Pulse+IT Blog

Telehealth restrictions a retrograde step

Debate over telehealth continued this week as the new restrictions ordered by the Department of Health came into force in a hurry. Some online appointment booking services are now asking patients trying to book a telehealth conference if they have seen a GP at that practice in the previous 12 months, with one reader telling us she had tried to book a telehealth conference to get a new referral but was knocked back because she hadn't presented there in person in over a year.

We had a lot of debate on the topic on our blog from last week, with numerous examples given of different cohorts of patients, especially vulnerable groups, who will now be prevented from accessing MBS-funded telehealth services just when they were finally given access to them. In an article in this week's MJA Insight, Elwood Family Practice GP Andrew Baird detailed a number of cases where vulnerable patients will be disadvantaged by the new rules and provides a great deal of food for thought.

Barriers to telehealth in danger of being rebuilt

Just as a long-awaited breakthrough occurred when the Australian Department of Health opened up the Medical Benefits Schedule to telehealth item numbers to help GPs deal with the coronavirus pandemic in March, that breakthrough may very well be in danger of being severely curtailed with new restrictions being placed on telehealth provision.

Under pressure from the doctors' lobby groups, Health Minister Greg Hunt announced on July 10 that restrictions would be placed on who can receive MBS-funded telehealth consults from July 20, limiting them to patients who have an existing relationship with a GP or practice and have been seen face to face in the last 12 months. Children and people at risk of homelessness remain covered.

COVID second wave threatens to swamp Melbourne Health's big bang

There's probably any number of excuses that people make to get out of training for new workplace IT systems, but “EMR training gave me the plague” is certainly a novel one. Something similar to that claim was made in a story in the Sydney Morning Herald and The Age newspapers this week, in which an unnamed doctor said Royal Melbourne Hospital was “putting staff in danger in order to satisfy their own timeline” for the roll-out of the new Epic EMR, which is due to go live next month.

Royal Melbourne, the Royal Women's and the Peter MacCallum Cancer Centre are all rolling out Epic in a big bang implementation as part of the $124 million Parkville Precinct project, which is using Royal Children's Hospital's 2016 implementation as a template. The Epic emergency department module is live at RMH and planning and training for a May go-live for the full system in the other facilities was well underway when the pandemic struck.

Turf wars pop up over telehealth

As has been widely reported here and elsewhere, the COVID-19 pandemic has seen a huge increase in telehealth provision in primary care. In Australia, MBS figures showing that 36 per cent of all GP consultations were done by telehealth in April alone, and that number is expected to remain high when the May and June figures are released. But now that the restrictions on movement are being lifted in many countries, doctors' groups like the RACGP are running a campaign to get patients back into general practice and not put off seeing their GP any longer.

In Australia, the RACGP is also running a campaign against what it is calling “pop-up” telehealth services, claiming that some of the new services are potentially providing sub-standard and inappropriate care. The AMA has joined the party and is actively lobbying the government to tighten the rules in order to prevent these services from potentially undermining the relationship between patients and their regular GP.

Digital Health CRC loses its head

We're not quite sure what's the deal here but the Digital Health Cooperative Research Centre, launched with much fanfare and buckets of cash in April 2018, has lost its second CEO in just over two years of operation.

No exact reason has been given for Victor Pantano's abrupt departure other than he has moved to find alternative employment, but it's not a great look for the initiative, which in addition to $55 million in federal government funds was pledged cash and in-kind funding from various universities and industry partners for a total of $279m over seven years.

My Health Record, eight years on

It's birthday time again for Australia's My Health Record system, which will next week celebrate eight years in operation following two years of gestation. And a difficult birth it was, as we not-so-fondly remember. Our reminiscing was inspired not just by its approaching birthday on July 1 but by a press release from the Australian Digital Health Agency, proudly boasting of a surge in use of the system during the COVID-19 crisis.

The term “surge in use” took us back to 2011 and 2012, when we were breathless with anticipation about the new baby, then known as the PCEHR. Some of our first online stories were about how the medical software industry was approaching the impending birth: first with trepidation, followed by alarm, and then with horror.

Back to the new normal

As the saying now goes, the coronavirus has brought the digital health sector 10 years of change in 10 days, but this week also brought us a reminder that some things haven't changed all that much. We refer to a return to the old normal, in which state health departments regularly struggle to procure and implement clinical IT systems large and small, as the repeated tendering for a statewide chemotherapy prescribing system in South Australia has shown us. It did it again this week.

Significant under-investment in IT systems and holding on to legacy platforms for far too long is also a constant refrain. This week, the New Zealand Ministry of Health released a current-state assessment of NZ's health assets, including buildings, infrastructure and IT, and it's not a pretty sight. The ministry is estimating that the DHBs will need $2.3 billion over the next 10 years to fix some of their legacy problems and reap the benefits of digital health systems, although even that seems a bit unambitious.

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