Weeks into the coronavirus crisis, social distancing and aggressive handwashing has somehow become second nature to us. With health clinics and critical shortgages of protective equipment for medical workers, Health Minister Greg Hunt has proposed embracing the benefits of digital and data technologies to combat the pressures placed on an increasingly overwhelmed health system. Telehealth, also known as Telemedicine, allows access to medical care remotely, usually through phone or video conferences services like Facetime, Zoom or Whatsapp. In light of lockdowns worldwide, remote health care has become an important part of the response, speeding up the telemedicine trend that has already been emerging in recent years. Whilst the technology already is in place, more innovation has sprung up to combat the pandemic.
As of Monday 30 March, all Australians have access to telehealth services.
Replacing in-person doctor visits with online video conferencing can have its ups and downs. While ‘telehealth’ can work in different situations, it is not yet a comprehensive solution – many prefer the contact with their regular doctor and the psychological assurance it provides.
However, given our current crisis, population growth, and technological advances, this might be the right time to start transitioning away otherwise avoidable needs on our physician’s time.
First among these needs relates to chronic illnesses, e.g. where repeat prescriptions and referral letters can be an easy print-out for the patient on the other end[i], reducing unnecessary travel. For instance, Dr Brett Montgomery (a Perth GP) recently wrote that he prefers using telehealth for his regulars and “managing long-standing health issues”[i].
Consequently, many Australians, who do not necessarily need to see their regular doctor, could simply have a bulk-billed session with the first available doctor they find online. In this case, the newly-minted ‘My Health Record’ system will prove useful[ii], keeping track of visits between different doctors.
If society takes to telemedicine in this way, we risk eroding the regular doctor-patient relationship; virtual visits to the doctor may become purely transactional.
Indeed, the technology is not yet so advanced as to replace all of our healthcare needs: an elderly Australian may not be able to dial-in on his own; a person may have privacy concerns[iii] about using programs like Zoom; a doctor might need to use a stethoscope or do other physical checks – these are all valid situations where we still might need a visit to the local GP.
An in-person visit to the GP allows unhindered checks on the wellbeing of a patient, as well as performing necessary tests on the spot – something that variable internet connections or webcams cannot currently supplement.
In this sense telehealth could function as a conversational triage for symptoms, where doctors could refer patients to in-person testing when necessary. This scenario aligns with our current situation, where doctors not only need to socially-distance, but also prioritise testing for the virus.
In any case, the times are certainly advocating for a telemedical future.
It would be erroneous to define telehealth as something of a new phenomenon. As stated in Medicare Benefits Schedules (iv) it has been steadily growing since 2011. More recently this growth has been in an exponential fashion, such that it has manifested into a body of its own – and not just an appendage to our traditional health care system.
In spite of its almost exclusive presence in rural and geriatric settings, the unprecedented impact of COVID-19 has catalysed a need for telehealth to be ubiquitous.
In any case of a disruption to a market’s structure there will always be victors and vanquished. This recent growth in telehealth has benefited patients (especially the at-risk patients), as this telehealth demand shock has manifested in high proportions of patients gaining greater access to GPs and specialists in these restrictive times. This new-found access compounded by the promised increase of $100 million in Government Medicare coverage (v) is a major win for consumers; for they not only receive more benefits, but they do so at a discount. From a less financially tangible perspective, the additional benefits of mitigating community transmissions, those from doctor-patient transmissions, is a major victory for consumers and health care professionals alike.
Converse to the veritable benefits of telemedicine’s newfound prominence are the very real disadvantages facing sectors of health care that have been slow or have even outright refused telehealth’s call to arms. The implication of individuals and sectors that do not participate in telehealth are highlighted by decreases in revenue and turnover as well as the potential for obsolescence. Many of the barriers for adopting telehealth have been the initial financial outlay required for the requisite technology – which average out to between $5000 – $10,000 (vi). Even if health care workers make the significant financial outlay, they are subject to enforced capping of fees at bulk-billing rates (vii). In addition to this financial strain is the lack of Governmental regulation on which platforms are secure enough to operate telehealth technology. Current options, for what should be a secure and regulated service, are providers such as Google, Skype and WhatsApp. This should be of concern to patients and doctors alike due to risk of security, reliability, accessibility and confidentiality. It is unlikely that these platforms will take any responsibility and the burden will therefore be borne by the health care practitioner. And in addition they will wear the consequences, which may be both financial and reputational. So, in antithesis to patients and consumers, doctors and health care sector workers lose much of their former producer surplus.
As it stands, it is difficult to argue that the negative aspects associated with the exponential surge of telehealth outweigh the positives. However, when the dust settles and we return to a semblance of normality, telemedicine will require serious reformation to remain financially and medically sustainable as well as ultimately secure.
As a result of incremental and technological progression of information systems we have been introduced to this pandemic better prepared than ever before. But telemedicine is used for rural consultations and mental health-related consultations too.
Telehealth can best be described as an efficiency gain within the medical field. For appropriate appointments patients and doctors alike need not travel long distances to facilitate medical consultation. Aboriginal people in remote communities may in some cases stay home, foregoing the need to travel unnecessarily.
Functionally, telehealth can be applied to a wide array of medical fields. There are theoretical cost and time reductions where eliminating the need for an in-person appointment would supposedly reduce strain on hospitals and allow patients more freedom to choose.
There are of course disparities between less developed and more developed regions. Successful telehealth requires a stable internet connection and adequate resources to facilitate proper consultation.
Generally, remote diagnosis is always feasible in developing and emerging countries. The situation breaks down however in relation to remote monitoring, intervention and education – areas the Australian medical field do facilitate.
The success of telehealth in regions such as Sub-Saharan Africa and the Pacific Islands is largely dependent on the general and technical infrastructure of these respective regions[viii]. In situations where their localised governments cannot adequately provide for their citizens charities and more developed regions have stepped in to help.
The Government of Luxembourg, along with medically focused NGOs have launched E-health program SATMED to provide a cloud-based platform to store health data and to enable remote consultation[x].
The coronavirus has shown, more than ever, that pandemics and structural health-related concerns are global problems. They must be dealt with specifically whilst also allowing for the free flow of bio-statistical information. Collaboration and efficiency stemming from telemedicine are evocative of how we collectively work effectively whilst adjusting for communal concerns.
iv) “Telehealth Quarterly Statistics Update”. (2016, August). Retrieved from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/connectinghealthservices-factsheet-stats)
v) “How does Telehealth work in Australia”. (2020, April). Retrieved from: https://www.finder.com.au/telehealth
vi) “I want to “do telemedicine”: What is involved and how much does it cost?”. AMD Global Telemedicine. (2015, July). Retrieved from: https://www.amdtelemedicine.com/blog/article/i-want-do-telemedicine-what-involved-and-how-much-does-it-cost
vii) “Are all doctors offering telehealth during the coronavirus pandemic and do you have to use it?”. ABC News. (2020, March). Retrieved from: https://www.abc.net.au/news/2020-03-30/what-is-telehealth-explainer-coronavirus-covid-19/12101316
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