Telstra Health goes live with 'doc around the clock'

Telstra Health has officially gone live with its ReadyCare telemedicine service, offering phone and video consultations with GPs 24 hours a day from a purpose-built facility in Sydney's Alexandria.

A joint venture between Telstra Health and Swiss telemedicine provider Medgate, ReadyCare is initially being targeted at the business-to-business market including health funds, mining companies, state governments and corporates.

It has signed its first big contract with travel insurance and medical assistance firm Cover-More, which insures 1.8 million travellers every year and handles 35,000 medical episodes. From next month, Cover-More will offer its customers the ability to call an Australian doctor 24/7 for medical assistance wherever they are in the world.

Telstra Health managing director Shane Solomon said ReadyCare was different to existing telephone advice lines in that its GPs are able to diagnose and treat medical conditions and to write prescriptions. ReadyCare GPs will be able to write a script that is then faxed to the patient's pharmacy of choice and a hard copy posted at a later date.

In addition to Medgate's evidence-based clinical guidelines and protocols – which have been Australianised from the original Swiss guidelines to take into account our interesting array of native fauna and their tendency to bite, including an impressive image library of spiders – ReadyCare has adopted the triage process used in Switzerland.

This involves the caller being triaged by a telemedicine assistant, who will then arrange a time for a GP to call back if the call is seen as appropriate. ReadyCare's chief medical officer, Amandeep Hansra, said the Swiss experience showed that about 60 per cent of callers could be assisted by telecare and the other 40 per cent were referred to face-to-face care.

However, with the use of video calls and a consumer app that ReadyCare is set to launch soon that will give patients the ability to take photos of bites or rashes and upload them to ReadyCare's cloud-based clinical software to be viewed by the GP, Dr Hansra said it was possible that the rate could be higher.

“It may be slightly different here but we'll find out,” she said. “In Australia at the moment we do have phone advice ... but with this we are adding video and images and that's what I think is going to improve our rates.”

Dr Hansra said the clinical guidelines were a decision support tool for GPs rather than the 'decision tree'-style protocols often used by nurse-led helplines. In the latter, nurses must follow the protocol whereas with ReadyCare, GPs will use their own clinical judgement.

ReadyCare is using the Clarity clinical and practice management system that Telstra Health owns following its purchase of cloud-based software vendor Cloud9 last year. Video calls will be handled initially by the BlueJeans browser-based cloud video conferencing technology.

A summary of each consultation will be sent by secure messaging to the patient's regular GP to ensure continuity of care, and the technology also has the normal prescription and referral writing capabilities.

While the joint venture is targeting the business market initially, the plan is to test the waters to gauge direct-to-consumer interest. Mr Solomon said he expected the convenience of the service to appeal to time-poor workers, new mothers, after-hours callers and those who simply cannot access a regular GP.

A consultation will cost $69 plus GST, which is comparable to a non-bulk billing GP visit, and according to ReadyCare's CEO, Gianin Zogg, the company will also offer an annual subscription plan. The cost to corporate or institutional clients will be customised, Mr Zogg said.

The plan is, however, to show that B2C telemedicine can work effectively, safely and efficiently in Australia and to provide it to GPs to use in their own practices and with their own patients, Mr Solomon said. Then the government will be able to take a good look at whether to allow GP to patient teleconsults on the MBS.

“Our whole objective here is to set it up and prove that it can be done,” Mr Solomon said. “It's very hard to get something on the MBS if it doesn't exist.”

While direct-to-consumer is part of the longer term plan, it is being tried out already through a discount offering to Telstra employees. However, Mr Solomon said the B2B market was actually larger than imagined.

“You start thinking about people in prisons, people in remote locations and mining companies, people who are insured but who don't have a regular GP and let things get to the point where they end up in the emergency department. There are a lot of B2B possibilities.

“We are testing the B2C, testing the willingness. It is routine to pay $70 or $80 for a GP visit and the rebate is $36, so you can be out of pocket by $50 anyway. We will test the consumer market and whether that convenience aspect is worth 50 bucks. I don't know the answer to that and that is something that we want to test and see if it can be translated into a consumer self-pay market in its own right.”

Mr Zogg, who helped establish Medgate in Switzerland 15 years ago, has come out to Australia to head up the new service. Medgate is now Europe's largest telemedicine provider, sees up to 4300 patients a day and has provided more than four million consultations in its time without an instance of a malpractice suit, he said.

“We are quite careful about our medical protocol system – we Swiss can't help that,” he said. “It is our mission to provide quality and cost effective immediate access to healthcare wherever you are and whenever you need it, at night or in remote areas or simply where there is no other form of access to healthcare.

“Our model is simple – it is 24/7 GP treatment including prescriptions at a distance, or to use a line from Switzerland – a doc around the clock.”

Twenty GPs have gone through two weeks of intensive training in using the system, all of them fellows of either the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine (ACRRM) or the Australasian College of Emergency Medicine (ACEM), and all of them working for ReadyCare part time and also working in traditional practice.

The company also has a clinical advisory panel that has reviewed the clinical protocols, consisting of former RACGP president Chris Mitchell, former ACRRM president Bruce Chater, and former ACEM president Sally McCarthy.

ReadyCare now plans to investigate how to begin offering the service to GPs for use in their own practice, and to test whether telemedicine will begin to reshape how healthcare can be delivered in Australia, Mr Solomon said.

“I want to emphasise that we are trying to prove something here,” he said. “We are trying to prove that [telemedicine has] quality, efficiency, safety and consumer value.

“It is a complex piece of IP, it's not just technology, but our vision is that part of every GP's normal practice will have a telemedicine component and what we're doing here is proving that it can be done.

“We can see GPs giving a proportion of their practice to patients that they know … through telemedicine. In two years' time or three years' time, this will become a normal part of everyday general practice.”

Posted in Australian eHealth

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