Articles and Case Studies

Tackling Telehealth

22 Jun 2020

Telehealth patient

Tackling Telehealth

Many doctors have been thrown into the deep end of telehealth. Here's what you need to know to make it through the challenges of COVID-19 and beyond.

 

When we refer to telehealth, we’re talking about patient consultations that use any form of technology as an alternative to face-to-face consultations1 – including, but not limited to, videoconferencing, internet and telephone. You might also see telehealth referred to by other terms such as telemedicine and eHealth.

Planning a video-based telehealth service

    1. Match your patient to the service

If the patient is known to you, you should consider whether a telehealth consultation is appropriate or if a face-to-face consultation may be needed. Patients who are deaf, have limited English, live in a noisy or chaotic household,2 or have poor IT access may find telehealth challenging.

Remember that not all patients or types of consultations and presentations will be amenable to telehealth.

    2. Your location

An appropriate location is one that is quiet, situated where you won’t be overheard or disturbed, well-lit, and with a neutral background colour.

    3. Get your setup right

Getting your office space telehealth-ready is one of the basics many people overlook when starting out with telehealth consults. Like setting up the flow of your clinic room for optimal patient interaction, investing in the right setup will make you more efficient and improve both your patient’s and your own experience.

Here’s what we recommend:

  • Dual screens – a minimum requirement to allow for the patient on screen and your electronic health record on another
  • Webcam – don’t rely on built-in cameras; buy one that’s enabled for high definition (minimum 1080P)
  • Headset – these provide better audio clarity. Built-in laptop microphones may decrease your audio quality and make it harder for patients to hear what you’re saying
  • Internet provider – invest in speed
  • Lighting – try to avoid light projecting from behind you as cameras will struggle to project your face.

 

Remember that adequate care requires reasonable quality of sound and images, so you also need to consider the equipment the patient will have available. Telephone will be good enough for some consultations – block your number from the communication if using a personal mobile phone.

    4. Software

The RACGP supports the use of some free apps for telehealth provided on an ad-hoc basis, but for an ongoing telehealth service a professional platform will provide greater quality and sustainability.

    5. Administration

Consider workflow, bookings, allocation of extra time for technical aspects, and staff training.3 This may take longer than normal until staff are familiarised with the new process. You’ll need read-write access to the practice’s record system if working remotely.

    6. Consent

Consent can be verbal or written, but the patient should be aware and understand:

  • the reasons and benefits
  • the process
  • it’s not the same as face-to-face, limited examination
  • the possibility of technical problems
  • that reasonable steps will be taken to protect privacy, but can’t be guaranteed
  • security features of transmission (e.g. encryption)
  • additional costs and the assignment of benefit.

If you intend to record the consultations, seek written consent including the reason for recording, where it will be stored, and for how long.

View a sample consent form at: ehealth.acrrm.org.au/sites/default/files/content/informed%20consent%20form.pdf

    7. Documentation

Documenting telehealth consultations requires the same level of detail as face-to-face, and your notes should include the type of consultation and patient’s location. The RACGP also recommends documenting information such as:

  • the rationale for a telehealth consultation vs a physical consultation
  • responsibility for any follow-up actions
  • the presence of other parties and the patient’s consent for their involvement any technical malfunctions that may have compromised the consultation.



    8. Follow up

 

Advise the patient if a physical examination is required or urgent care is needed. Ensure good documentation, clear communication, and your usual follow-up of results or referrals.

 

Tips for telehealth consultations

 

  • If you’ve called the patient, you should verify their identity by confirming name, address and date of birth.
  • All participants should introduce themselves (including a support person).
  • Adjust the camera, lighting or chair position if needed.
  • Avoid rustling papers near the microphone, enunciate clearly, and ask the patient to repeat your instructions if you have any concerns about being heard and understood.
  • Be prepared for technical issues.
  • Assess the patient’s condition based on the history and clinical signs to justify any proposed investigation or treatment.

 

Billing and Medicare

Prior to COVID-19, Medicare rebates were available for specialist video consultations in eligible (remote, rural and regional) areas and facilities, and for GP video consultations with eligible rural and remote patients.

In March 2020, temporary item numbers were created to allow telehealth items to be billed under Medicare in response to COVID-19. These item numbers and their requirements were expanded through March and April, with regular updates posted to MBS Online and MDA National’s dedicated COVID-19 advice page. These item numbers will be available until at least 30 September 2020 and their continuing availability will be reviewed prior to this date.

Telehealth consultations may also be privately billed, without any Medicare contribution or rebate, with sound informed financial consent.

Is telehealth covered under my policy?

Telehealth is covered under MDA National’s Professional Indemnity Insurance Policy, provided both you and the patient are in Australia and the practice is in accordance with the guidelines of the Medical Board, the relevant College and Medicare.


More resources

Medical Board of Australia

Guidelines for technology-based patient consultations

Inter-jurisdictional technology-based patient consultations

RACGP

Guide to providing telephone and video consultations in general practice

Telehealth video consultations guide

mHealth in general practice

ACCRM

Telehealth guidelines

Telehealth tool kit

RANZCP

Professional Practice Standards and Guides for Telepsychiatry

RACP

Telehealth guidelines and practical tips

AMA

Position Statement: technology-based patient consultations

University of Queensland, Centre for Online Health

Quick guides for telehealth

 

References

  1. Medical Board of Australia. Definition of ‘technology-based patient consultations’ in Guidelines for technology-based patient consultations: medicalboard.gov.au/codes-guidelines-policies/technology-based-consultation-guidelines.aspx

  2. ACRRM. How to do a high quality remote consultation: acrrm.org.au/docs/default-source/all-files/how-to-do-a-high-quality-remote-consultation.pdf?sfvrsn=86d02be8_2

  3. ACRRM. Organising telehealth services in your practice: acrrm.org.au/docs/default-source/all-files/organising-telehealth-services-in-your-practice-factsheet-final_v3.pdf?sfvrsn=2a5d74a_2

Communication with Patients, Confidentiality and Privacy, Clinical, Consent, Technology, Dermatology, Emergency Medicine, General Practice, Obstetrics and Gynaecology, Ophthalmology, Psychiatry, Physician
 

Library

Career complications and contending with uncertainty

Among the many challenges of the COVID-19 pandemic for junior doctors is how to respond to medical training impacts and career uncertainty. In this podcast, Dr Caroline Elton (a psychologist who specialises in helping doctors)and Dr Benjamin Veness (a Psychiatry registrar) share advice for coping with medical training and career delays, disruptions and unknowns.

Podcasts

10 Aug 2020

Diplomacy in a hierarchy: Tips for approaching a difficult conversation with a senior hospital colleague

Resolving a disagreement or conflict can be hard and it’s a skill that needs practise. In this podcast Dr Eddie Kim (a residential medical officer), Dr Paul Eleftheriou (a chief medical officer) and Dr Kiely Kim (MDA National medico-legal adviser and general practitioner), explore top tips for approaching a difficult and possibly daunting conversation with a senior colleague. References and related resources for this episode can be viewed at www.mdanational.com.au/miscellaneous/difficult-conversations-support-material

Podcasts

05 Aug 2020