Tuesday, September 22, 2015
Another Example Of Why We Really Need To Upgrade The Leadership And Governance Of E-Health.
This appeared earlier in the week:
Monday, 14 September, 2015
AUSTRALIA lacks nationally consistent telehealth clinical standards as its rollout gathers pace and new business models enter the field, say leading telehealth proponents.
Rural GP Dr Ewen McPhee, chair of Queensland Health’s Telehealth Advisory Committee, said a lot of work had been devoted to developing telehealth standards, but Australia still lacked a consistent, national framework for clinical governance.
“There are so many players who want to be a part of this space, but the issues around clinical safety, confidentiality and consent are all in a state of flux in Australia”, Dr McPhee told MJA InSight.
“It’s such that people don’t quite know what they are consenting to and what the implications are in telehealth and home monitoring. We certainly don’t explain it well”, said Dr McPhee, who has successfully integrated telehealth into his practice in Emerald, Queensland.
His comments came as the American College of Physicians released a position paper last week outlining an overall approach to the development of telemedicine in the US. (1)
The 13-point position statement aims to help balance the benefits of telemedicine against the risks to patients.
An accompanying editorial noted that: “The innovation that telemedicine promises is not just doing the same thing remotely that used to be done face to face but awakening us to the many things that we thought required face-to-face contact but actually do not”. (2)
Dr McPhee said his practice’s telehealth model had developed around existing clinical relationships with medical consultants, which had provided a “safety net”. However, he said as services began to offer consultations with specialists the treating GP did not know, issues with clinical governance might come to the fore.
“The most important thing about referrals is good clinical handover”, Dr McPhee said. “It’s not just about … the convenience of it all — it’s asking, has this actually improved the care of this person? Has there been a positive outcome from this event, or is it just another way of promoting a business model?
“We need to think more deeply into how we implement telehealth. We need to think about the evidence for what works and what doesn’t.”
Dr Victoria Wade, clinical director of Adelaide Unicare e-Health and Telehealth Unit, agreed that Australia had failed to develop nationally consistent models of telehealth care.
“About 30% of the population might live in a telehealth-eligible area, but the number of telehealth consultations is way under what it potentially could be”, said Dr Wade, who is also a research fellow at the University of Adelaide.
Here are some useful references:
If ever there was an area of e-Health that has been the victim of non-strategic dis-coordinated leadership and governance telehealth is it. E-Health Division of DoH and the Communications Department (NBN) have each funded initiatives and the success from both groups have crossed over, messed up and achieved very variable outcomes.
It is time the proposed ACeH was given a mandate to properly govern and encourage the area and to evaluate what is working - as much certainly is - and then foster and encourage the successes while being open to trials of potentially valuable initiatives that can be bought to critical mass and evaluated for continuing support.
It is not that hard - just needs some nouse, consultation with the proper stakeholders and decent leadership!
Posted by Dr David More MB PhD FACHI at Tuesday, September 22, 2015