This appeared a few days ago.
Telehealth and digital health navigators – a bright future for health delivery
Marie McInerneyon: July 09, 2020 In: Coronavirus outbreak 2019-2020, digital technology, general practice, health workforce, Healthcare and health reform, primary health care, Public health and population health, rural and remote health
Introduction by Croakey: The long-awaited access to telehealth consultations in the coronavirus pandemic has been broadly embraced by patients and health care providers, though it is not without concerns.
In the UK, the “telemedicine revolution”, which has come much faster than the NHS Long Term Plan anticipated, has been critical to continuing healthcare provision during the crisis but it has come at a cost for many of experience “digital exclusion”, according to this recent article in the BMJ.
Amid other concerns, the Royal Australian College of General Practitioners (RACGP) last week called for an urgent overhaul to telehealth and telephone consultations to ensure patients “steer clear of corporate telehealth pop-ups which have proliferated” amid the Federal Government’s expansion of Medicare-subsidised telehealth and telephone consultations.
The RACGP had long supported expanded telehealth and telephone consultations, which have helped decrease the risk of spreading COVID-19 to patients and practice staff and made care more accessible for vulnerable patients, said President Dr Harry Nespolon.
“But we have been deeply concerned to see the rise of more and more pop-up telehealth businesses offering low value medical services. These businesses promise a ‘quick fix’ for patients but there is no commitment to the ongoing care of the patient,” he said.
The RACGP is urging that telehealth services should only be accessible to patients through their regular GP, saying the evidence is clear that patients who have an ongoing relationship with their GP report higher levels of satisfaction and better health outcomes.
In the article below, previously published at John Menadue’s Pearls and Irritation blog, Professors Peter Brooks and Brian Oldenburg and Dr Stephen Duckett provide a road map to this “exciting time in health care”.
Peter Brooks, Stephen Duckett and Brian Oldenburg write:
Telehealth is not new in Australia but Covid-19 and the new Medicare item numbers have stimulated its rapid adoption across the country.
It is clear patients like it. They do not need to expose themselves to potentially dangerous environments such as hospitals and clinics.
It saves them time whether in rural or urban environments and it delivers care – and patient education, in their own environment.
Appropriate models of ‘virtual ‘care delivery need to be refined and appropriately funded with Medicare item numbers that are robust and include a wide range of services and individual health professionals.
Telehealth will make a big difference to care delivery around the world with a ‘new’ digitally enabled health workforce needing to be trained.
In Australia we must not revert to the health system we had pre-COVID-19 and we must train health professionals and patients alike to accept ‘virtual’ is just another way of communicating.
Institutionalising telehealth
Of the many changes to everyday life during the COVID-19 pandemic has been the massive growth in billed telephone consultations and video consultations.
The majority seem to be voice or text but the public have lapped up this new way of interacting and getting advice. After the pandemic, the health system – professionals and payers – need to institutionalise telehealth as a valid, useful and efficient part of the new health system.
Australia, especially Queensland with its dispersed population over vast distances, has been a leader in telehealth implementation and research for many years.
The Queensland Telehealth Unit has supported local telehealth initiatives, de-emphasising adoption of the latest technology, in favour of developing systems and processes which make telehealth sustainable within the budgets of local health services, for example, showing that telehealth implementation can reduce patient transport costs met by hospitals.
The University of Queensland-based Centre for Research Excellence in Telehealth supported cutting edge innovation and evaluation to show what worked and what didn’t. And this has helped inform a significant cultural change to adopt telemedicine broadly across Queensland Health facilities.
Other Australian states such as Western Australia have already adopted a plan to convert 30-40 percent of outpatient attendances to virtual consultations over the next few years.
Interestingly other countries have been much more open to embracing telehealth in their health systems. In the US, health care provider Kaiser Permanente said in 2016 over 50 per cent of some 100 million consultations undertaken were by telehealth and the Veterans Affairs system – which provides care to 10 million veterans – used telehealth in over 70 percent of interactions, up from around 10 percent over a three-year period.
It is not that there has been no interest in telehealth in Australia over the past 20 years; rather, it is just that uptake has been incredibly slow and unsupported until the last few months, with the introduction of a range of new telehealth item numbers primarily for doctors and nurses and allied health professionals.
Interestingly, although the traditional telephone was supposed to be the back-up if video were not available, telephone appears to be the dominant medium used with the new items.
Over the past few months many hospitals and health professionals are now conducting more than 50 percent of their interactions with patients ‘virtually’ – and it took COVID-19 to make us change our (health professionals’) behaviour.
Cultural change and leadership required
If these recent sudden changes are to be maintained in the future, it is important that health consumers are also supported in this ‘brave new world’ and that more effort is put into using video and more contemporary technology to manage complex chronic conditions at home.
This change, while enabled by technology, has to be a cultural change – but it will require leadership and the recognition that we need to engage consumers in decisions around the type of health care they want and how they want it delivered.
Telehealth provides a real opportunity for genuine patient participation in clinical decision making and in engaging patients in designing a health system that works for them as well as for health professionals and the payers.
Think, for example, the real savings (financial and time – which also has a monetary value, let alone a contribution to carbon emission reductions) to be gained by using telehealth when it takes around 2-2.5 hours and significant costs for transport and parking to keep a 20-minute health care appointment in the middle of most cities in Australia.
We know the benefits of telehealth to the rural/remote sector – we need to acknowledge them in urban settings as well.
Telehealth can also be used for patient and professional education, for expanding the reach of clinical trials so that those in rural areas have same access to new therapies as those living in our major population centres, home monitoring and many other health related activities including patient education.
The road ahead
As/when we emerge from the current ‘social distancing’ phase, it will be important to look at all of the ways in which health care can be delivered more effectively and efficiently to health consumers by using available technology.
More commentary here:
https://croakey.org/telehealth-and-digital-health-navigators-a-bright-future-for-health-delivery/
Clearly we are going to see a significant use of remote care provision into the future beyond the end of “COVIDTimes” – whenever that turns out to be in some distant future.
Crucial to all telehealth care delivery is the need for care to be delivered in a structured and properly organised and documented fashion with a clear recognition that there are real limitation to such care delivery and that there should be an easy conversion to face-to-face care if those limits are reached.
It is vital that quality of care is not compromised for the sake of convenience.
The rapid adoption and use of telehealth has also highlighted some potential for abuse and fraud which the Government has moved to address. See here:
Govt unveils restrictions on telehealth
The MBS items will be restricted to practices who have seen the patient face-to-face in the last 12 months
10th July 2020
MBS telehealth items will be restricted to GP practices with an existing relationship with the patient, starting 20 July, the Federal Government has announced.
The change – demanded by the RACGP and AMA to preserve continuity of care – will apply everywhere except Melbourne and the Mitchell Shire, the two areas in Victoria currently under stay-at-home orders.
The definition of a relationship will be having seen the same GP, or a GP at the same practice, face-to-face in the last 12 months before the telehealth consultation takes place.
The restrictions will apply to all the temporary GP telehealth items introduced in March under the government's COVID-19 measures.
Australian Doctor is seeking to clarify whether the items for other specialists and allied health providers will also be changed.
However, consultations with infants under 12 months of age, or with people who are homeless, will be exempt.
RACGP president Dr Harry Nespolon said the new rules would ensure telehealth was “not exploited”.
More here:
https://www.ausdoc.com.au/news/govt-unveils-restrictions-telehealth
This seems pretty sensible and will help reduce the risk of overuse and fraud while hopefully providing an uplift to the quality and continuity of care.
The rush to get this going with the pandemic was always going to leave some aspects a little rough around the edges and I expect some more tweaks in the future.
I hope some evaluation studies of quality, use and safety of these systems, and the surrounding processes, are being conducted.
David.
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