Videoconferencing between rural patients and urban specialists finally here

It started with a passing comment.  My GP told me to wait in another office because the usual one was being used for a SKYPE consult between a local patient and a Perth specialist.  ‘Really? How long have you being doing this?’ I feigned disinterest, proving that you can take the girl out of the rural health academy but you cannot … Anyway. Answer: ‘For a while but it is really picking up.’  He told me that once the specialists started they realised that videoconference consults could be more efficient.  They scheduled them like any other appointment.

So I tweeted, hey my GP is doing this, is it a national trend?  Mind you I don’t have a lot of followers so I wasn’t overwhelmed with responses.  But with a little help of useful links provided by @EdwinKruys I did some digging.  I wanted to know 1) how many videoconferenced consultations are being done and 2) are they using SKYPE or other specially packaged options.

In July 2011 the Department of Health and Ageing introduced a videoconferencing incentive payment (originally $6000 to specialists just for giving it a try—for those unfamiliar with health care in Australia, that is how most change is introduced) and a video-conferencing item on Medicare worth about 50% of the standard Medicare fee for the consult.  That means that the videoconference consult is worth 150% of a standard consult for the specialist. The patient has to be at a GP surgery (or other approved settings) and the GP can also participate in the consult or direct a practice nurse, nurse practitioner or other health care professional to attend.  At present the patient must be outside of Australia’s major cities at the time of the consultation.

Although still rare, video conference consults are increasing rapidly: from 1,305 in the third quarter of 2011 to 12,323 in the fourth quarter of 2012—more than 10-fold increase in 18 months. This is based on the numbers of videoconference related MBS item numbers charged to Medicare.  You can check them on the Medicare site here.  It is hard to imagine that this is not part of an accelerating trend which will continue.

Medicare items for ‘telehealth’ have existed for some time, particularly for psychiatry and their uptake has been disappointing.  Why does it seem to be taking off now?

I think flexibility is part of the reason.  Many initiatives to introduce information technology to health care have been extremely complex.  They require new software and new health care practices.  Overcoming these barriers have proved difficult in command and control health care settings like America’s Department of Veteran Affairs or health maintenance organisations or Australia’s Silver Chain. They have been virtually insurmountable in the private or cottage industry setting of most Australian health care practice.

Remarkably, in introducing the new videoconferencing items the Department of Health and Ageing did not mandate or endorse

‘any particular technical solution for telehealth. In providing MBS billed telehealth services, clinicians should be confident that the technical solution they choose is:
· capable of providing sufficient video quality for the clinical service being provided; and
· sufficiently secure to ensure normal privacy requirements for health information are met. Individual clinicians will need to be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy.’

Hence GPs and specialists were free to use communication methods with which they felt comfortable.

In health care, the quality of communication is unbelievably important.  We know from countless surveys that patients want their doctors to listen to them, explain options clearly.   Most doctors are able to do that and they value giving the best care possible to their patients.

So when a country patient complains about making yet another follow-up trip to Perth or a rural GP really needs input the specialist wants to help.  Bring on a financial incentive and a technology that is now as familiar as the phone to many people, and we have not a revolution in health care but an evolution to an even better form.

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