Issue 8 / 23 August 2010

The Prime Minister’s recent election promise to fund Medicare rebates for online consultations was good news, but the way the rebate is structured might represent a missed opportunity to really improve the efficiency and productivity of the medical workforce using technology.

Around 10 years ago, I along with three other GPs developed OzDocsOnline, a system which provides a web-based doctorpatient communication platform for prescribing, communicating test results, making referrals and e-consultations.

The system is growing nationally, partly because it’s easy to use, secure and integrates with practice desktop applications. Patients pay a fee for the service by credit card.

Like the impetus for the latest funding announcement, we created the product to address the lack of time for face-to-face consultations and as a conduit for delivering test results to our patients.

Given that the medical workforce is ageing and patients with chronic diseases require more monitoring, we wanted to engineer a new care delivery method to complement our practices.

The danger in focusing Medicare funding on patient videoconferencing is that it replicates the current face-to-face system, without adding much value, but still requires the same amount of workforce resources, if not more.

In my experience, early versions of technology tend to try to replicate the current way of doing things without using the technology’s inherent power.

For example, the earliest versions of software for keeping electronic consultation notes emulated paper notes and were typed in without a useful data structure.

Computers add value by providing searchability, pattern recognition and predictability.

When data is captured in this way it can be aggregated and used to improve patient outcomes.

Using asynchronous consultations, either text-based or via uploaded video, the doctor can attend to the patient without being interrupted or using up scarce face-to-face time.

OzDocsOnline allows patients to have asynchronous, non-urgent, online consultations with their GP or specialist through a secure web interface.

This system has been used in place of over 4000 consultations.

We find these online consultations fit in well with our normal workdays, and patients love having direct access to mini-consultations with their own GPs ― enhancing the doctor-patient relationship.

The advantages of asynchronous consultation include the fact that requests from patients are clearer, doctor-patient dialogue is opened up, “phone tag” is eliminated and patients have fewer return visits ― increasing the productivity of both parties.

An automatic record of the consultation is generated for incorporation into the clinical record but, unlike email, it is a structured system with failsafe mechanisms.

The doctor’s email address remains private throughout.

The online system also allows for direct communications between allied health providers and specialists, generating an interactive, shared online health record for coordinated care.

A Medicare rebate for asynchronous telemedicine consultations would extend access to a greater range of patients, especially those with transport difficulties and disabilities, and will go a long way to addressing many of the challenges facing health care delivery in Australia.

Dr Lajoie is a GP in Sydney. She launched OzDocsOnline, which currently processes around 200 online consultations per month, in 2003.

Posted 23 August, 2010

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