Telehealth consultations enable clinicians to see patients via a phone call or video chat, and they are claimable under Medicare.
As we know, throughout the pandemic we have seen an increase in telehealth consultations performed in Australia, and the Medicare billing items that have been created are likely to stay for the long term.
Telehealth consultations are here to stay, and the stats say that GPs are largely ‘believers’ in telehealth. In a recent survey by the RACGP, more than 50% of GPs think that up to a quarter of their consults can be done via telehealth post pandemic. 35% of GPs even think that as much as half of their consults can safely and effectively be performed by telehealth.
As most GPs have adopted telehealth, the industry has done well to replicate the traditional ‘in clinic’ physical consult that we all know and love. But is that all there really is to telehealth – shifting an in-clinic consult to a virtual setting?
Healthcare 2.0: Remote Patient Monitoring, AI and Asynchronous Communication
I think there’s way more to it…
The telehealth we see today in General Practice, is effectively Telehealth 1.0. We are striving to replicate the delivery of healthcare the only way we know how – by providing the waiting room and the consult room of a clinic, but just doing it virtually, on the phone or computer.
The problem with that is, it only gets us so far. Now don’t get me wrong, Telehealth 1.0 was a great stopgap solution for when the country needed to quickly implement a safe way to see patients, using the tools we had at our disposal. We saw many nimble technology providers roll out enhancements, updates and addons to their products in record time to enable GPs to perform telehealth consults in their clinics. Also, it is the next logical step to progression, but I feel like there is more work to do.
The implementation of telehealth consultations has certainly been successful – we’ve seen mass adoption, and it’s proven to be safe and effective. But if there is going to be transformational change made in primary care to help more patients across the country that need it most, then one could argue we need to do things differently, or else it will all stay the same.
With Australia’s increasing burden of chronic disease, ageing population, access issues for rural and remote or disadvantaged communities, and let’s not forget the impending tsunami of healthcare issues that GPs will be hit with in the coming months and years from those who put off routine screening – some GPs might be thinking about more tools enabled by technology they could have at their disposal to face these challenges ahead.
There are a number of opportunities that get unlocked when telehealth gets combined with other more progressive forms of healthcare delivery – including remote patient monitoring.
Remote patient monitoring can add depth and perspective to telehealth, and we’ve tried to describe a few scenarios as to how this might work in practice. But first…
What is Remote Patient Monitoring, and How Does It Influence Telehealth Consultations?
Remote patient monitoring is a subset of telehealth and is inclusive of the collection, transmission, evaluation, and communication of relevant patient data by the use of electronic devices. Some of these devices are implanted equipment, wearable sensors, and handheld instruments.
Below are 4 elements of remote patient monitoring that could take telehealth consultations even further than just episodic video or phone calls:
1. Using Wearables to Collect and Transmit Data
Wearables are devices that people wear that collect the data of users’ personal health and exercise. As technology improves, these consumer devices are becoming increasingly considered as potential to be clinical grade monitoring tools for patients. More purpose-built medical devices are now also available to allow patients to measure, monitor and transmit their latest results to their healthcare provider, allowing patients to be more engaged with their care, resulting in better outcomes. It is also a cost-effective and efficient way for those in rural and remote areas to reduce the need to travel hours into a clinic for something that can be done remotely. Wearables are cost effective and have potential to be the ‘eyes and ears’ to give clinicians access to current patient information, hopefully avoid patients deteriorating and reduce unnecessary clinic visits.2. Using Artificial Intelligence for Decision Support and Triage
Artificial intelligence in healthcare is the use of complex algorithms and software, to analyse vast data sets in order to efficiently predict health outcomes and inform decisions with minimal human intervention.
It is exciting to think of the potentials and theoretical use cases for artificial intelligence in healthcare, particularly when it comes to those AI tools that have a diagnostic claim. There is still time for those tools to become mainstream in medicine, as the TGA grapples with the concept of regulating AI software that acts like a medical device. In the meantime, AI can be used in other ways in healthcare on a day to day:
- Clinical Decision Support – by analysing large sets of data, AI can suggest to a clinician what diagnosis to look out for based on the data available, and also what recommendations to consider. This pattern recognition takes an element of cognitive load off clinicians in the diagnosing and decision stage to allow more focus time on the treatment and communication with a patient about their results.
- Triaging – much like in an emergency department where a nurse might triage a patient to determine the level of severity of their injury or illness, AI could be used as a triaging tool in a GP Practice in the future. With large numbers of results and messages coming into a clinic, knowing what to focus on can be overwhelming and costly. By utilising AI tools to help with this process it again allows clinicians to focus on more value adding tasks.
3. Utilising Technologies That Are Securely Integrated
Requiring patients to connect with a GP when they are not physically in the same place, requires the patient and GP to be utilising some form of technology to do that. The choices of technology platforms to enable communication are vast. When it comes down to it, a common critical factor that many GPs might use to decide on a piece of technology is how well it connects or integrates with the clinic’s Practice management system. There is little point having a super slick and easy communications platform for patients if GPs cannot securely and easily access the information – wouldn’t it be neat if you could just flick images and share videos with patients via WhatsApp or messenger, just like we do in normal life, complete with gifs and reactions? Unfortunately, it does not quite work like that…
Health data is sensitive, and decisions are complicated, so unfortunately many consumer and mainstream communications platforms don’t make for ideal choices for transmitting health data… and they don’t integrate with GP clinic software. So, if a GP was looking for a piece of technology in addition to their Practice management system, we would recommend doing research to confirm how well it integrates securely and appropriately with the clinic’s Practice management system.
4. Engaging With Patients Via Asynchronous Communication
Asynchronous communication is where you transmit a message and don’t expect an immediate response. An example of asynchronous communication is sending an image for review, awaiting the response, and then receiving it once ready.
Thinking about opening up some forms of asynchronous communication as part of the engagement with patients, brings new ideas on how healthcare can be delivered – patients can share notes as they think of them, results can be transmitted and only surface when they are issues.
Some of the benefits of asynchronous communication in healthcare include:
- It can help ensure more accurate documentation
- It allows a GP to manage multiple tasks at once, not having to wait for a response but at the same time not being overwhelmed with competing priorities
- Asynchronous communication promotes thinking more about patient outcomes as opposed to purely about episodes of care
- Patients could be more likely to be honest about their health concerns when they have the time and privacy to craft a message to their GP rather than sit in an unfamiliar room and discuss it live in person
As we move to the next stages of telehealth, asynchronous communication will be interesting to watch as it develops. As there is currently no Medicare funding for asynchronous communications with patients, the likelihood of it being adopted widely is low, at least for the time being.
As telehealth consultations become ‘the norm’ in clinics around Australia and are embedded seamlessly into clinic workflows, we watch with interest as additional technologies and approaches like those mentioned above get included in the mix to provide a more engaging experience for patients and a more efficient and effective process for GPs.
Peter Birch is the founder and host of Talking HealthTech, which began as a podcast in 2018 and has since expanded to a membership community and media company focused on healthtech.
Talking HealthTech recently hosted a panel from Best Practice Software for a discussion on Active Ingredient Prescribing. Listen to that episode of the Talking HealthTech podcast here.
You can find out more about Talking HealthTech by visiting their website.