Issue 27 / 18 July 2016

ON a recent visit to the US, it was brought home to me again how technology is transforming medical practice in a way that would have been unimaginable only a few years ago.

Colleagues, professional associations and indemnity providers I spoke to were grappling with the provision of health care via telehealth and the changes that are being embraced by patients.

Imagine being able to communicate directly with patients via a secure patient portal, or electronically writing repeat prescriptions which are transmitted direct to the pharmacist. Imagine also doing a “virtual” home visit, and using a device which can transmit heart and breath sounds, and looking into the patient’s ears and throat using an adaptor attached to a smartphone.

Better still, imagine being encouraged to do so in the interests of high quality continuing care, in an environment where 72% of hospitals and 52% of physician groups have a telemedicine program, according to a survey of 200 American health care executives conducted by Avizia.

As a GP I can understand why patients are enthusiastic about telehealth. As doctors, we often forget the disruption to our patients’ lives that even a routine face-to-face visit involves – the childcare drop-off, the trip to the practice, the wait, the consult, the trip back – a process which, even in urban areas, may take 2 to 3 hours.

I can also understand the clinical benefits. As a medical advisor at Avant, I also spend a lot of time talking to colleagues about how to ensure we adapt and engage with telehealth to ensure that risks are managed, standards are developed and patient care is safeguarded.

Telehealth revolution

To deal with some definitions first, both in Australia and overseas, telehealth and telemedicine are terms often used interchangeably to refer to the use of telecommunication techniques for the purpose of providing health care, medical education and health education over a distance.

Practically speaking, telehealth is anything that uses technology to treat a patient at a distance.

There are many different layers of telehealth with many different applications and meanings. The term encompasses anything from phone consultations with a patient; online prescription or medical certificate services; emailing an image to a specialist for a second opinion; remote video consultations involving a patient and a team of health care professionals in multiple locations; and tele-robotic surgery, with the surgeon not being in the same state, let alone the same operating theatre, as the patient. Or even technology that allows body sensors to alert a dialysis patient of rising potassium and urea levels.

Promise of telehealth

The literature is full of stated benefits of telehealth. Improving access to care is clearly one. Clinical effectiveness comparable to face-to-face care is another. Better coordination of care has been shown in overseas studies. Improvement in the care of some chronic diseases with telemonitoring has been reported in Australia.

But in concentrating on clinical or cost-effective benefits, it is often easy to forget the consumer-specific benefits which probably help drive the telehealth revolution.

Patients can feel more empowered. Some say it may provide a view into the patient’s home. Reduced waiting times and convenient access are two of the major benefits to the patient.

Risks and challenges

Although there are many benefits, telehealth in its various forms raises a number of risks and challenges. Many of these relate to the inability to examine the patient, or see the patient when video is not available. Patient selection is also clearly another.

But perhaps some of the most controversial are telehealth models which encourage episodic consultations outside an existing therapeutic relationship and the disruption of the continuity of care between doctor and patient.

An important discussion for the profession

Clearly it is important that we understand the context and the patient attitudes to telehealth consultations. In our discussions with professional colleagues about telehealth, a number of questions have particularly resonated.

What is the appropriate standard of care for consumers to expect from particular telehealth services? Who defines this standard of care, and what is the role of our professional colleges and societies in defining and outlining this standard?

Avant has produced a discussion paper on telehealth raising these and other questions, and we welcome your insights and comments.

Many of us probably feel we have enough challenges, without having to grapple with these issues. Others may already be embracing this technology and feel excited by the opportunities.

No matter our individual views, one thing is clear to me – telehealth is here to stay and will be changing the way we all work faster than many of us can imagine. We may not have a choice about whether change happens. We do have a choice about whether to prepare for it.

And that is why we need to have this discussion now.

Dr Walid Jammal is a GP and Senior Medical Advisor-Advocacy at Avant Mutual Group.

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Some guidelines are not relevant to my patients and I often ignore them
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