Dr Andrew Jeremijenko is CMO of TeleDr a leading Australian telemedicine company that provides video-consults through Telstra's Business Video Innovation Centre in this article he discusses how the new telehealth item numbers will lead to great things
A new era dawns, make it shine.
Telehealth service items are an important reform to make it easier for patients to access medical services and in particular specialists.
The Telehealth Service Items will commence on 1st July, 2011. Currently there is no requirement for training before starting services.
A telemedicine course that discusses the benefits and risks associated with video-consults should be considered by GPs and specialist to understand the risks and benefits of video-consultation.
Telehealth reform can be compared with the change to laparoscopic surgery as the task remains the same, but is made more complex by the tools (e.g. by the inability to touch the patient's ill area). In 1994 after the perforation of a bowel of a London woman, the BMJ wrote that 33% of surgeons conducting laparoscopic cholecystectomies were self taught and recommended guidelines, training and credentialing be introduced. Telehealth may benefit from a similar approach to ensure risks are understood and a cautious and safe approach is taken.
There is a $6000 Telehealth On-Board Incentive paid after the first consult. Large practices can receive multiple payments of $6000. (e.g 10 GPs - $60,000). Hospitals and large GP companies could potentially make millions.
Incentive payments to encourage uptake should be balanced by standards to prevent inappropriate use. The government is not mandating or endorsing any particular technical solutions.
Standards from colleges such as RACGP have not been released yet and there is a risk that this reform may fall into disrepute if there is insufficient regulation to assure both the public and the health care profession.
There are medico-legal risks as well as reputational risks and it is recommended doctors consult their insurers before doing video-consults. It is important to get expert advice and implement video-consulting properly. Lets not allow our profession's reputation be compromised like the insulaters. (24% of inspected homes under the failed government insulation scheme were substandard.)
Logistical support and co-ordination to ensure minimal time delays for both the GP and specialist should be considered. Practice nurses/ managers and IT support staff can make video-consults less painful.
A separate teleconsult room on both sides may also assist so doctors can keep working until everything is prepared.
Telehealth attendances will be audited by Medicare and incentive payments may have to be repaid. Doctors on both sides should keep careful records of all video consults.
A Senate enquiry found AHPRA's handling of the national registration process was a "dismal example of policy implementation and public administration." It is hoped this new Telehealth Service Items reform will be better implemented.
Telehealth item numbers and rapidly advancing technology have profound implications for the future of medical care. It is hoped that we can learn from the past to ensure maximum advantages and minimal disadvantages so this new era will shine.