To telehealth via video, or not to telehealth via video, that is the question

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Doctor thinking about telehealth

While global COVID-19 infections continue to surge and the use of telehealth booms, more than 12 months into the pandemic, one statistic won’t budge – the number of physicians using telehealth video consultations.

According to statistics from the Medicare Benefits Schedule (MBS), of the 3.3 million telehealth consultations in Australia in December 2020, 93 percent were by telephone and seven percent were by video conference. Compared to the start of the pandemic, this ratio has deteriorated:  in March 2020, 89 percent of 1.3 million telehealth consultations that month were by telephone, and 11 percent were by video.

Key statistics for December 2020 Telehealth Summary

Source: University of Queensland Australia, Centre for Online Health

One explanation for the rise in telephone consultations is the government’s expansion of its telehealth Medicare items in 2020. More than 250 telehealth items were made permanent at the end of last year and these changes have permitted the widespread use of telephone consultations without a video element. Historically this has not been permitted as part of MBS telehealth.

So, how do you know if telehealth video consultations are right for your practice? To help you make an informed decision, we have compiled a list of links to helpful resources at the end of this article.

The telehealth tech gap

A study commissioned by American video technology giant, Vidyo, lists the top ten reasons why people are unsure about using telehealth video consultations in their practice. These include, in descending order:

1.     Concerns about privacy.
2.     Not enough demand to justify the expense.
3.     The cost of implementation.
4.     The complexity of implementation.
5.     Disadvantages compared to face-to-face encounters.
6.     Lack of infrastructure.
7.     Integration issues with the practice electronic health record (EHR).
8.     Lack of supportive state or national policy.
9.     Lack of data to support return on investment/outcomes.
10.  Complex reimbursement rules and regulations.

Source: Making Telehealth Work for You: The Ultimate Guide by Vidyo

Why should I use telehealth video consultations in my practice?

According to an October 2020 article in The BMG (The British Medical Journal)information regarding the benefits of video consultations versus telephone consultations is sparse, but what available studies and evidence show, is:

  • Video consultations led to high satisfaction among patients and clinicians when used by hospital outpatient clinics for patients with chronic conditions.
  • Patient preferences for, and satisfaction with, video consultations is favourably high.
  • Doctor’s attitudes towards video consultations are mixed: As a plus, telehealth provides visual cues and easier rapport; as a minus, there are concerns around burgeoning workload, reimbursement, and privacy.
  • The scope for video consultations for long-term conditions is wide and includes management of diabetes, hypertension, asthma, stroke, psychiatric illnesses, cancers, and chronic pain.
  • Video consultations can also be used for triage and management of a wide range of acute conditions including, for example, emergency eye-care triage.

Telehealth help is at hand

Deciding whether to use telehealth video consults is an issue that healthcare practice managers need to consider.

The Royal Australian College of General Practitioners (RACGP) has a publication – the Telehealth video consultations guide– to help GPs navigate the new world of telehealth video consultations. The guide focuses on telehealth video consultations covered under the MBS where a GP, practice nurse, or Aboriginal health worker is physically present with the patient to provide patient-end services during a consultation with a specialist at another location.

The guide was created to help GPs and other eligible practitioners to provide safe and effective telehealth video consultations. It outlines the clinical, administrative, and technical considerations when introducing this mode of healthcare delivery into a medical practice.

You can download a copy of the RACGP’s Telehealth video consultations guide here, as well as its other publication, Guide to providing telephone and video consultations in general practice.

Practice tip 1

If you are unsure whether or not telehealth is viable for your practice, drawing up a business plan can help you assess the broad categories of people, opportunities, context, risks, and rewards related to setting up telehealth video consultations.

Practice tip 2

It may be that telehealth video consultation facilities are used initially only by one or two GPs or other eligible practitioners in the practice who are more enthusiastic about its use and understand the benefits. As acceptance grows, more clinicians can be trained in video consultations.

Practice tip 3

If you use equipment with a wireless connection to the practice router, you may experience a significant drop in video quality in rooms that are far from the router. This is a small but important consideration when selecting appropriate rooms for video consultations.

Practice tip 4

To ensure they do not get missed, include maintenance checks of video conferencing equipment in the practice’s maintenance schedule.

Practice tip 5

If you experience issues with the quality of a consultation, use a telephone speaker phone for the audio component of the consultation. If you have poor internet coverage, muting the audio could save some bandwidth and increase the picture quality.

Helpful resources about telehealth

Learn more about the Australian Government’s guidance on specialist video consultations under Medicare:MBS online - Telehealth: Specialist video consultations under Medicare
The Royal Australian College of General Practitioners’ guide to telehealth video consultations:Telehealth-video-consultation-guide.pdf.aspx
The Royal Australian College of General Practitioners’ general guide to telehealth:Guide-to-providing-telephone-and-video-consultations-in-general-practice.pdf.aspx
The Australian Medical Association’s guidance on COVID-19 telehealthThe Australian Medical Association’s guidance on COVID-19 telehealth:
The Australian Department of Health’s report on telehealth recommendations, following a review of the Medicare Benefits Schedule:Telehealth Recommendations 2020 | Australian Government Department of Health
The Australasian College of Dermatologists has a selection of telehealth guidelines and resources on its telehealth webpage:https://www.dermcoll.edu.au/covid19updates/telehealth/
The Nursing and Midwifery Telehealth Consortia has produced two telehealth standards – one for registered nurses and one for registered midwives. The Consortia comprises the Australian Nursing and Midwifery Federation, the Australian Practice Nurses Association, the Australian College of Midwives, the Australian College of Nurse Practitioners, and CRANAplus (the Council of Remote Area Nurses of Australia). For registered nurses click here
For registered midwives click here
Telehealth and pain management for Aboriginal people is discussed in this publication by the NSW Agency for Clinical Innovation: Telehealth consultations with Aboriginal people for pain management
Telehealth considerations for Aboriginal and Torres Strait Islander health checks created by the Royal Australian College of General Practitioners and the National Aboriginal Community Controlled Health Organisation:Telehealth – considerations for an effective Aboriginal and Torres Strait Islander health check
Medicare eligibility requirements for telehealth services to support Indigenous health:Education guide - Telehealth - supporting Indigenous health
The Federal Government’s Australian Digital Health Agency’s web resources on telehealth initiatives, programs, and resources:Telehealth | Australian Digital Health Agency
The most recent MBS fact sheet (as of February 2021) from the Australian Department of Health:COVID-19 Temporary MBS Telehealth Services
The Australian Department of Health’s COVID-19 Telehealth Items Guide:COVID-19 Telehealth Items Guide
The Australian College of Rural & Remote Medicine Telehealth Guidelines:ACRRM Framework and Guidelines for Telehealth Services
The Australian Physiotherapy Association’s Telehealth Guidelines:Australian Physiotherapy Association Telehealth Guidelines
Services for Australian Rural and Remote Allied Health telehealth resources:Telehealth | Services for Australian Rural and Remote Allied Health
The University of Queensland’s Centre for Online Health has easy-to-read and up-to-date statistics about MBS activity in Australia:Telehealth and coronavirus: Medicare Benefits Schedule (MBS) activity in Australia
The University of Queensland’s Centre for Online Health has some excellent telehealth quick guides for healthcare professionals:Quick guides for telehealth
The BMJ (the British Medical Journal) has an excellent practical guide about video consultations in primary and specialist care that was published in October 2020: Video consultations in primary and specialist care during the covid-19 pandemic and beyond

Visionflex – telehealth technology that goes way beyond video conferencing to deliver the next generation of remote medical care. Learn more here.