Telehealth in general practice: providing alternative access options for people in regional, rural and remote areas

HIV Australia | Vol. 10 No. 2 | October 2012

JOANNE HEREWARD looks at the benefits of telehealth and reports on the rollout of a new national initiative.

In 2011 the Australian Government introduced a range of rebates through the Medicare Benefits Scheme (MBS), and other financial incentives, to support telehealth video consultations between a patient and a GP in the same location and a specialist in another location.

The Royal Australian College of General Practitioners (RACGP) is playing a leading role in supporting telehealth as an alternative option to physical consultations, where it is clinically justifiable and where it enables more convenient and accessible health care delivery without compromising patient care.

Telehealth video consultations have been around for a while in the hospital sector. Affordable software technology and the Medicare Benefits Schedule (MBS) rebates have made it possible to introduce telehealth services intoprimary healthcare.

The benefits of telehealth are extensive, providing better access to specialists for patients who live in outer metropolitan, rural and remote areas, and those in eligible residential aged care facilities or Aboriginal medical services anywhere in Australia.

People want to have more control over their healthcare and they want to do this with healthcare providers they know and trust. Many patients have a good and longstanding relationship with GPs in their local community.

Video consultations can facilitate the provision of collaborative care, by the specialist and GP, without the patient having to leave their community and incur the costs and time associated with travelling long distances.

Telehealth services also provide GPs and other specialists opportunities for informal GP education,opportunities to clarify any patient confusion or misunderstanding(early and effectively) and also improvepeer-to-peer contact and discussionbetween GP and specialist.

Practice nurses and Aboriginal health workers can also provide clinical support to patients on behalf of a GP during a video consultation with a specialist.

The telehealth MBS items and financial incentives that are currently available make it an opportune time for GPs to implement telehealth services into their practices and offer telehealth consultations to their patients.

However, not all consultations will be suitable for telehealth and GPs need to consider a number of key areas when planning to offer videoconsultation services.

The RACGP Standards for general practices offering video consultations: An addendum to the Standards for general practices (4th edition) covers the practical side of video consultations, such as setting up the consultation room to facilitate successful video consultations, as well as the issues surrounding patient privacy and confidentiality, and the training and education for practice staff involved in these consultations.

Implementing video consultations in a practice is a gradual process. Each general practice is unique and there are many technical, organisational and human factors that need to be taken into consideration to achieve a high quality video consultation.

The practice needs to provide the best environment for the consultation which includes the equipment, technology, and data connections to deliver theconsultation.

A key component of successful video consulting is selecting the appropriate technology, and it is advisable for the practice to trial a range of video conferencing software to find the most suitable one.

Telehealth video consultations also need to ensure that the patient’s health and personal information is protected, and to ensure this, the consultation must be conducted in a technical environment that is reliable and has effective security measuresin place.

The RACGP Computer and information security standards offers comprehensive and up-to-date advice on the requirements to ensure the appropriate security measures are in place within the practice during the video consultation.

From an organisational and human perspective, there are many contributing factors to the overall success of the video consultation, including engagement with specialists, practice staff education and training in relation to new technologies and work processes, clinical and operational guidelines, managing change, monitoring mechanisms, and appropriate infrastructure.

An enthusiastic video consultation coordinator can also help enormously when implementing video consultations into a practice.

Their responsibilities can include coordinating bookings, managing the video conferencing equipment and software, providing patients with relevant information, and ensuring there is a contingency plan for managing technical issues that may come up during the consultation.

The RACGP Implementation guidelines for video consultations in general practice (3rd edition), published in September 2012, provides practical and comprehensive advice on all aspects involved in offering video consultations including:

• setting up
• telehealth MBS item numbers and the range of telehealth incentives currently available
• information on which videoconferencing options for GPs and practices to consider
• the viability of implementing telehealth
• information on engaging with specialists, including a letter template to initiate contact with specialists
• advice on change management
• advice on using Skype™
• technical advice
• assistance with the end-to-end management/process of conducting the video consultation
• popular software video conferencing options and hardware options for clinicians to consider.

The RACGP offers a range of factsheets, resources, and templates, including a booking checklist, patient information brochures, an introduction to specialist letter, and a post-video consultation patient evaluation tool.

Another key question often asked in relation to video consultations relates to the use of Skype™. Currently there is no clear evidence to suggest that Skype™ is unsuitable for clinical use; however, there are issues that GPs and other medical professionals need to be aware of before making the decision to use Skype™.

The RACGP recommends that GPs (and those providing clinical support on behalf of GPs) should register a Skype™ name that providessome anonymity.

It is additionally recommended that, during a video consultation using Skype™, medical content is not exchanged (e.g. still images) and that there is a back-up mode of communication in case the connection cannot be made. Skype™ does not provide instantaneous technical support.

Skype™ should be considered as a low cost entry point to the world of telehealth. If selecting Skype™ initially, over time (and once the ongoing demand and usage of video consultations has been quantified) it may be worth considering moving to a professional software and hardware solution.

The RACGP advice on using Skype™ provides more detailed and comprehensive information and can be found on the RACGP website at www.racgp.org.au

Decisions about offering video consultations should be made by individual practices and careful consideration should always be given to the needs of the patient and the viability of telehealth within the practice.

As part of the telehealth initiative, the RACGP has been funded by the Australian Government Department of Health and Ageing to provide a telehealth support service until May 2013.

For further information, or to access a range of online resources, visit the RACGP website at www.racgp.org.au/telehealth or contact the RACGP telehealth support service on 1800 257 053 or via email at telehealth@racgp.org.au

Joanne Hereward is Telehealth Project Officer at the Royal Australian College of General Practitioners.