Call the midwife: Telehealth has arrived
Health & Biotech
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In the last two weeks medical professionals in Australia have been forced online, in a radical upheaval of the health sector.
On Sunday, the federal government went even further, opening telehealth services “to every Australian anywhere” in order to allow access to health services at home during the COVID pandemic, said Health Minister Greg Hunt.
It has committed $669m to expanding Medicare subsidies to make telehealth services universal for the next six months.
For more than a decade, Medicare funding for telehealth had been limited to a very small number of services, and operators of telehealth platforms say they didn’t expect to see changes of this magnitude for five to 10 years.
But the new funding measures are temporary: the government plans to review them after September 30 “in light of the need to continue the fight against coronavirus”, suggesting it may not continue to support the new sector in perpetuity.
Telehealth providers are hoping they can gain enough support among previously sceptical medical practitioners to become, in six months, a new essential service worthy of long-term funding.
Until last year telehealth services were limited to Indigenous communities and some aged care services. Patients had to be further than 15km from their GP and consults had to be via video.
The door was chocked open a little more last year for time-limited mental health and GP services following floods, the drought, and bushfires, and then two weeks ago opened a little further to five vulnerable groups, including pregnant women and the over 70s.
Then as of Sunday, “everything that can be done by telehealth, will be done by telehealth,” said Hunt during a press conference.
“What we are doing now is a radical transformation in the way we deliver our health services.
“It’s a decade’s worth of work in a couple of days.”
Some private health funds have also committed to funding certain telehealth services for allied health operators, such as physios and psychologists.
Telehealth providers say it’s been a wild ride.
Coviu CEO Silvia Pfeiffer says they went from about 300 consults a day on their video software a fortnight ago to 10,000 in the space of a week.
1st Group (ASX:1ST) boss Klaus Bartosch says flu vaccine bookings for March through his online appointment service are up 1000 per cent on last year, a month that is usually very quiet.
The change was forced on medical professionals by necessity.
“Clinics and medical businesses are needing to do this in order to survive, not only in terms of their business but to provide a safe method of providing a service to patients,” Bartosch says.
“The other choice is to have no income. At least with an initial consult by telehealth there can be a risk assessment made to see whether the patient has to come in.”
On the ASX, the optimism around telehealth has spread to other companies that have software in place to allow remote working, such as ResApp (ASX:RAP), which designed an app to diagnose the type and severity of a cough, Pro Medicus (ASX:PME), and even to a certain extent Volpara (ASX:VHT), which offers a remote diagnostic service for breast cancer density images and last year bought a lung cancer screening business.
Morgan’s health analyst Scott Power says telehealth funding will likely make subspecialities such as radiology more appealing as a remote service, because globally the sector was already moving that way.
Until now the government, health lobby groups, and medical professionals had, if not actively opposed telehealth, then been sceptical of its usefulness in a busy clinic.
It was in the “too hard basket” for doctors because so few services were funded, and some in the allied health and specialist sectors are still finding it’s not more efficient over face-to-face consults.
However, 1st Group’s Bartosch believes now telehealth is largely being used as a triaging service, allowing medical professionals to decide whether a face-to-face visit is necessary.
Lobby groups have been skeptical in the past, claiming it posed a risk to patient safety. Indeed, the Royal Australian College of General Practitioners (RACGP) said in September 2017 of allowing people to “access prescriptions, referrals and/or medical certificates through online systems” unless it was by their usual GP.
Studies undertaken since the 1990s broadly suggest that telehealth services have benefits over the short-term, but managing patients’ health over a longer period becomes more difficult.
Finally, the government had been afraid that patients and doctors would abuse the Medicare subsidy system if consults were not held in person, Coviu’s Pfeiffer says.
Pushing an entire industry online in two weeks doesn’t come without challenges.
Bureaucratic rules that have been tailored to a pre-digital system are creating more challenges to overcome: last week the RACGP called for all prescriptions to be allowed to be electronic rather than a piece of paper with an ink signature from a doctor, allowing pharmacies to provide medicines without needing to see a physical piece of paper.
At the start of March, the Department of Health said it was planning a “development sprint” with medical and pharmacy software vendors that would enable electronic prescribing by early May.
Doctors who are still using fax machines and have never used a video conferencing service before, let alone a digital service to deliver prescriptions, are stumped.
If they stay open — some clinics are not — they’re having to figure out how to manage workflows that involve phone and video consults, how bulk billing works when a patient hasn’t presented a Medicare card to a receptionist, and how to issue scripts and get medication to people who may not be able to leave their homes.
Patients too are struggling: it’s not clear how to find a provider who does telehealth right now or, until Sunday, what was covered under Medicare.
Karn Ghosh from NDIS provider Kinela says doctors need urgent technology literacy training both in using telehealth technology and in how to develop a rapport with patients when not in the same room with them.
The digitally savvy professionals in the medical sector are still not at a complete advantage.
Ghosh says industry fragmentation means there are many, many different technology stacks in use in each subsector that have been jerry-rigged together, and one will not necessarily talk to another. For example, from next month CBA will no longer support card payment terminals from one of the two major private insurance payment systems.
Finally, as hackers begin to take advantage of the chaos caused by the COVID-19 pandemic — the latest being against the WHO itself — cybersecurity will lag the urgent adoption of telehealth.
Ghosh says specialist platforms will have security systems built into their video services, but many doctors will need to move quickly and where they start with Google Hangouts or Zoom, there will be weak points where patient data can be lost or stolen.
“It’s a double sided market. On one side the marketplace matures faster than the other, whether it’s on-demand food or transport. Normally it’s the supply side that goes first, but here we’re all going together,” he says.
Companies which are already in position as telehealth providers, medical professionals who have support from their industry bodies, and patients who at a time of stress can navigate through a new digital experience will undoubtedly applaud the radical changes to the healthcare system.
But it’s unclear whether once this health crisis is over their voices are louder than those with an eye on a straightened federal budget.