New COVID-19 rules have driven an explosion in the use of telehealth services by patients, but general practitioners’ almost universal failure to use video as intended has exposed a gap between government digital health policy and the reality it creates.
Recognising early on that doctors would need a way to manage COVID-19 isolating patients outside of their clinics, in March the Department of Health introduced 283 temporary Medicare Benefits Scheme (MBS) item numbers allowing healthcare providers to deliver consultations remotely.
Each MBS item number stipulates conditions that must be met before healthcare providers can use them to claim benefits from the government.
The previous 23 item numbers were, for example, designed around antiquated telehealth models presuming dedicated videoconferencing equipment, requiring the doctor and patient to be located more than 15km apart, and requiring regional, rural, and remote patients to attend a GP’s office for the video consult.
Health services waded through overly complex and expensive telehealth initiatives, and the GP item numbers have been largely ignored since they were introduced in 2011 – with just 236,910 visits claimed during the entire 2018-19 financial year and 384,300 claims during 2019-20.
The new COVID-19 item numbers, by contrast, explicitly allow GPs to perform video consultations with patients in their homes anywhere using everyday tools like FaceTime, WhatsApp, Skype, Zoom, and similar platforms.
Healthcare providers delivered 28 million COVID-19 telehealth services to 10.15m patients between March and the end of August – over 118 times as many telehealth consultations as were delivered in the whole of 2018-19 – according to newly released Department of Health figures, provided on notice to the Inquiry into the Business Case for the National Broadband Network (NBN).
This surge – which is likely to continue after the government recently extended the items’ lifespan through March 2021 – confirms patients value the convenience and flexibility of video consultations, Prof Kerryn Phelps, the former head of the Australian Medical Association (AMA) and current member for City of Sydney, said during a recent panel discussion.
“We’ve been told for a decade that this couldn’t happen because there would be all sorts of reasons and problems why it couldn’t happen,” she said.
“But suddenly it happened, and GPs were able to deal with patients remotely – and it was incredibly well accepted by people of all ages when people were frightened to come into a clinical setting.”
Surging use – of the phone
Yet despite the apparent success of the telehealth initiative, the numbers also tell an important story.
Time-pressured GPs, it turns out, have almost universally been conducting telehealth consultations by simple phone calls rather than taking the time and effort to set up video consultations as the government intended.
Only 3.1 per cent of GP consultations were conducted by video, the Department of Health figures revealed, compared to 16.5 per cent of non mental health specialist doctors.
Mental health providers, by contrast, were much more likely to use video services when conducting telehealth consultations – with 63.8 per cent of allied mental health providers (such as psychologists) using video and 40 per cent of specialist mental health providers (such as psychiatrists) doing the same.
GPs’ extremely low use of video services flies in the face of the original intention of the temporary item numbers, which specify that “videoconference services are the preferred approach for substituting a face-to-face consultation” but allow telephone services “if video is not available”.
Time pressures and the need for the items to be bulk-billed – minimising the revenues available to GPs who, Phelps said, have “had to take quite a large cut in their income to provide this service for patients” – have likely driven the dominance of phone-only consultations, since setting up a video call takes more time and may be challenging for some patients.
Patient care vs customer service
Yet they also highlight some of the challenges that Australia’s health industry has faced in rolling out what has been a piecemeal array of digital health services.
While government initiatives like My Health Record (MyHR) have improved the exchange of clinical data between providers, its spotty adoption – and requirement that doctors contribute information digitally – remains an inhibitor for an industry where many processes, and records, are still created and maintained by hand.
“Health services are very good at investing in clinical technology but not so committed to the investment in information technology,” Bendigo Hospital Peter Faulkner group executive noted.
Whereas industries like banking have become “very customer centric driven” through digital initiatives that have fostered two-way digital engagement, Medibank CEO Craig Drummond offered, “in healthcare, broadly adopted technology has been less patient or consumer centric…. We’re at a very immature phase or stage in healthcare, and a lot of work needs to be done.”
Patient-related healthcare technology doesn’t have to be complex, NSW Health secretary Elizabeth Koff said in flagging the “world of difference” for patients thanks to the department providing rapid SMS text notifications for negative COVID-19 test results.
“Sometimes clinicians don’t like calling it the customer or patient experience,” Koff said, “but reforming the system around what matters to the patients we see, is critical for the future of healthcare delivery.”
“We had to pause our future health strategy when COVID-19 came along, but then a lot of the things we had identified, were taking place during COVID-19 and the digital acceleration during that period was phenomenal.”