Should video kill the audio star?
Telehealth was again a hot topic this week, with Andrew Baird's article on how GPs were using both phone and video our most popular. The AMA and RACGP have both been hard at it lobbying the federal government to extend the temporary MBS items for telehealth beyond September 30 and everyone seems to agree it would be a good idea.
Federal Health Minister Greg Hunt does too, repeatedly saying he's keen on telehealth and touting the benefits of the temporary measures. That he is in the unique position of actually being able to make them permanent but as yet has not done so seems to have escaped his notice.
When the temporary measures were introduced, it was made clear by the Department of Health that video conferencing was the preferred option, with telephone as back-up if video was not available. However, as Dr Baird reports, just three per cent of GP consultations completed in May and June this year in Australia were conducted by video, and while there are obvious barriers to telehealth, it is still hard to get a good idea of exactly why the numbers for video are so very low.
Reports from the UK and New Zealand appear to show similar low percentages of video for telehealth in general practice, although this data is difficult to interpret. The NHS data is from GP appointments and the NZ data from surveys. However, the US seems to be bucking that trend somewhat. Centers for Medicare and Medicaid Services (CMS) administrator Seema Verma says that of the nine million telehealth consults funded by CMS between mid-March and mid-June, three million have been done by telephone. CMS figures include telehealth by “eVisit” or patient portal as well as by video and there do not appear to be separate figures for this available as yet, but it seems that phone consults as a proportion of telehealth are much lower there.
While we wait for definitive research on exactly why video is so vastly underused in Australia, perhaps we could debate whether something should be done about it. Should phone consults, for example, attract a lesser rebate than video? Or should MBS-funded phone consults be restricted to regular patients who the GP knows well, while video is opened up to new patients? With video conferencing platforms offering benefits over telephone for healthcare purposes, should they not be encouraged by regulation? Let us know what you think.
In other news, we were on the money with our story earlier this week that the new chief of the Australian Digital Health Agency would be announced. We were told by several sources that former Department of Health deputy secretary Caroline Edwards was the favourite, but some late money came in for Medicare CEO Amanda Cattermole. As of Friday at 5pm, Ms Cattermole was confirmed.
Also this week, it was National Stroke Week in Australia and the WA government came to the party by announcing that it would put some funds forward towards making its telestroke service operate 24/7. Victoria has a well-established telestroke service that is now helping Tasmania with remote stroke care, and South Australia has also been running a telestroke service for a couple of years. NSW has committed to implementing its service over the next three years following a successful pilot, and New Zealand is also moving ahead with a hub and spoke model that hopefully will cover the entire country in the longer term. Australia still needs Queensland and the NT to get on board for a truly national system that the Stroke Foundation is in favour of.
We also had an interesting story on a remote monitoring platform for confirmed and suspected COVID-19 patients that is being offered to general practices in Gippsland by the local PHN. It's on offer to the Gippsland Contact Tracing Unit as well. While the platform can be hooked up to common Bluetooth-enabled devices, at the moment it is just using manual vital signs data entry and patient-reported outcomes surveys, which can be monitored by care teams and quick interventions made if the patient deteriorates.
The Gippsland project is similar in intent to other remote monitoring of COVID patient programs being run by various health services such as Sydney LHD, Western Sydney LHD and Melbourne Health. We think this sort of technology should be on offer to all COVID positive patients with mild symptoms who are recovering at home. It can then be repurposed once the pandemic is over for chronic disease management.
That brings us to our poll question for the week:
Should telehealth rebates be adjusted to promote video conferencing over telephone calls?
Vote here and feel free to leave your comments below.
Last week we asked: Will the pandemic spur the further use of remote monitoring technologies in aged care? Overwhelmingly yes, readers say. 93 per cent said yes, just seven per cent said no.