At least one specialist health journalist is now reporting real issues with the rapid introduction of telehealth to avoid some COVID-19 risks. See here:
4 April 2020
Telehealth on path to rip govt’s COVID plans (and general practice) asunder
How did general practice get here?
Where both the federal government and the general public aren’t aware that the profession that is their front line defence against the most serious crisis since both world wars, is rapidly drowning in front of their eyes. (See our survey story on how 50% of GP practices are reporting losing more than 30% of income).
What have we done?
How did we come to guarantee the future of the banks, private hospitals, the childcare centre industry, a good chunk of small business and a swathe of other groups , and not the people who are at the frontline of the health crisis fight of our lives and who are risking their lives each day just by turning up to work?
Is it going to be the “same as it ever was”?
Are we doomed to keep regarding general practice as a disparate group that will loyally keep coming back for more because of their patients and their love of the job?
Not this time.
If the government doesn’t step in quickly and fix this current and rapidly unfolding mess, the profession is going to be ripped apart by rapid structural change, financial ruin and technology.
And we will never be able to put it back together again.
The federal government’s well-intentioned rapid introduction of telehealth to all MBS items for GPs is starting to rip apart general practice. And no one is noticing.
Opening up telehealth had to be done. Patients were going home to isolate as was required. Doctors are too, in some cases. It was the only solution to a myriad of problems presented by the nature of the crisis.
But the simplicity of the government’s telehealth solution is looking increasingly like a recipe for a much bigger disaster than cruise ships, PPE shortages and not shutting down earlier.
Telehealth is far more complex than the government has calculated. According to experts, this is probably because the government didn’t really listen that carefully to telehealth lobbyists in the past about how they should and could introduce it to our healthcare system.
The government didn’t pay attention because the government has been, with some justification, obsessed with the idea that telehealth was too easy to abuse. It is. But telehealth experts are now pointing out that this lack of understanding is catalysing a new front in the COVID-19 crisis: the rapid degeneration, and potential collapse, of general practice.
A GP leader in the e-health space, who chose to remain anonymous, told The Medical Republic that any introduction of telehealth would always have needed significant training and education of GPs, along with appropriate funding for infrastructure, and careful planning of the MBS items to be made available.
“What the government doesn’t yet realise is that this isn’t a whole lot of extra money trickling down to primary care and it’s not supporting people on the frontline,” she said.
Vastly more here:
While it may be (indeed it is certain) that there some other factors contributing to the impact of the changes wrought by COVID-19 on GP the sudden ramp up of use remote consultation electronically is certainly a component.
The clearest indication of the truth of this is provided by a presentation given a week or so ago which was hosted by the Digital Health CRC and chaired by Dr Norman Swan via Zoom.
Here is a link to the recording of the session – it lasts a little over 1.5 hours.
The presentation title was:
COVID-19 and digital technology: The roles, relevance and risks of using telehealth in a crisis
Here is the event description:
Panel chair - Dr Norman Swan (physician and journalist)
Panellists include:
Professor Trish Greenhalgh (Primary Care Health Sciences, University of Oxford, UK)
Dr Amandeep Hansra (GP, Bondi Doctors, NSW, Australia)
Dr Neale Fong (WA Country Health Service Board Chair, WA, Australia, and medical practitioner)
Karrie Long (School of Nursing and Midwifery, La Trobe University and Director, Nursing Research Hub, The Royal Melbourne Hospital, Victoria, Australia)
Dr Daniel Stefanski (Staff Specialist Infectious Diseases Physician, Queensland Health, Queensland, Australia).
Set against the backdrop of the COVID-19 crisis, our webinar panellists will discuss the role telehealth can play in primary and secondary care. The panel will present practical strategies for healthcare professionals and outline the risks and rewards of telehealth for practitioners and patients alike.
Key topics will include how to:
- identify and adopt successful telehealth models
- modify business models for practices when implementing telehealth
- use remote triaging and online consultations to manage situations like COVID-19
- engage technology to support infection control and protect staff and patients
- best utilise existing online consultation platforms and implement new systems
- build a health workforce and patient ecosystem that is confident in using telehealth technology
- consider clinical governance issues in relation to telehealth
- select patient settings where telehealth is most valuable
- enable video consultation capability and why this might be appropriate
- address common telehealth challenges and communicate benefits
- find relevant resources and where to access support
Is COVID-19 the disruption that will lead to changes in the way we use technology over the longer term? During the discussion you will find out what our experts think.
This webinar is proudly bought to you by the Digital Health CRC in collaboration with Curtin University and La Trobe University.
Here is the link:
https://zoom.us/webinar/register/WN_b44fGZNmSTqH4WSVzIR18A (Not active now webinar is over)
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All the presenters were excellent and highly informative and expert with the special shout-out to Professor Trish Greenhalgh who skillfully showed just how much training, insight and thought was needed to undertake phone / video consultation safely and with proper record keeping.
The further you go on listening to these presentations the clearer it is that this mode of consultation is very different, has its own set of rules and needs to be undertaken with a considerable understanding of the risks / rewards of the approach.
The bottom line is that this is a really different mode of delivering care – and I am not sure there is any depth of understanding on this reality, just yet. Additionally we need to be very clear as to when we need to revert to the more usual one-on-one mode of consultation!
Watch the webinar recording and see what I mean! A lot of further work is needed.
Comments welcome.
David.
ps. There is a practical summary of how to go about telehealth here:
https://www.ausdoc.com.au/opinion/how-get-best-out-telehealth-covid19-era
Well worth a browse. The changes in work processes and adaption to new ways of working will be pretty big!
D.
ps. There is a practical summary of how to go about telehealth here:
https://www.ausdoc.com.au/opinion/how-get-best-out-telehealth-covid19-era
Well worth a browse. The changes in work processes and adaption to new ways of working will be pretty big!
D.
14 comments:
David,
are you suggesting that just implementing technology without dealing with all the other issues, problems and consequences might not be a good idea?
Golly gosh, who'd have thought it?
Not sure Technology is the real issue currently. From my observations there is a real disconnect between what the Pollies want and what the bureaucracy is willing or able to administer. I say administer because it is clear we have Policy makers and policy administrators but seem void of policy implementers.
As with telehealth this Centrelink catastrophe is about to create a lot of pain on unsuspecting citizens. The bureaucracy has created such rigid process that they are unable to operate under the new Government guidelines. My son who has kids and a mortgage has been told he cannot claim Centrelink because he was a contractor and he had money in his offset mortgage account. They have informed him he might get $ 250 sometime in mid July. So he needs to be made broke, put the family home in jeopardy. Not quite what I thought the PM and FM where telling the public.
Not sure Technology is the real issue currently
Technology is not the issue, the problem or the solution. Those selling technology would love it to be so, so they can make money.
The problem is the virus, the way it infects people and the way it transfers from person to person. It is a population health problem and self isolation is a major part of the solution and is a behavioral problem.
Contrary to what governments and others say, the virus is not deadly - statistically - most people will easily get over it, but it can cripple healthcare systems.
This is not a healthcare problem it is an organizational problem. As April 05, 2020 9:02 PM says, it is an implementation problem.
April 05, 2020 9:02 PM. I am hearing similar stories. This should concern the Health Minister as it is going to result in a spike in mental health issues and the sad outcomes that can result from this.
For the PM, this highlights that for all the rhetoric and "telling" departments they do what the Minister demands, they simply ignore any such instruction. Our government departments are broken and unable to operate in a modern age in a way that works for society.
Thanks David, interesting insights on the learning and adapting needs of using telehealth.
Not sure the "the most serious crisis since both world wars". This statement firstly ignores things like the Spanish flu and polio, secondly the pandemic and world wars are in different ball parks.
As for all this "technology" being deployed to track and report on patterns, I do hope we know how to turn it off once this is over.
> ignores things like the Spanish flu
Not sure about the others, but this one. Without modern medical support, the CFR rate for this one appears to roughly match the 1918 flu. (Beware media CFR reports - it's never clear whether they are reporting treated/untreated rates and how much they area allowing for collapse of healthcare systems)
But this is very different from 1918 because we have deeper and fragile information and supply lines compared to then - so we should expect a much deeper impact.
When you say impact - what impact do you mean? I am interested rather than nit-picking I ask as the fact the world is less isolated today as it was in 1918. It may also mean that communities are more resilient than they would have been in 1918. The linkage to war is perhaps that the WW1 trenches would have been the perfect breeding grounds for infections among the WW1 soldiers, who in turn then dispersed around the globe. Deaths might also have been a direct result of the appalling living conditions at this tragic time in human history and the medical tools and knowledge available.
Somewhere in the region of 50 million are thought to have died from the 1918 pandemic – compared to 2 million for the Asian flu (the mid-1960s), and over half a million for the 2009 swine flu, both of which had a mortality rate of less than 1% as I understand.
As a world, we have come along way, and some have shown that ignorance and hesitation are not optimal, what will need to be learned from this is how to balance the forces that go towards a stable modern age.
A deeper impact? That's comforting, considering the Spanish flu killed between 50 and 100 million.
Technology even then had its problems and failed promises
How the telephone failed its big test during 1918’s Spanish flu pandemic
https://www.fastcompany.com/90484820/how-1918s-spanish-flu-outbreak-crushed-the-u-s-telephone-system
I think that we'll have less death because of all the advances in health since then - way less deaths - 2 orders of magnitude, generally. But I think the impact on our lifestyles will actually be much more invasive and long-lasting. In particularly, the nationalization of supply chains that we're seeing evidence of this week ... going to be nasty.
Yes I see your concern. There will be much that will need undoing, some will be reluctant to hand back their pieces of pie.
The question that needs raising is - how long should the world quarantine America? Seem to me all travel in and out needs to be stopped for at least 18 months least the world face deadlier levels of reinfection amd possible evolved strains that are more deadly. The world needs to recover and quickly from this. To isolate just 4% of humanity to ensure safety of the rest is a small sacrifice.
Trump should have built that Mexican wall of his. And another one to keep Canadas safe.
Global Stock Market - that is a very good question. We certainly need to consider locking the US out for a while they seem to have lost control of the situation and do present a very real risk. China had travel restriction placed on them and that helped.
Create an app that delivers benefits and it gets used:
Emergency app saves lives in Australia’s bushfire disaster
https://www.healthcareitnews.com/news/europe/emergency-app-saves-lives-australia-s-bushfire-disaster
and then there's all those telehealth solutions.
If My Health Record had any meaningful benefits to GPs or patients, after 7 years everyone would have one.
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