Development and evaluation of a program to improve clinician and patient communication during a telehealth consultation : C.R.I.S.P. Telehealth

Introduction: The delivery of health care in the 21st century will look like no other in the past. The fast paced technological advances that are being made will need to transition from the information age into clinical practice. The phenomenon of e-Health is the over-arching form of information technology and telehealth is one arm of that phenomenon. The uptake of telehealth both in Australia and overseas, has changed the face of health service delivery to many rural and remote communities for the better, removing what is known as the tyranny of distance. Many studies have evaluated the satisfaction and cost-benefit analysis of telehealth across the organisational aspects as well as the various adaptations of clinical pathways and this is the predominant focus of most studies published to date. However, whilst comments have been made by many researchers about the need to improve and attend to the communication and relationship building aspects of telehealth no studies have examined this further. The aim of this study was to identify the patient and clinician experiences, concerns, behaviours and perceptions of the telehealth interaction and develop a training tool to assist these clinicians to improve their interaction skills. Methods: A mixed methods design combining quantitative (survey analysis and data coding) and qualitative (interview analysis) approaches was adopted. This study utilised four phases to firstly qualitatively explore the needs of clients (patients) and clinicians within a telehealth consultation then designed, developed, piloted and quantitatively and qualitatively evaluated the telehealth communication training program. Qualitative data was collected and analysed during Phase 1 of this study to describe and define the missing 'communication and rapport building' aspects within telehealth. This data was then utilised to develop a self-paced communication training program that enhanced clinicians existing skills, which comprised of Phase 2 of this study to develop the interactive program. Phase 3 included evaluating the training program with 26 clinicians and results were recorded pre and post training, whilst phase 4 was the pilot for future recommendations of this training program using a patient group within a Queensland Health setting at two rural hospitals. Results: Comparisons of pre and post training data on 1) Effective communication styles, 2) Involvement in communication training package, 3) satisfaction pre and post training, and 4) health outcomes pre and post training indicated that there were differences between pre and post training in relation to effective communication style, increased satisfaction and no difference in health outcomes between pre and post training for this patient group. The post training results revealed over half of the participants (N= 17, 65%) were more responsive to non-verbal cues and were better able to reflect and respond to looks of anxiousness and confusion from a 'patient' within a telehealth consultation. It was also found that during post training evaluations, clinicians had enhanced their therapeutic communication with greater detail to their own body postures, eye contact and presentation. There was greater time spent looking at the 'patient' with an increase of 35 second intervals of direct eye contact and less time spent looking down at paperwork which decreased by 20 seconds. Overall 73% of the clinicians were satisfied with the training program and 61% strongly agreed that they recognised areas of their communication that needed improving during a telehealth consultation. For the patient group there was significant difference post training in rapport with a mean score from 42 (SD = 28, n = 27) to 48 (SD = 5.9, n = 24). For communication comfort of the patient group there was a significant difference between the pre and post training scores t(10) = 27.9, p = .002, which meant that overall the patients felt less inhibited whilst talking to the clinicians and more understood. Conclusion: The aim of this study was to explore the characteristics of good patient-clinician communication and unmet training needs for telehealth consultations. The study developed a training program that was specific for telehealth consultations and not dependent on a 'trainer' to deliver the content. In light of the existing literature this is a first of its kind and a valuable contribution to the research on this topic. It was found that the training program was effective in improving the clinician's communication style and increased the satisfaction of patient's within an e-health environment. This study has identified some historical myths that telehealth cannot be part of empathic patient centred care due to its technology tag.

Automatic segmentation of choroidal thickness in optical coherence tomography

The assessment of choroidal thickness from optical coherence tomography (OCT) images of the human choroid is an important clinical and research task, since it provides valuable information regarding the eye’s normal anatomy and physiology, and changes associated with various eye diseases and the development of refractive error. Due to the time consuming and subjective nature of manual image analysis, there is a need for the development of reliable objective automated methods of image segmentation to derive choroidal thickness measures. However, the detection of the two boundaries which delineate the choroid is a complicated and challenging task, in particular the detection of the outer choroidal boundary, due to a number of issues including: (i) the vascular ocular tissue is non-uniform and rich in non-homogeneous features, and (ii) the boundary can have a low contrast. In this paper, an automatic segmentation technique based on graph-search theory is presented to segment the inner choroidal boundary (ICB) and the outer choroidal boundary (OCB) to obtain the choroid thickness profile from OCT images. Before the segmentation, the B-scan is pre-processed to enhance the two boundaries of interest and to minimize the artifacts produced by surrounding features. The algorithm to detect the ICB is based on a simple edge filter and a directional weighted map penalty, while the algorithm to detect the OCB is based on OCT image enhancement and a dual brightness probability gradient. The method was tested on a large data set of images from a pediatric (1083 B-scans) and an adult (90 B-scans) population, which were previously manually segmented by an experienced observer. The results demonstrate the proposed method provides robust detection of the boundaries of interest and is a useful tool to extract clinical data.

Food and Brisbane households : dietary, social and health consequences of food insecurity

Background & Aims: Access to sufficient amounts of safe and culturally-acceptable foods is a fundamental human right. Food security exists when all people, at all times, have physical, social, and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Food insecurity therefore occurs when the availability or access to sufficient amounts of nutritionally-adequate, culturally-appropriate and safe foods, or, the ability to acquire such foods in socially-acceptable ways, is limited. Food insecurity may result in significant adverse effects for the individual and these outcomes may vary between adults and children. Among adults, food insecurity may be associated with overweight or obesity, poorer self-rated general health, depression, increased health-care utilisation and dietary intakes less consistent with national recommendations. Among children, food insecurity may result in poorer self or parent-reported general health, behavioural problems, lower levels of academic achievement and poor social outcomes. The majority of research investigating the potential correlates of food insecurity has been undertaken in the United States (US), where regular national screening for food insecurity is undertaken using a comprehensive multi-item measurement. In Australia, screening for food insecurity takes place on a three yearly basis via the use of a crude, single-item included in the National Health Survey (NHS). This measure has been shown to underestimate the prevalence of food insecurity by 5%. From 1995 – 2004, the prevalence of food insecurity among the Australian population remained stable at 5%. Due to the perceived low prevalence of this issue, screening for food insecurity was not undertaken in the most recent NHS. Furthermore, there are few Australian studies investigating the potential determinants of food insecurity and none investigating potential outcomes among adults and children. This study aimed to examine these issues by a) investigating the prevalence of food insecurity among households residing in disadvantaged urban areas and comparing prevalence rates estimated by the more comprehensive 18-item and 6-item United States Department of Agriculture (USDA) Food Security Survey Module (FSSM) to those estimated by the current single-item measure used for surveillance in Australia and b) investigating the potential determinants and outcomes of food insecurity, Methods: A comprehensive literature review was undertaken to investigate the potential determinants and consequences of food insecurity among developed countries. This was followed by a cross-sectional study in which 1000 households from the most disadvantaged 5% of Brisbane areas were sampled and data collected via mail-based survey (final response rate = 53%, n = 505). Data were collected for food security status, sociodemographic characteristics (household income, education, age, gender, employment status, housing tenure and living arrangements), fruit and vegetable intakes, meat and take-away consumption, presence of depressive symptoms, presence of chronic disease and body mass index (BMI) among adults. Among children, data pertaining to BMI, parent-reported general health, days away from school and activities and behavioural problems were collected. Rasch analysis was used to investigate the psychometric properties of the 18-, 10- and 6-item adaptations of the USDA-FSSM, and McNemar's test was used to investigate the difference in the prevalence of food insecurity as measured by these three adaptations compared to the current single-item measure used in Australia. Chi square and logistic regression were used to investigate the differences in dietary and health outcomes among adults and health and behavioural outcomes among children. Results were adjusted for equivalised household income and, where necessary, for indigenous status, education and family type. Results: Overall, 25% of households in these urbanised-disadvantaged areas reported experiencing food insecurity; this increased to 34% when only households with children were analysed. The current reliance on a single-item measure to screen for food insecurity may underestimate the true burden among the Australian population, as this measure was shown to significantly underestimate the prevalence of food insecurity by five percentage points. Internationally, major potential determinants of food insecurity included poverty and indicators of poverty, such as low-income, unemployment and lower levels of education. Ethnicity, age, transportation and cooking and financial skills were also found to be potential determinants of food insecurity. Among Australian adults in disadvantaged urban areas, food insecurity was associated with a three-fold increase in experiencing poorer self-rated general health and a two-to-five-fold increase in the risk of depression. Furthermore, adults from food insecure households were twoto- three times more likely to have seen a general practitioner and/or been admitted to hospital within the previous six months, compared to their food secure counterparts. Weight status and intakes of fruits, vegetables and meat were not associated with food insecurity. Among Australian households with children, those in the lowest tertile were over 16 times more likely to experience food insecurity compared to those in the highest tertile for income. After adjustment for equivalised household income, children from food insecure households were three times more likely to have missed days away from school or other activities. Furthermore, children from food insecure households displayed a two-fold increase in atypical emotions and behavioural difficulties. Conclusions: Food insecurity is an important public health issue and may contribute to the burden on the health care system through its associations with depression and increased health care utilisation among adults and behavioural and emotional problems among children. Current efforts to monitor food insecurity in Australia do not occur frequently and use a tool that may underestimate the prevalence of food insecurity. Efforts should be made to improve the regularity of screening for food insecurity via the use of a more accurate screening measure. Most of the current strategies that aim to alleviate food insecurity do not sufficiently address the issue of insufficient financial resources for acquiring food; a factor which is an important determinant of food insecurity. Programs to address this issue should be developed in collaboration with groups at higher risk of developing food insecurity and should incorporate strategies to address the issue of low income as a barrier to food acquisition.

Hepatitis C, mental health and equity of access to antiviral therapy : a systematic narrative review

Introduction Access to hepatitis C (hereafter HCV) antiviral therapy has commonly excluded populations with mental health and substance use disorders because they were considered as having contraindications to treatment, particularly due to the neuropsychiatric effects of interferon that can occur in some patients. In this review we examined access to HCV interferon antiviral therapy by populations with mental health and substance use problems to identify the evidence and reasons for exclusion. Methods We searched the following major electronic databases for relevant articles: PsycINFO, Medline, CINAHL, Scopus, Google Scholar. The inclusion criteria comprised studies of adults aged 18 years and older, peer-reviewed articles, date range of (2002--2012) to include articles since the introduction of pegylated interferon with ribarvirin, and English language. The exclusion criteria included articles about HCV populations with medical co-morbidities, such as hepatitis B (hereafter HBV) and human immunodeficiency virus (hereafter HIV), because the clinical treatment, pathways and psychosocial morbidity differ from populations with only HCV. We identified 182 articles, and of these 13 met the eligibility criteria. Using an approach of systematic narrative review we identified major themes in the literature. Results Three main themes were identified including: (1) pre-treatment and preparation for antiviral therapy, (2) adherence and treatment completion, and (3) clinical outcomes. Each of these themes was critically discussed in terms of access by patients with mental health and substance use co-morbidities demonstrating that current research evidence clearly demonstrates that people with HCV, mental health and substance use co-morbidities have similar clinical outcomes to those without these co-morbidities. Conclusions While research evidence is largely supportive of increased access to interferon by people with HCV, mental health and substance use co-morbidities, there is substantial further work required to translate evidence into clinical practice. Further to this, we conclude that a reconsideration of the appropriateness of the tertiary health service model of care for interferon management is required and exploration of the potential for increased HCV care in primary health care settings.

Galectin-1 : a link between tumor hypoxia and tumor immune privilege

Purpose: To identify a 15-KDa novel hypoxia-induced secreted protein in head and neck squamous cell carcinomas (HNSCC) and to determine its role in malignant progression. Methods: We used surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS) and tandem MS to identify a novel hypoxia-induced secreted protein in FaDu cells. We used immunoblots, real-time polymerase chain reaction (PCR), and enzyme-linked immunoabsorbent assay to confirm the hypoxic induction of this secreted protein as galectin-1 in cell lines and xenografts. We stained tumor tissues from 101 HNSCC patients for galectin-1, CA IX (carbonic anhydrase IX, a hypoxia marker) and CDS (a T-cell marker). Expression of these markers was correlated to each other and to treatment outcomes. Results: SELDI-TOF studies yielded a hypoxia-induced peak at 15 kDa that proved to be galectin-1 by MS analysis. Immunoblots and PCR studies confirmed increased galectin-1 expression by hypoxia in several cancer cell lines. Plasma levels of galectin-1 were higher in tumor-bearing severe combined immunodeficiency (SCID) mice breathing 10% O 2 compared with mice breathing room air. In HNSCC patients, there was a significant correlation between galectin-1 and CA IX staining (P = .01) and a strong inverse correlation between galectin-1 and CDS staining (P = .01). Expression of galectin-1 and CDS were significant predictors for overall survival on multivariate analysis. Conclusion: Galectin-1 is a novel hypoxia-regulated protein and a prognostic marker in HNSCC. This study presents a new mechanism on how hypoxia can affect the malignant progression and therapeutic response of solid tumors by regulating the secretion of proteins that modulate immune privilege. © 2005 by American Society of Clinical Oncology.

Promoting self-determination for better health and wellbeing for adolescents who have an intellectual disability

The focus of this paper is on an Australian research project that evaluated the effectiveness of a resource called the Ask Health Diary, which is used in the school curriculum to promote self-determination for better health and wellbeing for adolescents who have an intellectual disability. Education and health researchers used questionnaires and interviews to gather data from adolescents attending special schools and special education units located in secondary schools in south-east Queensland, their teachers and their parents/carers. This paper reports on two research questions: First, ‘How did the teachers use the Ask Health Diary to promote self-determination in health?’, and second, ‘How did teachers, parents/carers and students perceive the benefits and value of the Ask Health Diary?’ The findings indicate that the Ask Health Diary provides a sound curriculum framework for teachers, adolescents and parents/carers to work together to promote self-determination and better health outcomes for young people who have an intellectual disability.

Placement Trajectory : mapping the journeys of children and young people in out-of-home care

Significant problems confront our child protection out-of-home care system including: high costs; increasing numbers of children and young people entering and remaining in care longer; high frequency of placement movement; and, negative whole-of-life outcomes for children and young people who have exited care. National policy and research agendas recognise the importance of enhancing the evidence base in out-of-home care to inform the development of policy, programs and practice, and improve longitudinal outcomes of children and young people. The authors discuss the concept of placement trajectory as a framework for research and systems analysis in the out-of-home context. While not without limitations, the concept of placement trajectory is particularly useful in understanding the factors influencing placement movement and stability. Increasing the evidence base in this area can serve to enhance improved outcomes across the lifespan for children and young people in the out-of-home care system.

The impact of the built environment on health across the life course : design of a cross-sectional data linkage study

Introduction: The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course. Methods and analysis: This cross-sectional data linkage study involves 15 954 children (0–15 years), young adults (16–24 years), adults (25–64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australia's (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants’ residential address was geocoded and features of their ‘neighbourhood’ were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages. Ethics and dissemination: The University of Western Australia's Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents.

Prevention of Alcohol-Related Crime and Trauma (PACT) : brief interventions in routine care pathway – a study protocol

Background Globally, alcohol-related injuries cause millions of deaths and huge economic loss each year . The incidence of facial (jawbone) fractures in the Northern Territory of Australia is second only to Greenland, due to a strong involvement of alcohol in its aetiology, and high levels of alcohol consumption. The highest incidences of alcohol-related trauma in the Territory are observed amongst patients in the Maxillofacial Surgery Unit of the Royal Darwin Hospital. Accordingly, this project aims to introduce screening and brief interventions into this unit, with the aims of changing health service provider practice, improving access to care, and improving patient outcomes. Methods Establishment of Project Governance: The project governance team includes a project manager, project leader, an Indigenous Reference Group (IRG) and an Expert Reference Group (ERG). Development of a best practice pathway: PACT project researchers collaborate with clinical staff to develop a best practice pathway suited to the setting of the surgical unit. The pathway provides clear guidelines for screening, assessment, intervention and referral. Implementation: The developed pathway is introduced to the unit through staff training workshops and associate resources and adapted in response to staff feedback. Evaluation: File audits, post workshop questionnaires and semi-structured interviews are administered. Discussion This project allows direct transfer of research findings into clinical practice and can inform future hospital-based injury prevention strategies.

Professional conversations : a collaborative approach to support policy implementation, professional learning and practice change in ECEC

In 2012, Australia introduced a new National Quality Framework, comprising enhanced quality expectations for early childhood education and care services, two national learning frameworks and a new Assessment and Rating System spanning child care centres, kindergartens and preschools, family day care and outside school hours care. This is the linchpin in a series of education reforms designed to support increased access to higher quality early childhood education and care (ECEC) and successful transition to school. As with any policy change, success in real terms relies upon building shared understanding and the capacity of educators to apply new knowledge and to support change and improved practice within their service. With this in mind, a collaborative research project investigated the efficacy of a new approach to professional learning in ECEC: the professional conversation. This paper reports on the trial and evaluation of a series of professional conversations to support implementation of one element of the NQF, the Early Years Learning Framework (DEEWR,2009), and their capacity to promote collaborative reflective practice, shared understanding, and improved practice in ECEC. Set against the backdrop of the NQF, this paper details the professional conversation approach, key challenges and critical success factors, and the learning outcomes for conversation participants. Findings support the efficacy of this approach to professional learning in ECEC, and its capacity to support policy reform and practice change in ECEC.

Variability of metal composition and concentrations in road dust in the urban environment

Urban road dust comprises of a range of potentially toxic metal elements and plays a critical role in degrading urban receiving water quality. Hence, assessing the metal composition and concentration in urban road dust is a high priority. This study investigated the variability of metal composition and concentrations in road dust in 4 different urban land uses in Gold Coast, Australia. Samples from 16 road sites were collected and tested for selected 12 metal species. The data set was analyzed using both univariate and multivariate techniques. Outcomes of the data analysis revealed that the metal concentrations in road dust differ considerably within and between different land uses. Iron, aluminum, magnesium and zinc are the most abundant in urban land uses. It was also noted that metal species such as titanium, nickel, copper and zinc have the highest concentrations in industrial land use. The study outcomes revealed that soil and traffic related sources as key sources of metals deposited on road surfaces.

Malnutrition coding shortfalls in Australian and New Zealand hospitals

Aim The International Classification of Diseases, version 10, Australian modification (ICD-10-AM) is used to classify diseases in hospital patients in Australia and New Zealand. ICD-10-AM defines malnutrition as ‘[body mass index] BMI <18.5 kg/m2 or unintentional weight loss of ≥5% with evidence of suboptimal intake resulting in subcutaneous fat loss and/or muscle wasting’. The Australasian Nutrition Care Day Survey (ANCDS) is the most comprehensive survey to evaluate malnutrition prevalence in acute care patients from Australian and New Zealand hospitals. This study determined if malnourished participants were assigned malnutrition-related codes according to ICD-10-AM. Methods The ANCDS recruited acute care patients from 56 hospitals. Hospital-based dietitians evaluated participants' nutritional status using BMI and Subjective Global Assessment (SGA). In keeping with the ICD-10-AM definition, malnutrition was defined as BMI <18.5 kg/m2, SGA-B (moderately malnourished) or SGA-C (severely malnourished). After 3 months, in this prospective cohort study, staff members from each hospital's health information/medical records department provided coding results for malnourished participants. Results Malnutrition was prevalent in 30% (n = 869) of the cohort (n = 2976) and a significantly small number of malnourished patients were coded for malnutrition (n = 162, 19%, P < 0.001). In 21 hospitals, none of the malnourished participants were coded. Conclusions This is the largest study to provide a snapshot of malnutrition coding in Australian and New Zealand hospitals. Findings highlight gaps in malnutrition documentation and/or subsequent coding, which could potentially result in significant loss of casemix-related revenue for hospitals. Dietitians must lead the way in developing structured processes for malnutrition identification, documentation and coding.

Promoting active lifestyles in young children: investigating mothers’ decisions about their child’s physical activity and screen time behaviours

Objectives Given increasing trends of obesity being noted from early in life and that active lifestyles track across time, it is important that children at a very young age be active to combat a foundation of unhealthy behaviours forming. This study investigated, within a theory of planned behaviour (TPB) framework, factors which influence mothers’ decisions about their child’s 1) adequate physical activity (PA) and 2) limited screen time behaviours. Methods Mothers (N = 162) completed a main questionnaire, via on-line or paper-based administration, which comprised standard TPB items in addition to measures of planning and background demographic variables. One week later, consenting mothers completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their child’s PA and screen time behaviours during the previous week. Results Hierarchical multiple regression analyses revealed support for the predictive model, explaining an overall 73% and 78% of the variance in mothers’ intention and 38% and 53% of the variance in mothers’ decisions to ensure their child engages in adequate PA and limited screen time, respectively. Attitude and subjective norms predicted intention in both target behaviours, as did intentions with behaviour. Contrary to predictions, perceived behavioural control (PBC) in PA behaviour and planning in screen time behaviour were not significant predictors of intention, neither was PBC a predictor of either behaviour. Conclusions The findings illustrate the various roles that psycho-social factors play in mothers’ decisions to ensure their child engages in active lifestyle behaviours which can help to inform future intervention programs aimed at combating very young children’s inactivity.

Research roadmap summary - Integrated Design and Delivery Solutions (IDDS)

Changes in the construction sector are creating opportunities in research to maximise the benefits of those changes and to continue the exciting developments in improved people skills, new processes and developing technologies. Many research centres around the world are investigating aspects of the current changes to drive their particular expertise forward. However, the CIB Integrated Design and Delivery Solutions (IDDS) priority research theme takes a higher-level view of the changes and then focuses down on a prioritised set of research targets. These targets have been investigated, re-focussed and validated over a period of four years through many workshops, conferences and meetings by a wide ranging group of representatives from approximately 90 industry and research organisations. The outcomes of such research, once put into practice should be significantly shortened timespans from conception of need to occupation of new or revised structures. As time is money, the owners will get their investments into productive use sooner, which means a shorter payback time. In addition, there will inevitably be a reduction in construction costs as productivity increases. The improvements in reliable delivery and improved quality currently being seen in relatively simplistic use of Building information Modelling (BIM) (compared to full IDDS) will inevitably continue its on-going trajectory of improvement. We should also consider the wider economic contribution to society that will stem from such improvements and, finally, and by no means unimportantly, the reliable modelling and delivery of sustainability at both the building and estate/ area scale will significantly improve carbon footprints and other sustainable outcomes. Whilst there are huge opportunities for early adopters, the primary risk will be the expansion of the gap between those working in this way and those who are not so advanced or who even refuse to progress . The opportunities to address the significant and widely varying wastes within the structure of the construction sector and within and across projects are huge and timely and industry is encouraged to become involved.

Research roadmap report : Integrated Design and Delivery Solutions (IDDS)

Changes in the construction sector are creating opportunities in research to maximise the benefits of those changes and to continue the exciting developments in improved people skills, new processes and developing technologies. There are many research centres around the world investigating aspects of the current changes to drive their particular expertise forward. However, the CIB Integrated Design and Delivery Solutions (IDDS) priority research theme takes a higher-level view of the changes and then focuses down on a prioritised set of research targets. These targets have been investigated, re-focussed and validated over a period of four years through many workshops, conferences and meetings by a wide ranging group of representatives from approximately 90 industry and research organisations. This roadmap prioritises and details the research to be performed, why and by whom. In particular, some 25 CIB Working Commissions and Task Groups are explained as having potential roles in the delivery of this research theme. We are extremely privileged to have been urged on by such distinguished construction professionals in their forewords and the case for research. The outcomes of such research, once put into practice should be significantly shortened timespans from conception of need to occupation of new or revised structures. As time is money, the owners will get their investments into productive use sooner, which means a shorter payback time. In addition, there will inevitably be a reduction in construction costs as productivity increases. The improvements in reliable delivery and improved quality currently being seen in relatively simplistic use of Building information Modelling (BIM) (compared to full IDDS) will inevitably continue its on-going trajectory of improvement. We should also consider the wider economic contribution to society that will stem from such improvements and, finally, and by no means unimportantly, the reliable modelling and delivery of sustainability at both the building and estate/ area scale will significantly improve carbon footprints and other sustainable outcomes. Whilst there are huge opportunities for early adopters, the primary risk will be the expansion of the gap between those working in this way and those who are not so advanced or who even refuse to progress1. However, a similar issue arises between industry, clients, educators and trainers; the latter have particular challenges, having existed for many years in a sector that has had relatively few technological changes. However, the opportunities to address the significant and widely varying wastes within the structure of the construction sector and within and across projects are huge and timely. Whilst this Roadmap is specifically targeted at the Standing Commissions and Task Groups of the CIB, it is hoped that there are elements for research and applied research across academia and industry.