Pulse+IT Blog

RACGP view on telehealth is self-serving at best

Telehealth and its various policy and political ramifications was back in the news this week, with the Royal Australian College of General Practitioners (RACGP) again changing its policy position on MBS funding of primary care telehealth, despite previous lobbying efforts to the contrary.

We’ve been critical of the changing position of the college on Medicare-funded telehealth and its fellow travellers at the AMA in the past, but this week we saw a triple backflip with pike as Omicron swept through the land. We have witnessed the medical fraternity going from dead set against telehealth in primary care to agreeing it is essential in a pandemic, but all of this is conditional it seems on doctors’ income not being affected.

Paper route dropped in favour of eReferrals

There was welcome news in the primary care sector this week with a new trial being launched in Victoria to use secure messaging technology to inform GPs if patients at medium risk of hospitalisation for COVID-19 have tested positive. The trial is using existing secure messaging technology and vendor directories for patients receiving in-home monitoring from programs like hospital in the home or HARP, and also taps into the Victorian COVID Positive pathways program.

Hopefully, the trial will go some way to solving problems for GPs in actually knowing which of their patients are positive and may need extra support. It doesn’t really solve a problem that former AMA president Mukesh Haikerwal has raised about immediately alerting GPs to ensure at-risk patients receive treatment straight away, but it’s a start at least.

Remotely monitoring the Omicron wave

Just as telehealth dominated the last two years of digital health, remote monitoring is likely to dominate the next: that’s pretty much our prediction for the coming year or two under these strange days indeed. Everyone is getting in on the remote monitoring act and it makes sense, clinically, practically and financially.

We reckon the alleged revolution in telehealth in Australia has turned out to be overhyped in a practical sense. While the acute care sector has struggled valiantly over the years to develop funded telehealth models of care using video conferencing, the modality has not been taken up in primary care in the slightest, predominantly due to funding concerns. But when funding does comes through – such as, say, temporary MBS items during a pandemic – phone calls are not really what telehealth is all about. GPs claiming for monitoring known patients by phone should be a given under a properly funded primary care system. Unfortunately, we are stuck with fee for service so even the most minor funding shift is heralded as revolutionary.

“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.

After a decade on FHIR, where are we at?

This week saw international standards body HL7 celebrate the 10th anniversary of the adoption of the FHIR specification, which has since become one of most widely used standards in the world for healthcare interoperability. Created by Victorian Grahame Grieve and now adopted by any global health software company worth its salt, FHIR is widely touted as nothing short of a revolution in health IT.

We remember doing some of the first reporting on FHIR back in the early days, when we were alerted to the concept by former chair of HL7 Australia Klaus Veil. Klaus told us back in 2012 that FHIR was “the latest trending interoperability technology that has taken the eHealth world by storm”, and he was right. The promise was that it would be faster, easier and far more comprehensible than standards like HL7 v3, which got so bogged down in its own complexity that it was pretty much dropped.

Heading into the holidays, health sector goes heavy on the hyperbole

Pulse+IT has been running our annual eHealth year in review series this week as we wind down for an extended holiday, but we did take a bit of time out to read up on Australian health minister Greg Hunt’s announcement that telehealth will apparently become a “permanent” feature of the MBS. In amongst a lot of hyperbolic announcements amounting to what seems like eleventy billion dollars in funding for the government’s COVID-19 response, we discovered that the “permanent” telehealth measure merely amounted to just over $100 million over four years.

It appears that the guts of this measure is that a patient can be phoned or consulted by video and the GP can claim for it if they have seen that patient in person in the previous 12 months, as is allowed now under the COVID-19 provisions. The only change is the permanent bit. However, the government’s plans for voluntary patient registration are destined to restrict this further in the future to only those patients registered with one practice. It’s not exactly the free for all the press releases promise but Mr Hunt managed to roll out RACGP president Karen Price for the announcement, which is apparently all that matters.

Tech for COVID care in the community is there, but where is the money?

As the Omicron variant of the coronavirus plunges the world into new waves of restrictions and reinforces that COVID-19 is here to stay, governments around the world are struggling to communicate a long-term plan for living with the virus. This is most obvious in the public squabbles over vaccine mandates and passports, but also in shifting the burden from acute to primary care.

It is very clear that we will need to live with COVID-19 in the community for the foreseeable future, and we very much need to come up with long-term solutions on how to manage it as efficiently and financially sustainably as possible. The obvious answer is in technology solutions, of which there are many but which very much need to be backed up by long-term workforce reforms and needless to say, a bit of cash.

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