Our Journey
A history in telehealth
Attend Anywhere has been at the leading edge (sometimes bleeding-edge!) of using video technology in the health sector for many years.
We realised early on that the main challenge was making it easy for healthcare providers to say "yes, you can attend via video". This was a workflow and operational integration challenge, not a technical one.
Each time the technology improves and gets closer to the consumer, our team is reinvigorated by the immense potential to address challenges faced by health systems around the world, and a passion to help bring its immense value to patients, health systems, and society in general.
We realised early on that the main challenge was making it easy for healthcare providers to say "yes, you can attend via video". This was a workflow and operational integration challenge, not a technical one.
Each time the technology improves and gets closer to the consumer, our team is reinvigorated by the immense potential to address challenges faced by health systems around the world, and a passion to help bring its immense value to patients, health systems, and society in general.
Attend Anywhere's development - a timeline
1996 |
Founder Chris Ryan involved in first telemedicine project. |
1997 |
Chris helped install over 100 video conferencing systems in Victoria on the promise of telehealth, however this promise was not realised due to a lack of service providers. |
1998 |
Founded Global Telehealth (GTH) to remove barriers to adoption, especially by the providers of health care services. |
1999 |
TeleHealth Victoria founded with the Victorian Healthcare Association. |
1999 |
Telemedicine tour of the US. |
2000 |
Began work with Bayside Heath at the Alfred Hospital - helped set up the first telehealth department. |
2001 |
Won a grant from the Department of Health and Human Services (DHHS) to explore a model for the effective exchange of services via video call. |
2002 |
Partnered with the Royal Australasian College of Physicians (RACP) in Victoria. |
2002 |
First 15 basic trainees attend the Physician Education Program (PEP) via video conference. |
2002 |
Received a grant from the DHHS to expand video access to PEP across Victoria. |
2003 |
Established three key elements of the model – video just replaces travel; consumer-driven inbound workflows key to sustainability; decentralised model key to scale. |
2003 |
Developed first Management Platform to streamline administration |
2005 |
Global Telehealth splits into Attend Anywhere (access to clinical) and GTH Events (access to education). |
2007 |
RACP acquire GTH Events. |
2007 |
Developed Attend Anywhere Management Platform (version 2) using Vidyo™ video technology. |
2010 |
First direct-to-patient video consultations from the Alfred Hospital, Melbourne. |
2011 |
First Attend Video Appointment button placed on a hospital website. |
2011 |
Collaborated with the Alfred Hospital and Monash University on a Victorian Government - funded research project around direct-to-patient video consultations. |
2012 |
Contracted by Healthdirect Australia (HDA) to manage program of adding video call access to after-hours GP service. |
2013 |
Became one of the first to explore the potential of new open-source WebRTC video technology in health. |
2013 |
After approaching the wider market for solutions and finding no viable offerings, HDA looked to Attend Anywhere to provide a solution, based on its existing IP and management model. |
2014 |
WebRTC video technology replaces Vidyo™ with the Attend Anywhere Management Console. |
2014 |
Video call access to HDA Pregnancy Birth and Baby service. |
2015 |
Contracted by HDA to run exemplar program in a range of health care settings, Healthdirect Video Call program launched. |
2015 |
Contracted by HDA to expand access to Healthdirect Video Call program with Federal and State (NSW, WA) funding – vision to enable mainstream video call access to existing health services. |
2016 |
Won public tender to provide services to National Health Service (NHS) Scotland, launches NHS Attend Anywhere. |
2017 |
NHS Highland launch NHS Near Me, powered by Attend Anywhere. |
2017 |
DHHS Victoria adopts model and platform via Healthdirect Australia to support its telehealth strategy. |
2017 |
Received a grant from the Victorian Department of Premier and Cabinet (DPC) to pilot video call access to Family Violence service-providers. |
2018 |
NHS Scotland invests in national video consulting scale-up program. |
First forays into telehealth
In the mid-nineties, Chris Ryan (founder of Attend Anywhere) worked for PictureTel, which was one of the first companies to offer low-bandwidth video conferencing using ISDN.
A psychiatrist from Bendigo thought this new technology could help him provide child and adolescent mental health services up on the Mallee Track. As a result, some of the first video conferencing systems in the world used specifically for health were installed.
The main reasons these systems were not used to their full potential, were a lack of health care providers and the need for coordination.
In 1998, Global Telehealth was founded with the aim to reduce the barriers to the adoption of video calling by the health sector.
In the mid-nineties, Chris Ryan (founder of Attend Anywhere) worked for PictureTel, which was one of the first companies to offer low-bandwidth video conferencing using ISDN.
A psychiatrist from Bendigo thought this new technology could help him provide child and adolescent mental health services up on the Mallee Track. As a result, some of the first video conferencing systems in the world used specifically for health were installed.
The main reasons these systems were not used to their full potential, were a lack of health care providers and the need for coordination.
In 1998, Global Telehealth was founded with the aim to reduce the barriers to the adoption of video calling by the health sector.
Turning the vision into reality
Telehealth Victoria was founded in partnership with the Victorian Hospitals Association. It successfully lobbied Telstra for reduced ISDN call charges for telehealth, and funds were raised to install a video conferencing system at the Emergency Department of the Royal Children’s Hospital in Melbourne, one of the first to be installed in a metropolitan centre.
One of the first telehealth directories was assembled to promote coordination.
A large Department of Health and Human Services (DHHS) grant helped establish video call access to Alfred Health - based clinicians working with hospitals in Gippsland (who had already had video conferencing systems).
There was success on two fronts:
Telehealth Victoria was founded in partnership with the Victorian Hospitals Association. It successfully lobbied Telstra for reduced ISDN call charges for telehealth, and funds were raised to install a video conferencing system at the Emergency Department of the Royal Children’s Hospital in Melbourne, one of the first to be installed in a metropolitan centre.
One of the first telehealth directories was assembled to promote coordination.
A large Department of Health and Human Services (DHHS) grant helped establish video call access to Alfred Health - based clinicians working with hospitals in Gippsland (who had already had video conferencing systems).
There was success on two fronts:
- Service exchange between Alfred Health’s own campuses, which allowed the Alfred to track both the benefits and the financial savings
- Enabling video call access to the Physician Education Program provided at the Alfred for basic trainees that were on rotation in the bush
The Physician Education Program (PEP)
The PEP, which commenced in 2002, was led by Professor John Wilson (now President of the Royal Australasian College of Physicians — RACP).
The PEP involved 155 hours of lectures that started with five participating sites, and grew to 800 basic trainees attending once a week, across 90 hospital video-conferencing locations in Australia and New Zealand.
Realisations:
The PEP, which commenced in 2002, was led by Professor John Wilson (now President of the Royal Australasian College of Physicians — RACP).
The PEP involved 155 hours of lectures that started with five participating sites, and grew to 800 basic trainees attending once a week, across 90 hospital video-conferencing locations in Australia and New Zealand.
Realisations:
- A video conference system simply replaces the travel component involved with service delivery
- Everything surrounding that system should remain the same
First version of the Management Platform
The video consulting Management Platform (now the Attend Anywhere Management Console) was an invention borne of necessity.
Trainees at five locations, which grew quickly to 30, then 65, then 85. In order to cost-effectively handle the volumes of participation, event administration and coordination had to be automated.
The software was web-based from the beginning. Hospitals registered their video conference room as a ‘Local Venue’, and physicians subsequently registered to attend at that venue.
The management platform coordinated activity between dozens of support staff in various hospitals (dubbed local venue coordinators).
Up to seven bridging organisations (conferencing service providers) tied it all together technically.
PEP was the first of dozens of programs that were developed after that, some of which are now entering their 18th year.
The video consulting Management Platform (now the Attend Anywhere Management Console) was an invention borne of necessity.
Trainees at five locations, which grew quickly to 30, then 65, then 85. In order to cost-effectively handle the volumes of participation, event administration and coordination had to be automated.
The software was web-based from the beginning. Hospitals registered their video conference room as a ‘Local Venue’, and physicians subsequently registered to attend at that venue.
The management platform coordinated activity between dozens of support staff in various hospitals (dubbed local venue coordinators).
Up to seven bridging organisations (conferencing service providers) tied it all together technically.
PEP was the first of dozens of programs that were developed after that, some of which are now entering their 18th year.
Direct-to-patient video consultations
Inbound patient access to health services were designed around 2010, with John Wilson and the Cystic Fibrosis team at The Alfred Hospital, and with Monash University, with funding from DHHS.
Initially, links were sent to virtual meeting rooms. Later, links to appointment times.
In hindsight, shoehorning conferencing workflows into clinical service delivery settings was difficult.
Version two of the management platform took advantage of technology innovation from a new video conferencing company called Vidyo.
Vidyo did two things differently:
Inbound patient access to health services were designed around 2010, with John Wilson and the Cystic Fibrosis team at The Alfred Hospital, and with Monash University, with funding from DHHS.
Initially, links were sent to virtual meeting rooms. Later, links to appointment times.
In hindsight, shoehorning conferencing workflows into clinical service delivery settings was difficult.
Version two of the management platform took advantage of technology innovation from a new video conferencing company called Vidyo.
Vidyo did two things differently:
- They offered APIs, so the management software could automatically send links, instead of requiring dial-in instructions to be entered manually
- They radically improved the quality of the video transmission over imperfect networks such as the Internet. The ability to use the Internet for the first time (without needing special quality-of-service connections) removed ISDN call costs.
The invention of the button
The first Attend Video Appointment button was launched in 2011. It was the forebear of hundreds of buttons that exist on healthcare provider websites today.
The first Attend Video Appointment button was launched in 2011. It was the forebear of hundreds of buttons that exist on healthcare provider websites today.
A new benchmark for success
Focus on mainstream patient access accelerated from 2012, working with Healthdirect Australia to add video call access to its after-hours GP service.
The benchmark for cost, ease-of-use, quality, and access became the telephone, as opposed to the tyranny of travel.
Urgent, unplanned video calls from consumers anywhere in Australia needed to be supported. People had to be attended to by any one of a number of clinicians, as well as be transferred between services if necessary – without setting up or installing anything beforehand. (All our tests and proof-of-concepts showed that, however simple and automated we made it, it just wasn’t feasible to ask callers to install a video software client prior to making a call.)
These requirements had to be sustainable within a government healthcare context, where the standards and expectations for privacy, security, and data protection are extremely high.
The workflow management layer aside, the fact was that the video technology didn’t yet exist that could match our requirements.
Focus on mainstream patient access accelerated from 2012, working with Healthdirect Australia to add video call access to its after-hours GP service.
The benchmark for cost, ease-of-use, quality, and access became the telephone, as opposed to the tyranny of travel.
Urgent, unplanned video calls from consumers anywhere in Australia needed to be supported. People had to be attended to by any one of a number of clinicians, as well as be transferred between services if necessary – without setting up or installing anything beforehand. (All our tests and proof-of-concepts showed that, however simple and automated we made it, it just wasn’t feasible to ask callers to install a video software client prior to making a call.)
These requirements had to be sustainable within a government healthcare context, where the standards and expectations for privacy, security, and data protection are extremely high.
The workflow management layer aside, the fact was that the video technology didn’t yet exist that could match our requirements.
Web Real-Time Communications (WebRTC) arrives
WebRTC offered the best, most resilient video technology we had seen. It was open-source, ‘bleeding-edge’, and it was free.
The fact it travelled between browsers and not through a data centre was a natural fit with the decentralised management model, and offered many cost and quality advantages, especially for those in regional areas.
The combination of a mature management platform and cutting-edge video technology proved powerful, and produced one of the first, entirely web-based, video consulting platforms in the world.
The work by Healthdirect helped pave the way for many solution developers in the health space. See 2013 Pulse+IT article.
WebRTC offered the best, most resilient video technology we had seen. It was open-source, ‘bleeding-edge’, and it was free.
The fact it travelled between browsers and not through a data centre was a natural fit with the decentralised management model, and offered many cost and quality advantages, especially for those in regional areas.
The combination of a mature management platform and cutting-edge video technology proved powerful, and produced one of the first, entirely web-based, video consulting platforms in the world.
The work by Healthdirect helped pave the way for many solution developers in the health space. See 2013 Pulse+IT article.
Healthdirect Video Call: Mainstream video access to existing health services
In order to explore platform options, Healthdirect Australia independently ran an Expression of Interest (EOI) and a detailed Request for Proposal (RFP) process, to which Attend Anywhere was not allowed to respond.
The EOI and RFP established that there were no viable options on the market at the time. Attend Anywhere’s management platform was already web-based and designed to use any video technology engine, meaning it was viable to switch to the open source WebRTC.
It was this that was subsequently approved for use by Healthdirect and its stakeholders.
In October 2014, after the launch of video call access to the first of Healthdirect’s own services (www.pregnancybirthbaby.org.au) the federal Government funded Healthdirect Australia to establish national exemplars of how mainstream video call access for patients could be achieved in a variety of common health care settings.
We collaborated with several state-based organisations to achieve this goal. In doing so, we gained valuable insights that would underpin our approach to scaling up the Healthdirect Video Call program (as it became known) when it was expanded the following year.
Read more at https://about.healthdirect.gov.au/video-call
In order to explore platform options, Healthdirect Australia independently ran an Expression of Interest (EOI) and a detailed Request for Proposal (RFP) process, to which Attend Anywhere was not allowed to respond.
The EOI and RFP established that there were no viable options on the market at the time. Attend Anywhere’s management platform was already web-based and designed to use any video technology engine, meaning it was viable to switch to the open source WebRTC.
It was this that was subsequently approved for use by Healthdirect and its stakeholders.
In October 2014, after the launch of video call access to the first of Healthdirect’s own services (www.pregnancybirthbaby.org.au) the federal Government funded Healthdirect Australia to establish national exemplars of how mainstream video call access for patients could be achieved in a variety of common health care settings.
We collaborated with several state-based organisations to achieve this goal. In doing so, we gained valuable insights that would underpin our approach to scaling up the Healthdirect Video Call program (as it became known) when it was expanded the following year.
Read more at https://about.healthdirect.gov.au/video-call
NHS Scotland
In 2010 NHS Scotland ran a public tender for the provision of a patient-centric telehealth capability; Attend Anywhere responded. The Scottish Government's Cabinet Secretary for Health launched nhs.attendanywhere in December 2016.
Their platform and services were bundled into a standalone hosted offering.
Thanks to a range of factors, the Attend Anywhere program, which now incorporates initiatives such as NHS Near Me and the new GP Near Me, is being enthusiastically adopted.
In 2010 NHS Scotland ran a public tender for the provision of a patient-centric telehealth capability; Attend Anywhere responded. The Scottish Government's Cabinet Secretary for Health launched nhs.attendanywhere in December 2016.
Their platform and services were bundled into a standalone hosted offering.
Thanks to a range of factors, the Attend Anywhere program, which now incorporates initiatives such as NHS Near Me and the new GP Near Me, is being enthusiastically adopted.
First foray outside the public health system
In 2017 Attend Anywhere received an innovation grant from the Victorian Department of Premier and Cabinet (DPC) to explore video call access to the providers of family violence - related services.
This involved establishing a hosted version of the management platform for use outside of the public health system.
In 2017 Attend Anywhere received an innovation grant from the Victorian Department of Premier and Cabinet (DPC) to explore video call access to the providers of family violence - related services.
This involved establishing a hosted version of the management platform for use outside of the public health system.
A telehealth model grown in Victoria
The secret to mainstream adoption of video consulting lies in the framework, as opposed to the technology.
The management software and online resources are the supporting tools that have grown out of that framework and help people put it into practice.
The fact Attend Anywhere grew up in Victoria has a lot to do with the how the framework evolved. Victoria has a decentralised healthcare system; there are no shared technical networks or services, no telehealth department and no shared finance systems. Funding telehealth in Victoria was not a priority due to the state's relatively small size, so everything had to be financially sustainable.
Collaboration and co-design are at the heart of the framework, particularly with clinicians and clinic staff, and also with other program managers.
The secret to mainstream adoption of video consulting lies in the framework, as opposed to the technology.
The management software and online resources are the supporting tools that have grown out of that framework and help people put it into practice.
The fact Attend Anywhere grew up in Victoria has a lot to do with the how the framework evolved. Victoria has a decentralised healthcare system; there are no shared technical networks or services, no telehealth department and no shared finance systems. Funding telehealth in Victoria was not a priority due to the state's relatively small size, so everything had to be financially sustainable.
Collaboration and co-design are at the heart of the framework, particularly with clinicians and clinic staff, and also with other program managers.
Summary
It’s taken a long time for the technology to catch up with the vision, but the core values and principles of a decentralised, patient-centric model are more relevant today than ever.
In 2010 the Commonwealth Government set aside $50m to enable video call access to just one of Healthdirect Australia’s services, without any idea of how this could be done.
The Attend Anywhere team not only ensured that this was achieved for a fraction of the budget, but in doing so built a capability allowing thousands of public healthcare providers to embed secure video call access within their existing service offerings.
We now collaborate directly or indirectly with hundreds of healthcare providers in the public health sector.
The framework and capabilities continue to improve, with collaboration at their core.
It’s taken a long time for the technology to catch up with the vision, but the core values and principles of a decentralised, patient-centric model are more relevant today than ever.
In 2010 the Commonwealth Government set aside $50m to enable video call access to just one of Healthdirect Australia’s services, without any idea of how this could be done.
The Attend Anywhere team not only ensured that this was achieved for a fraction of the budget, but in doing so built a capability allowing thousands of public healthcare providers to embed secure video call access within their existing service offerings.
We now collaborate directly or indirectly with hundreds of healthcare providers in the public health sector.
The framework and capabilities continue to improve, with collaboration at their core.