The fax fights back

In welcome news today, Australian Health Minister Greg Hunt announced that the temporary MBS item numbers for telehealth introduced in March have now been made permanent. Telehealth has been hugely popular, and even better news is that neither Mr Hunt nor the Department of Health has been silly enough to take it away once the floodgates were opened. Hopefully further changes will be made in future to remove the requirement that the patient must have seen the GP in the previous 12 months to be eligible for MBS funded telehealth, which we have argued in the past is a backward step.

In a similarly retrograde step, New Zealand's Ministry of Health has dropped its directive that healthcare organisations ditch the use of analogue faxes by next month. It appears that the telecommunications providers are still supporting faxes for the time being, and from what New Zealand Doctor is reporting, those still using them for healthcare purposes weren't paying much attention to the ministry's directive anyway. The fax lives to fight another day.

NSW Health has finally come to the real-time prescription monitoring party, making provision in last week's budget to introduce a system. We asked but eHealth NSW didn't tell us how much was set aside or whether a tender will be issued. NSW is in discussions with pharmacy system and prescription exchange vendor Fred IT to join the National Data Exchange (NDE) but Fred is currently very busy on this front. Fred is working with WA Health at the moment on entering the NDE as well as rolling out versions of the SafeScript system it built for Victoria to South Australia and Queensland. NSW will probably do the same, or select the other option of the national ERRCD system developed by XVT Solutions, which WA is going to use. After years of dithering, it's good to see NSW finally getting this done.

There was also funding put aside in the budget for a new laboratory information management system. Similar to the RTPM system, the single LIMS was mentioned in the budget but no firm numbers were attached. This will be a big undertaking for NSW Health Pathology, which uses three different systems at the moment, and will be running alongside another big job in the roll out of a single digital patient record in the state. Bringing together the many instances of the state's two EMRs and the different patient administration system versions with the new LIMS will be a fascinating project to watch.

As will the development of the national Health Information Platform (nHIP) in New Zealand, which is now back underway following a postponement for the pandemic. A request for information on the provision of a number of foundational elements of the nHIP is out at the moment. The Ministry of Health is taking a federated approach to bringing data and services together for the platform using an API ecosystem. At the core of the system is a data service that will provide access to federated sources of health data that are stored in a variety of technology platforms and a record locator service to establish where trusted sources of data can be found. The ministry wants patients and providers to be able to securely access the data service on phone and web apps and is looking for ideas on a consent model for this as well. Interesting stuff.

Finally, there was a big report out this week from the Aged Care Industry IT Council (ACIITC) as part of its CARE-IT research project. This report – which is excellent, by the way, and can be found here – is probably the first national technology benchmarking step for the industry in Australia and gives some good insight into what technologies are being used and what are the barriers to uptake. (Cost, mainly.) There were some interesting facts on telehealth and telecare, with just on half of all aged care organisations using telehealth in a sector where it could do so much good.

ACIITC committee chair and report co-author Anne Livingstone told a webinar this week that if aged care providers are to invest in technologies, they need to be assured of a return on that investment. This sort of benchmarking is a good first step.

That brings us to our poll question for the week:

Is cost the main factor in aged care's digital divide?

Vote here and feel free to leave your comments below.

Last week, we asked: is the Health API Gateway model a good first step in modernising the national infrastructure? Most agreed: 81.5 per cent said yea, 18.5 per cent said nay.


0 # Andrew Baird 2020-12-08 15:28
Re: Hopefully further changes will be made in future to remove the requirement that the patient must have seen the GP in the previous 12 months to be eligible for MBS funded telehealth, which we have argued in the past is a backward step.
This requirement does not necessarily support continuity of care. It simply supports the in-person consultation as the preferred mode of consultation for a patient who has not consulted a GP within the previous 12 months.
For example, a patient has not attended their regular general practice, A, for 15 months. The patient wants a telehealth consultation with a GP at practice A. The patient is not eligible for a Medicare rebate for this. The patient is eligible for a Medicare rebate for an in-person consultation with a GP at practice A.
However the patient has difficulty getting to practice A, which is why the ;patient wanted a telehealth appointment. The patient can't get a Medicare rebate for a telehealth consultation at practices B, C, and D, but the patient can get a Medicare rebate for an in-person consultation at practices B, C, and D.
So the patient decides to attend practice B for an in-person consultation.
This compromises rather than enhances continuity of care. A patient who is regular patient at practice A is now attending a different practice, practice B, for a consultation - with a Medicare rebate.
So the restriction is supporting in-person consultations, and potentially compromising continuity of care at the expense of telehealth consultations.
This will disadvantage many people in disadvantaged groups, rural residents, people with mental illness, people with mobility problems, young people, people with access difficulties (eg transport), etc
If there must be a restriction, it would be more reasonable to:
1. Restrict Medicare rebates to GPs who work at Practices that also provide in-person consultations, or
2. Set up a system of enrolment, so that patients only get Medicare rebates (for in-person and for telehealth) at the Practice with which they are enrolled.(exemp tions would be authorised by the Practice)

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