Past time for government to move on telehealth

As the coronavirus outbreak continues to escalate amid personal protective equipment shortages and indecorous scuffles over rolls of dunny paper, we find ourselves asking a simple question. If now is not the time for the Australian government to finally drop its intransigence and introduce an MBS item number for GP telehealth, then when is?

Doctors' groups have been calling for the capability for years, particularly for housebound patients and those in residential aged care, but so far GPs have only been allowed to claim for remote consultations under very limited circumstances. This week, Australia's chief medical officer Brendan Murphy finally admitted that the government had listened and was considering the option, telling a Senate estimates hearing on Wednesday that it was also considering the possibility of allowing video consults with elderly patients and those with chronic diseases who would prefer not to venture out at the moment.

We reckon the time has come and the federal government needs to act now. There have been some complaints of mixed messages coming out of the state health departments, with advice from one state to call ahead to the GP or hospital and another to present in person, so it is essential that general practices have time to prepare and that patients know the option is there. It seems clear that a massive media campaign will need to get under way soon.

A case in point is a practice in New Zealand, which has closed its doors to walk-ins. As NZ Doctor reports today, the Auckland practice has a large overseas-born population and many patients have travelled recently via Singapore, Thailand or Hong Kong. The practice is only accepting patients with an appointment or those who are known to it, and walk-ins with symptoms will be asked to sit in their car while they are triaged by a nurse wearing protective gear.

If they are showing symptoms, the clinic's waiting room will be cleared and the patient may be ushered into an isolation room that was put aside for the measles outbreak last year.

As we've seen with the disgraceful attacks on people of Chinese descent in Australia and the current bout of toilet paper hoarding lunacy, some people are losing whatever common sense they have and these are the people who are likely to swamp emergency departments if they pick up a sniffle.

The government needs to allow GPs to be paid to provide video and telephone consultations to prevent this escalating, not just for COVID-19 itself but to manage the elderly and the chronically ill during the pandemic. And there needs to be some flexibility in this model so there are no strict requirements about technologies. Skype and Facetime will be perfectly adequate.

The US Congress has already moved to do it, introducing as part of its $US500 million emergency spending bill an authorisation to waive geographical restrictions on telehealth. This will allow Medicare reimbursement for care providers using telehealth to treat the elderly at home.

We need to do the same here. And most hospitals have telehealth and hospital in the home capabilities that should be ramped up immediately in case things get out of hand. The US Centers for Disease Control (CDC) is recommending that hospitals there use telehealth tools for patients who can be cared for at home. We should do the same.

Still in the US, and the big health IT trade association HIMSS announced today that it has cancelled its annual conference, due to be held next week in Orlando. Earlier this week some big names had begun to pull out, worried about allowing staff to attend. HIMSS today accepted that it clearly had no other choice.

This will mean the industry sadly misses out on the opportunity to hear US president Donald Trump expound about his views on eHealth interoperability. Mr Trump was due to attend the conference next week to speak on his administration's new policies, which would have been something to behold. After all, his pronouncements on coronavirus this week have been baffling, to put it mildly, so we can only imagine how he would grapple with concepts like FHIR APIs and information blocking in electronic medical records. It could have been glorious, but sadly the coronavirus has struck again.

We'll leave you with that thought and our poll question for the week: Should the government introduce a new MBS item for telehealth immediately?

Sign up to our weekend edition or Pulse+IT Chat to vote, or leave your thoughts below.

Last week, we asked: Do you support SA Health's policy not to allow uploads to the MyHR for children? Most of our readers disagreed with SA Health: 33 per cent said yes they supported the policy, while 67 per cent said no.

In light of COVID-19 and the possibility that a child diagnosed with the infection in a public health facility but has no record of it on their MyHR, we think SA Health should reconsider.


0 # Angela Conway 2020-03-07 13:27
Not just for GPs. Our paediatric practice could be severely restricted quite quickly. We are heavily booked and some of our paediatricians undertake private neonatal care. We will probably need to provide telehealth to patients in their homes, and also perhaps to newborns in private hospitals as admitted and non admitted patients. Its likely our doctors and staff will become infected, or at least be exposed to Covid-19 and may only be able to work via telehealth. It will be unsustainable if this care must be provided for minimal fees because the telehealth restrictions are maintained. I have written to the Minister of Health and invited his office to speak with us about the situation.If the Government chooses to maintain the restrictions, private community health services may be severely limited,and perhaps financially damaged beyond repair, the government will save money on Medicare rebates and foist further health costs onto State services. Allowing telehealth will allow for a much closer alignment of services with normal services.
+1 # Steven Whittington 2020-03-08 14:49
Let's not forget Allied Health practices in the call for funders to allow Telehealth. Patients won't delay seeing a GP or specialist for a health issue; however, many including mental health patients will drop out of care plans unnecessarily due to not wanting to visit in person. These patients would attend a session via Telehealth, except there is NO funding for these sessions unless conducted in person. It's about time Allied Health practitioners were respected enough by Funders to determine the clinical effect on client outcomes if appointments are held by Telehealth and fund them without discriminating.

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