the Centre for Online Health, recently presented research on using Telstra's 4G LTE network - rather than a fixed-line connection - to provide connectivity for RES-e-CARE.

"Some western parts of Queensland such as Chinchilla suffer from poor DSL connections but telcos there have made some investment in 4G towers," Dr Caffery said.

"We started looking at running videoconferencing over the 4G networks there because they were a better alternative than using the DSL connections."

Dr Caffery asked clinicians to rate the quality of videoconferencing consultations over 4G LTE, using rating scales from the International Telecommunication Union (ITU).

The research concluded 4G LTE was stable enough to run telehealth consultations, producing low rates of jitter and packet loss, and "good-to-excellent" scores for audio and image quality on the ITU scale. The end result? 4G LTE is now being used in a production telehealth system in Australia.

RCH's Kornberg is excited by a future for telehealth that isn't tied to "big" hardware-based systems, but that can instead be run using a smartphone and 4G.

"This is a new way not bound by hardware," he said. "It's convenient and a positive for institutions, patients and doctors".

The technology RCH presently uses to run its consultations is Citrix GoToMeeting, though it is trialling other systems.