Go hard, go early
As the Australian government ups the national response to the coronavirus outbreak by banning non-essential gatherings of more than 500 people from Monday, the federal Department of Health on Friday released a package of welcome measures to try to help manage the coronavirus outbreak and the massive pressure it is destined to place on our healthcare system.
The department has made available 30-odd new MBS items that will allow GPs, specialists, nurse practitioners, psychologists and occupational therapists to treat patients remotely, either by video or telephone. The items cover not just those diagnosed with COVID-19 or requested to quarantine themselves, but vulnerable groups like the elderly and those with chronic illnesses.
Some of the items will also allow healthcare practitioners who have been exposed themselves or are in quarantine at home to continue working by telehealth. This sounds good in theory but we can see a few structural issues in the way, such as how to schedule appointments and how to remotely access software and billings systems.
We also see a problem with how this will work in practice, and Missy Higgins' dad Chris is a case in point. The Toorak GP who rose to prominence last week by being somewhat unfairly criticised by the Victorian Health Minister had about 70 patients who have been asked to self-isolate, all of whom could be handled by another GP in the practice who could take care of them in his absence, as well as his other regular patients. However, the item says that non-infected patients can only be seen by telehealth if they have had a face-to-face consultation with that specific practitioner in the previous 12 months. We think there is room for the department to be far more flexible than this during the crisis.
In fact, some doctors have called for even more flexibility. Melbourne GP Nathan Pinskier told us yesterday that he believed telehealth should be extended to the general population in the face of what could prove to be a financial crisis for general practice. AMA WA president Andrew Miller said the same today, calling for telehealth capability for all doctors and all patients. In late news, AMA federal president Tony Bartone has backed the call.
We believe the department needs to prepare itself to relax its rules and allow telehealth for all. There are justifiable fears that as the pandemic spreads, some medical practices will go under as their billings plummet when patients begin to delay non-urgent treatments like screenings, check-ups and even immunisations as they don't wish to go out in public or to places where there are sick people.
The old adage of going hard and going early is a good one: just like Kevin Rudd's stimulus package for the GFC, which has been copied by the present government, the government needs to go hard and go early to face this pandemic head on.
Another part of the $2.4 billion package announced on Wednesday was a promise to fast-track the roll-out of electronic prescribing and dispensing capabilities in what the department is calling a “development sprint”. Apart from the silliness of the term, we believe there is little chance of getting a functioning ePrescribing network up and running with the ability to generate SMS tokens in that timeframe. The specifications have certainly been developed but they have not been tried in the real world, with the first trial not scheduled to kick off until this month.
Rather than waste time fast-tracking eScripts, we need to use existing technologies that eScripts will be built on anyway: the existing prescription exchange systems eRx and MediSecure. Most GPs and pharmacies have electronic transfer of prescriptions capability now, and the department just needs to be more flexible in allowing pharmacists to dispense from faxed and emailed scripts, and even photos of those scripts, during the crisis. It will mean a lot of scripts owing, but pharmacies are used to that. The home deliveries will be the easy part; it's the rules that will be harder to overcome.
Meanwhile, the pandemic has hit the healthcare conference sector hard. HINZ has been forced to cancel its planned Innovations in Digital Health (IiDH 2020) conference in Wellington in May, IQPC has postponed Australian Healthcare Week until September, and HIMAA postponed a leadership conference until next year. Just today, the Pharmacy Guild announced the postponement of the APP conference despite its confidence earlier this week that it will go ahead. This follows the cancellation of the big HIMSS conference last week.
The good news is that with HIMSS now having some time on its hands, it can spend it sharpening its buzzword skills. It certainly has come came up a few beauties in a proposed definition of digital health that it released this week. Behold its majesty:
“Digital health connects and empowers people and populations to manage health and wellness, augmented by accessible and supportive provider teams working within flexible, integrated, interoperable, and digitally-enabled care environments that strategically leverage digital tools, technologies and services to transform care delivery.”
We are inclined to tell HIMSS to strategically leverage its tools somewhere else, but the organisation has form with weasel words. Here it is describing moving the Thai eHealth system towards “Thailand 4.0”. “Now that the foundations have been laid, it is time to address the issues at different levels of the healthcare ecosystem in order to create stakeholder synergy and harness their fullest potential.” It's gloriously awful.
Next week, Pulse+IT plans to publish some information for medical practices on the digital resources and technologies currently on the market that they use now to help manage patients during the pandemic. Vendors are encouraged to contact us to tell us what they can offer.
That brings us to our poll question for this week, which we have borrowed from the UK's Digital Health News: Will the COVID-19 outbreak speed up digital adoption?
Last week, we asked: Should the government introduce a new MBS item for telehealth immediately? This one was a bit of a no-brainer: 95 per cent said yes, just five per cent saying no.