Queensland calls for MBS item for GP-to-patient telehealth
A Queensland parliamentary committee that has conducted an extensive inquiry into telehealth services in the state has recommended that GPs be able to bill Medicare for direct telehealth consultations with patients, and that priority be given to implementing the NBN in remote communities.
Chaired by LNP MP Trevor Ruthenberg, the committee has been holding a series of public consultations and site visits since March, following the allocation by Queensland Health Minister Lawrence Springborg in last year's budget of $30.9 million over four years to set up a rural telehealth service.
While the committee found that Queensland Health currently has good telehealth infrastructure, it was difficult for clinicians to access, particularly on mobile devices, and was not yet providing a great deal of benefit to patients.
In addition to recommendations that the Minister for Health make representations to his federal counterpart to amend the MBS to enable GPs to bill for patient consultations, the inquiry has also recommended that the eligibility requirements in metropolitan areas be revised so that the elderly and people with a disability or in palliative care can also receive Medicare-funded telehealth services.
It also recommended that the Queensland government propose to the Commonwealth that priority be given to implementing the NBN in remote communities to provide better access to health services for Aboriginal and Torres Strait Islander peoples and other remote residents.
It also wants the Department of Health to give greater priority to improving connectivity for clinicians wanting to use the existing infrastructure through personal devices, and to consider setting up a statewide telehealth scheduling system to coordinate telehealth in the state.
While the inquiry found that Queensland has one of the largest managed telehealth networks in Australia, it also found that much of the existing infrastructure was not being put to the best use.
In his foreword to the inquiry's report (pdf), Mr Ruthenberg made the point that although there has been significant investment in infrastructure in the past, and that infrastructure is highly regarded, the use of it for the benefit of patients remains low.
This echoes common criticisms that while most hospitals have video conferencing suites, they are often found in boardrooms and meeting rooms and are not accessible for clinical purposes. The report cites a submission from the Australasian Telehealth Society (ATS), which noted that video conference endpoints are commonly in conference or seminar rooms that are unsuitable for clinical consultations, and ad hoc clinical uses cannot be accommodated.
“The ATS argued that Queensland Health should focus telehealth expansion on incorporating video communication into routine IT systems, selecting appropriate software, and prioritising video traffic over traffic such as email and web browsing,” it says.
While Queensland Health says bandwidth across its facilities is generally very good, with 70 per cent of Queensland Health facilities connected to the state's fibre optic networks, the report found that in the areas where telehealth is most beneficial – western Queensland and remote areas – many facilities did not have reliable internet.
“During a visit to Thursday Island the committee observed that the quality of videoconferencing to Torres Strait islands was highly variable and, in some instances, not of sufficient quality for a clinical consultation,” the report says.
“The committee noted the remoteness of some islands, the substantial improvements in health care that could be achieved if this barrier was overcome, and that the financial investment required would be significant.”
Some islands use a mixture of microwave broadband and copper links, but these are often affected by the weather. Satellite infrastructure could be explored, but the report notes that the effect of time delays can be an issue for telehealth.
“The committee suggests that the technical barriers to high quality telehealth in remote communities should be addressed with some urgency, particularly in those locations with a high proportion of Aboriginal residents and high rates of chronic disease.
“The committee recommends that the Queensland Government propose to the Commonwealth that priority be given to implementation of the National Broadband Network in remote communities to provide better access to health services for Aboriginal and Torres Strait Islander peoples and other remote residents."However, the report also echoes the common opinion that greater telehealth provision is not so much a technical challenge as one of coordination and workflow change management. “With a few exceptions, technology and infrastructure are not barriers to greater use of telehealth in Queensland,” the report states. “Clinician engagement emerged as an important factor in overcoming the barriers to the greater use of telehealth.”
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