Given the success of telehealth during the COVID-19 pandemic for patients and health case workers, it’s about time it was made permanent in Australia.
On April 26, Health Minister Greg Hunt announced that telehealth rebates for GPs, specialists, nurse practitioners, allied health and some dentists would be extended to the end of 2021 to take some pressure off hospitals.
Until such time as the federal government makes permanent the provision of federal funding of telehealth, we will continue to see uncertainty in the healthcare market, discouraging those health professionals who have not yet embraced telehealth from learning about it, and from properly equipping their practices with the necessary digital technology to afford patients with this option.
In a recent article in The Australian Financial Review, Tom Burton highlights the benefits of out of hospital care, which should focus our minds on what our health system could look like as we emerge from the Covid pandemic. Health systems in Australia and around the world have dramatically changed the model of healthcare from a hospital to community focus, taking some of the pressure off hospitals and their staff, and allowing them to concentrate on those in need of inpatient care (whether it be from a Covid related issue or other acute condition).
Patients are clearly enthusiastic about these changes, appreciating the fact that not attending clinics or hospitals reduces their risk of exposure to infections (including but not limited to Covid), reduces travel time and individual carbon footprints, and often provides care in a more culturally diverse environment.
Discussions about the merits of developing a policy strategy for telehealth in Australia are not new, and pre-date the Covid pandemic, as indicated by the results of a policy forum “Telehealth Futures”, conducted in October 2019 under the auspices of the University of Queensland’s Centre for Health Services Research.
As it is evident, whilst new models of care have by necessity been accelerated by the pandemic, there has been a slow realisation over the last two decades that good healthcare can be provided using telehealth and a range of other digital technologies.
New technologies such as telehealth, including their mode of delivery, of course need to be shown to be of benefit to patients and appropriately funded, just as is required for medicines on the PBS or services provided through Medicare.
For 21st century primary health care, we need bold and brave leadership
And it is important to understand that telehealth is not just about technology.
It is also about culture, including the attitudes and behaviours needed as we create a safe and appropriate health system for the future, to deliver care to all. We need to monitor and research new ways of using technologies, and evaluate their efficacy and cost effectiveness. This includes all the research we normally do in any health intervention we deliver.
We must also ensure we have a workforce able to use these technologies, and that the system (including any new technology) does not create health inequalities, which can so easily arise.
And we need to provide the community with basic information about these systems and how they can assist patients to be better engaged with their own and their families’ health care, and perhaps even with the health of their neighbour.
Funding of telehealth should obviously be subject to appropriate guidelines that prevent cost overruns, though these are unlikely, given that the majority of such “virtual” services should be an “option” to face-to-face consultations.
Of course, regular reviews should accompany any major government program such as this.
Guidelines should make funding conditional on the health provider having an ongoing relationship with the patient. Any virtual consultation should be able to facilitate participation by other carers and family members if appropriate.
It is instructive to see how far telehealth has advanced in comparable overseas jurisdictions.
In the US, Kaiser Permanente delivered over 50 per cent of its 100 million consultations in 2018 via telehealth, and over the period between 2016 and 2018, the VA Health arm of the US Department of Veteran Affairs — which delivers care to 10 million Veterans and 1000 institutions — radically changed its model of care to provide 70 per cent of its services by telehealth.
A recent US literature review surrounding the utilisation of telehealth (what the Americans call “telemedicine”) articulates the case for fully immersing telehealth services into the healthcare landscape. In the UK, the NHS has developed a long term plan for virtual care, building on the Topol Review, which provided an extensive roadmap for future virtual health systems pre-Covid. Importantly, this followed wide consultation with all levels of society — “Liberating the NHS: No decision about me without me“.
Telehealth is just another way of communicating with patients, and their carers and families.
It must be seen as part of any health delivery system — allowing patients the opportunity of having a face-to-face consultation, a telehealth interaction or just a phone call or text message.
Telehealth will not work for everyone, and its benefits and safety will vary depending on each clinical circumstance.
Participants — health professionals and patients — need to understand what each communication modality brings to the health professional interaction and engage in an exercise of joint decision making to determine which “communication interface” is best for that particular clinical circumstance.
Many groups, such as the Centre for Online Health at the University of Queensland, have developed guidelines for use of telehealth to gain maximum benefit, as well as providing information on research data underpinning these innovations.
In conclusion, telehealth funding must become a permanent feature of our health system.
Patients and health providers need certainty.
The upcoming federal election provides a good opportunity for all political parties to demonstrate their willingness to embrace and harness the power of new and more efficient ways of delivering healthcare.
If the success of a Covid-induced telehealth option is any guide, patients, it seems, are receptive to such change.
Peter Brooks trained in medicine as a rheumatologist and has a major interest in health workforce reform in particular new models of care with role substitution and team care. He established the first Physician Assistant program in Australia and more recently was instrumental in the develop of a Health Navigator Program . He has been a major promotor of Digital solutions particularly for chronic disease and established the Centre for On Line Health at UQ in 2000. He is also a strong advocate for patient engagement in all aspects of health decision making and health policy issues including research integrity and use of technology in healthcare .
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