Telehealth in the time of coronavirus

Despite the release last Friday by Australia's Department of Health of new item numbers for telehealth, lobbying continued this week by a number of doctors' groups as well as the Consumers Health Forum to allow any patient consultation to be handled by telehealth if clinically appropriate.

There was a slight relaxation of the rules this week to remove the term “usual GP” from the requirements, allowing a doctor from the same practice to see a patient remotely if their usual doctor isn't available. Midwives and obstetricians have also been given item numbers to use telehealth to monitor women remotely, but there is still a great deal of confusion out there.

In a comment on our story about the Australian GP Alliance (AGPA) and the Australian Medical Association (AMA) joining other doctors' groups in calling for an extension to the rules covering the new MBS telehealth item numbers, practice director Angela Conway makes clear just how frustrating the situation is for specialist practices as well as general practice.

Such is the confusion that MBS expert Margaret Faux has sprung into action, setting up a daily Q&A to try to explain questions about billing for telehealth, not just on the MBS but from health funds as well.

The New Zealand government also took action this week on telehealth, allocating $20 million from its $500 million coronavirus package to expanding telehealth provision. The actual details of what it will be spent on remain unclear, but there is an extra $20 million for its Healthline national advice line, which is fielding seven times more calls per day than normal.

We expect the pressure will remain on governments to remove more restrictions on telehealth as the pandemic grows. It is happening overseas: in Canada, Ontario says it is shifting to a virtual-first model. The province is set up well through the Ontario Telemedicine Network (OTN) and healthcare providers are being encouraged to use virtual care whenever appropriate. Ontario’s Ministry of Health has also introduced temporary billing codes to support the effort.

The UK is well ahead on that front as well, with GPs advised two weeks ago to assess patients remotely where possible.

This week, NHS clinicians have been told that they can use apps like WhatsApp “where the benefits outweigh the risk” to share information about coronavirus. Discussing patients on WhatsApp was previously a big no-no.

Even the US is joining the party, with the Centers for Medicare & Medicaid Services this week releasing details of its expansion of payments for telehealth for Medicare recipients. Geographic restrictions have been removed, and the agency within the US Department of Health and Human Services responsible for privacy and administering the HIPAA act has eased restrictions on the technology that providers are allowed to use. The OCR has promised it won't impose penalties on providers who use non-HIPAA-compliant remote communications technology during the pandemic.

Unsurprisingly, there wasn't much other news this week although Fred IT and its subsidiary eRx did announce the availability of MedView Flow, which will help pharmacists manage the different types of scripts they will soon be seeing with the advent of electronic prescriptions. Whether they are scanned in from paper scripts, scanned in from tokens, ordered online or sent in by text, email or through consumer apps, MedView Flow promises to give pharmacists a single view of their dispensing workflow.

As we reported last week, the federal government wants to fast-track the rollout of eScripts to help with the pandemic, and the pharmacy software vendors are up for it. The GP software vendors on the other hand have enough on their plate with requirements such as implementing the new secure messaging standards and integrating the National Cancer Screening Register in their software, not to mention helping customers with the new telehealth items and all of their normal work. We still can't see how electronic prescriptions will be up and running in eight weeks without some divine intervention.

By far our most popular story this week has been our list of technologies being released to help with the pandemic. We are updating this resource every day and are still happy to hear from vendors who are releasing new or updated tools to help their users. We also plan to categorise each entry before the list gets a bit too unwieldy. More information is coming in from the hospital technology sector along with remote monitoring tools, and from Monday we'll be adding in some information on technologies for aged and community care.

Speaking of which, we had a chat this week to two seriously impressive young health IT entrepreneurs who have developed quite simple technologies that can be used to unobtrusively monitor older people at home or keep in contact with them. We'll have those stories next week.

In the meantime, in our poll last week we asked: Will the COVID-19 outbreak speed up digital adoption? A clear majority were positive: 80 per cent said yes, 20 per cent said no.

This poll mirrors one conducted by the UK's Digital Health News, and they had a similar outcome, with 87 per cent of its readers saying they believe the outbreak of Covid-19 will help speed up the adoption of digital tools across the NHS.

That brings us to our poll question for this week: Should governments relax restrictions on telehealth even further?

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


0 # Angela Conway 2020-03-21 13:35
A Conway back to report on our very difficult week- we are sure that our decision to shift most of our service delivery to telehealth has been the right one. Its costing us dearly but our doctors actually care about their patients and about maintaining their capacity to keep providing care. I have rarely met a doctor who would deviate from this commitment. Despite this, federal health seems wedded to the conviction that providers are inherently dishonest, rapacious and cannot be trusted to inform policy or to be professional and responsible regarding Medicare rebates for appropriate telehealth delivery of normal necessary care. It has taken them decades and a week of panic to finally acknowledge (sort of) the unworkability of the bulk bill consent forms in telehealth. Just one more thing we had to allocate and waste extremely scarce resources on this week.

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