“Permanent” telehealth just a laundry load of nonsense

Welcome back to another thrilling year in the world of digital health, which kicked off for the new year just as we ended the old: consumed by confusion over telehealth policy. The Australian government seems to change the rules on telehealth as often as it changes its underwear and it must be said, the elastic is getting a little bit frayed.

Last Sunday, after repeated claims about telehealth being “permanent” and “10 years rolled out in 10 days”, we experienced yet another change in the rules. According to various statements from the Department of Health, health minister Greg Hunt, the AMA and the RACGP, the rules that applied to MBS-funded telehealth in the early stages of the pandemic were to be reinstated for the next six months to help general practice cope in the face of the Omicron wave.

Everyone took this to be a relaxation to the “existing patient rule” and opening telehealth up to all and sundry. It was not to be so, with the AMA clarifying later in the week that it only applied to the reinstatement of an MBS item for level C phone consults and does not return procedure to the early pandemic stages in the slightest. The AMA says it will continue to lobby for a relaxation of these rules in the short term, even though it is opposed to them in the long term. The Department of Health does not seem to be interested in clarifying anything at all.

Our contact at the department had assured us early in the week that the existing patient rule was gone for six months, as we reported on Monday, but this turns out to be incorrect. We are assured, however, that along with a relaxation in compliance measures over the 30/20 rule, no one is going to be raising concerns if GPs bill a new patient for telehealth. That is until June 30 2022, of course, when everything is probably going to change again, if not sooner. Their Bonds is their word.

Meanwhile, state and federal governments continue to reassure us that everything is going swimmingly. In NSW, Victoria and Queensland, this is patently absurd. There may have been a few highlights in our low death rate early in the response but since then it has been a disaster, from late orders for vaccines to later orders for RATs, opening up too early and opening up too late, and the ongoing aged care crisis. Nothing, though, has been more shameful than the buck passing that has gone on. The Novak Djokovic debacle was the perfect illustration. Our federation is broken, and rather than bring us together, the virus has torn us apart more than ever.

There are many who will differ on this opinion, saying our health system has stood up under terrible, once-in-a-lifetime pressure and once we are over the next wave, we’ll be right. Nonsense. If you don’t accept healthcare workers’ dire stories, how about these ones, from highly articulate, invested patients and commentators. First is an absolutely terrific long post by Medical Republic reporter Felicity Nelson on Medium, as reproduced on news.com.au. The essential role of the GP has never been brought home more clearly. Second, a deeply concerning story from SMH/The Age reporter Erin Pearson on the situation in hospitals. And finally, what GPs themselves are saying. It’s pretty bad.

Back in the world of health IT, where we develop solutions to fix these problems, the WA government finally dug into its pocket to pay for a remote monitoring solution for COVID+ people in advance of its planned opening up in early February – which has subsequently been put on hold. There are solutions galore, but in the absence of a true national strategy to response to the pandemic, all of these continue to be implemented ad hoc. From the start, the federal government has washed its hands of overall responsibility for the pandemic, placing it squarely in the hands of the states and territories. Judge each jurisdiction’s performance as you will, but in our opinion, the federal response has ranged from incompetent at best to disastrous at worst.

It is not just disappointing but deeply, deeply depressing. In the past, we have relied on our public health services to get us through these sort of catastrophes but decades of cost cutting, ideologically motivated restructuring and plain old denigration of the public service has seen sometimes amateurish people put in charge of our pandemic strategies who are unsurprisingly belittled, demeaned and undermined. Is it any wonder we are struggling with the basics?

In other health IT news there is a great deal happening, not the least in buying, selling and investing in health tech stocks. In Australia, a big sale went through with Citadel finalising its purchase of Genie Solutions for $260 million. Overseas, it got a bit bigger. While IBM struggles to offload Watson Health for less than a billion, surgical robotics firm Stryker bought Vocera Communications for close to $3 billion, and Oracle shelled out close to $30 billion for Cerner. Word is this puts Oracle into the junk stock category considering the debt it needs to take on to buy Cerner, but anyone who has betted against the world’s leading EMR vendor has always lost so far.

With changes to telehealth rules starting this year much as it was finished, our first poll for the year reflects this. Our last poll for 2021 asked: Are the MBS-funded GP telehealth plans a real game-changer, or are they just a small step? Most thought they were just a small step: 64 per cent said they weren’t a game-changer, but 36 per cent were more positive. Here’s what you thought:

Rather than go over the telehealth debacle yet again, we thought we’d ask in this week’s poll what you think will be the main trends for the coming year. Post your thoughts here or fire away in our comments below.

Will digital health be important in the COVID-19 response in 2022?

Vote here or leave your comments below.

Comments  

0 # Kate McDonald 2022-01-28 11:58
Will digital health be important in the COVID-19 response in 2022? Absolutely, our readers say: 94 per cent said yes, just four per cent said no.

We also asked why you thought so and what trends you think will come to the fore. Here’s what you said:

- More GP and more specialist visits than ever before will be by Tele health
State based RAT result upload apps; higher ePrescribing; Telehealth for referral issuing & repeat medication scripts

- As Covid continues to spread throughout the community, there will be increased demand for telephone consultations, as GPs need to further limit face to face consults to minimise their own infection risk, that of their staff and patients and remain in a position to continue to care for the community. GPs are the forgotten doctors. They are the mainstay of the health system, are self-employed, poorly paid, have no job security and do not have the financial or other supports available to employed hospital staff. The current Medicare rebates are a disgrace. The community needs to start appreciating the work GPs do and be prepared to pay for it before it’s too late.

- Increasing need to provide care and advice remotely

- Online prescriptions, regular reviews with GPs and specialists, links to care in the home

- I see a strong move to Virtual care inevitable

- Digital health services will minimise contact with health care workers and settings for diagnosis and treatment, help avoid public transport and taxi services, save time and effort and reduce carbon emmisions. Escripts are a very good current working example.

- a good solution for remote patient monitoring that doesn't exhaust patients and supports GPs

- Remote monitoring and virtual health delivery will rapidly mature into essential services.

- ePrescriptions, eReferrals, Telehealth

- shared health records being required for continuity of care with tele/videohealth

- If we think this is the last varient of covid with itss mutation rate we are sorely underprepared. Given most GP's are overworked and have been pushed to their limits with covid response, telehealth has offered a reprieve allowing for improved workflow as you type while having a phone consultation, order tests, send referrals etc. Likewise, telehealth offers a safer alternative than face to face consultations reducing the potential stress related to 'picking up' covid from a patient which could have potential impacts on a clinician's own health as well as their families.

- COVID-19 and other strains are here to stay. The Health Depts will have to stop reacting to the numbers like it is a disaster, we cannot afford that commercially, and start responding in a way that normalises how we manage COVID ongoing. Telehealth has an important part to play as a service framework across all of health, as we settle down to normality.

- Access for GPs to specialist input for suitable patients via eConsultant will be important for reducing the requirement for patients to attend face-to-face outpatient appointments. The fast turn around of this advice system will improve access, continuity of care and reduce time to non-GP specialist input.

- (1) Greater reliance on non-contact consultation and diagnosis. (2) Smarter, more capable assistive technologies in health and aged care.

- Coordination, Personalised care

- So far, all the digital spin has not lived up to its stated benefits and is overpriced, particularly when bought by the federal government based on a value for money return.

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