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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.
She said there had been steady growth in the uptake of telehealth, but overall use remained low. Medicare Benefits Schedule-rebated telehealth specialist consultations had increased in the past three financial years — 46 389 (2012‒2013), 67 108 (2013‒2014) and 84 390 (2014‒2015).
Dr Wade said some successful telehealth models had been developed at local and state levels — such as the Australian College of Rural and Remote Medicine’s Tele-Derm model, and the Queensland Telepaediatric Service — but the lack of national models of care hindered the effective and widespread implementation of telehealth. (3), (4)
“It’s different in every jurisdiction because they have all been started by enthusiasts”, she said.
Efforts to develop guidelines and frameworks had trailed off due to a lack of funding, said Dr Wade, who was involved in the development of telehealth guidelines for ACRRM and other colleges. (5)
“The Commonwealth really abandoned its responsibility”, Dr Wade said. “It had the opportunity to develop a national approach to this and it didn’t, it just gave project funding to a lot of different people and then wandered off.”
Australia was also seeing the rise of “Uber” models of telehealth, she said, referring to the Uber rideshare service, where banks of specialists were made available nationally for one-off telehealth consultations.
This model was not well suited to some specialties such as psychiatry, where the development of a doctor–patient relationship and knowledge of local health services was essential.
Dr Wade said the next wave of telehealth — mobile health and health apps for home monitoring — was moving quickly and was promising, but researchers were struggling to evaluate the effectiveness of the many apps being released.
“We need more research on what apps actually work, but the field is developing so quickly, it’s difficult for the research to catch up”, she said.
(Photo: Andy Dean Photography / shutterstock)
Telehealth services work well where there is a coordinator managing all the services. We are accessing TH services in SEQ, AMS’s and the model is working well both for ad hoc & pre-scheduled telehealth consultations with specialists. I also think the flexiblity of the program is working in our favour as it enables us to utilise TH whenever the need arises without too much red taping. It has also saved a lot of money for organisations that cannot invest in point to point VC systems, which end up being an inhibiting factor, since it restricts who you can access via VC. The only major impeding factor according to me, was stopping funding for support officers, as they are crucial in successful utilisation of TH services. I was also invovled in the developement of the ACRRM standards and TH protocols and those are easily adaptable to all contexts. The ACRRM Provider Directory is the most valuable resource for accessing TH specialists in Australia, and so far I have been able to coordinate hundreds of TH consults with specialists from our AMS’s. We work in an urban environment and the 15km rule doesn’t apply to us as we are AMS, and as is seen there is still a big need in the urban areas, so removing the 15km rule for all patients will see a huge growth in the TH numbers. I will be evaluating the program as a part of my Phd and this will give us some literature on successful implentation of TH services, hopefully.
Views & Comments are my own & do not represent any organisation.
What rural GPs want is to engage with local services, ie, to the consultants in the local or capital city base hospital we would normally refer to but because of time, distance and waiting times have problems. If patients with complex chronic conditions could be managed by a mix of outpatient appointments or private specialist visits and then telehealth consults WITH THE SAME SPECIALIST we would save time (and money) and be able to manage the load better. Consults with interstate remote specialists who then recommend they need to see a (local) specialist just fragments care. I don’t use the telederm service because of this. I either biopsy the lesion or rash myself and get the pathologist’s opinion, and/or send (via email in the absence of any other method) a high quality photo to our local dermatologist who will comment on it despite his 8 month waiting list for consults.
a point of clarification– The Australian College of Rural and Remote Medicine’s TeleDerm Model which has been operatng continuously for over 10 years is a National Model.. not a ‘local or state model’ as referred to in this article.
ACRRM Telehealth Guidelines amd resources are freely available at http://www.ehealth.acrrm.org.au