The debate over the Medical Board of Australia’s proposed changes to its guidelines for telehealth consultations with patients was reignited this week, with the Medical Software Industry Association taking aim at what it says are potential unintended consequences of the recommendations.
The MSIA points out that rules for a pre-digital world are not really going to hack it these days. Regulating specific technologies such as SMS-based prescriptions would be “hazardous in a fast moving technological world”, MSIA says, and quite honestly, doctors should be able to exercise their professional judgement regardless of the technology.
The MBA’s revised guidelines specifically call out prescribing for a patient with whom a doctor has never consulted. While it is not a ban, discouraging these consultations would directly affect companies like MedMate and InstantScripts that do asynchronous or questionnaire-based prescribing. Other services these companies offer such as blood test and COVID PCR test orders without seeing the patient are seemingly not considered problematic.
The MSIA argues that reducing avenues for care by effectively disallowing virtual consultations with patients could affect the safety of vulnerable people who are unable to see a regular doctor. We agree. It also removes a patient’s right to choose the method of accessing care. The RACGP and AMA have already been successful in restricting patient access to MBS-funded telehealth; we think this proposal would be another backward step.
In its submission to the Medical Board’s consultation, the Australasian Institute of Digital Health made good point that the very definitions that the board is using are a bit out of date. The guidelines for “technology-based consultations” were first issued in 2012 and the board is just getting around to revising them now, renaming them telehealth consultations in the meantime.
As the AIDH points out, telehealth doesn’t really cover the full gamut of technology-delivered healthcare, and virtual care is a more appropriate concept. There is much more to virtual care than just a doctor-patient consult by phone or video, and the guidelines really don’t take this into account.
Perhaps the MSIA’s call for a decision to be delayed until a proper consultation can be held is the right one. Otherwise, the board’s recommendations are probably going to be ignored.
Also this week, we learned that with the launch of ScriptCheckWA at the end of the month, the much touted national approach to real-time prescription monitoring will finally be complete. This has been an ongoing saga covered extensively by Pulse+IT for over a decade and to see if finally achieved is most welcome.
While WA Health will not yet make use of the system mandatory, we expect this will be the case once everyone gets used to it. NSW Health is also rolling out its SafeScript NSW on a voluntary basis. Up in banana land, Queensland Health is having a review of its requirement to look up patients in its QScript system, with the local branch of the AMA calling for exemptions to be made for emergency department patients and patients in residential aged care for practical reasons.
There’s a bit of common sense in these proposals, which accept that things have changed in a digital world and nuance rather than blanket rules is required. The Medical Board might take note.
That brings us to our poll question for the week:
Do you agree with the Medical Board’s proposed changes to its telehealth guidelines?
Vote here and comment below.
Last week we asked: do aged care providers need an incentive program to invest in resident care IT? The vast majority agreed: 91 per cent said yes.
We also asked if you voted yes, how you thought such a program could work? If no, how else could aged care providers be incentivised?
Kate, I have followed these recent postings on Telehealth. It is a new frontier. The Goy link is an interview with a colleague of mine, Dr Danny Sands, who is a world leader in e-communications with patients. [ePatients]. It may help these discussions. He has been in ausomany times (ACHI/AIDH). https://medium.com/authority-magazine/telehealth-best-practices-dr-danny-sands-on-how-to-best-care-for-your-patients-when-they-are-not-p-3c2aa5a4b22
So, do you agree with the Medical Board’s proposed changes? Most of our readers said no – 65 per cent to 35 per cent.
We also asked: If yes, what will they achieve? If no, what are the main problems? Here’s what you said:
– The definition is too narrow and misses a broad range of medical telehealth including for example teleradiology and telepathology
– Patients should be free to choose how they consult with doctors. Patients using these services do so for good reasons and are not naieve to risks.
– Appropriate care
– The outright denial that telehealth extends beyond phone and video calls. The concept of virtual care (which includes asynchronous digital health, remote patient monitoring, wearables technology, apps and digital mental health tools) need nationally-agreed safety and quality standards with an associated accreditation scheme. These standards would cover clinical and technical governance, medication safety, model of care and information security management to name a few elements. Government needs to step in, work with industry to develop these standards and override the MBA.
– Barrier to patient care and encourages ableist thought processes to continue throughout the field of medicine.
– Safer for patient.
– To prevent cowboys in the industry.
– Better standard of care delivery and medical oversight
– Patients should be given the choice of how they access and manage their own health care. Many patients know exactly what medication they need scripts for esp if repeats and quick and easy virtual care functionality to do that is great.
– Also how does the new guideline cover a patient needing to change Dr due to the Dr leaving – surely improved digital health records promote the patient choice for ongoing virtual care provision
– It will reduce the cherry, picking and fragmentation of care, so a more positive step forward would be to explore how technology can supplement good quality care, rather than fragmented into lots of little sections
– Continuity of care best practice and needs to be supported.
– Many patients have no easy access to a GP
– Reduces choice (patient and clinician,) and reduces the utility of technological innovation and options
– The doctors are just trying to protect their own turf and not do what some of their patients need them to do.
– we need to ensure that there is an adequate consultation either F2F or video between teh doctor and the patient (as a known not anonymous person (?except for STI) to practice reasonable medicine and to prevent the very ” entrepreneurial” doctors doing shonky things
– The new limitations that have been brought in are not based on research findings, but mostly based on managing perceived risks that the group have not even started to fully understand. By limiting the abilities for delivering care via technology, we’re limiting our abilities to innovate as a nation. The rules should be written such that there is trust put in the clinicians for making decisions on how best to deliver care and a framework should be created that makes recommendations for what to use in what circumstances. Blanket no on many novel approaches for delivering care is simply destructive and sets our digital transformation as a country decades back.
– Restriction of patient choice, just more anti-competitive blathering