Following an extensive consultation process, the Medical Board of Australia has released revised guidelines relating to telehealth consultations. The updated guidelines take effect from 1 September 2023 and aim to raise the standards of current telehealth consultations and protect patients.
Telehealth consultations, which grew in popularity throughout the COVID-19 pandemic, are consultations that use technology as an alternative to an in-person consultation. The technology can extend to telephone, video or other internet-based systems. A practitioner is also able to prescribe medication following a telehealth consultation. Telehealth has emerged as a transformative approach to healthcare in Australia, harnessing the power of technology to deliver remote medical services and offering immense opportunities for both healthcare and technology organisations.
Medical practitioners have a duty to provide competent and ethical care, which includes obtaining informed consent, maintaining patient confidentiality, and delivering appropriate treatment. However, the virtual nature of telehealth consultations may introduce challenges in upholding these obligations.
The current guidelines, which were issued in 2012, explain the benefits of telehealth consultations but lack clarity around more recent methods of telehealth consultation and prescribing including asynchronous communication methods. These methods, which have recently gained popularity, involve asking a patient a series of ‘tick-box’ questions prior to prescribing medication, as opposed to facilitating a live consultation using technical means of real-time communication.
The updated guidelines make three major points:
- There is a need for telehealth consultations in Australia and they should continue being used by practitioners and patients
- In-person consultations remain important, and a practitioner must use their discretion to assess whether a telehealth consultation is appropriate for safe prescribing
- Prescribing medication via asynchronous methods is not good practice and is not supported by the Medical Board of Australia.
Asynchronous consultations
In telehealth, asynchronous consultations refer to a mode of communication between a healthcare provider and a patient where there is a time delay between the exchange of information or messages. Unlike synchronous consultations, where the interaction happens in real-time, asynchronous consultations allow patients to submit their medical queries or concerns at their convenience, and healthcare providers respond to them later, typically within a specified timeframe.
Some common examples of asynchronous consultations in telehealth include:
- Secure Messaging and “chat” functions: Patients can use a secure messaging platform or patient portal to send non-urgent questions or concerns to their healthcare provider. The provider can review the messages and respond at a later time, providing advice, clarifications or recommendations.
- Email Communication: Patients can email their healthcare provider with questions about their symptoms, medication, or general health concerns. The provider can respond within an appropriate timeframe, offering guidance or requesting additional information if needed.
- Online Forms: Healthcare providers may offer online forms or questionnaires that patients can fill out to provide information about their condition, symptoms, or medical history. The provider can review the submitted forms and subsequently respond or provide recommendations based on the provided information.
- Pre-recorded Videos: Patients can record and upload videos describing their symptoms or demonstrating specific concerns, such as a visible skin condition. The healthcare provider can view the videos and then provide a diagnosis or further recommendations.
- Image Sharing: Patients can capture images (e.g., photos of rashes, wounds, or skin conditions) and share them with their healthcare provider through a secure platform. The provider can review the images and provide guidance or advice based on the visual information.
- Online Patient Portals: Many healthcare organisations offer patient portals where individuals can access their medical records, test results, and treatment plans. Patients can leave messages or questions for their healthcare provider through the portal, and providers can respond accordingly.
Asynchronous consultations are said to offer several advantages. They provide flexibility for both patients and healthcare providers, allowing them to communicate without being restricted by time zones or immediate availability. Patients can take their time to articulate their concerns and provide detailed information, while healthcare providers have the opportunity to review the patient's medical history and research any necessary information before formulating a response. Proponents argue that this can lead to more thoughtful and comprehensive answers.
However, there are also potential drawbacks to asynchronous consultations. The delay in communication may not be suitable for urgent or time-sensitive medical issues that require immediate attention. It may also limit the ability to establish a rapport or engage in real-time dialogue, which can be important for effective communication and building trust between the patient and healthcare provider. Additionally, the reliance on written communication alone may not capture non-verbal cues or allow for a physical examination, potentially impacting the accuracy of diagnoses and treatment plans.
The suggested use of telehealth
The guidelines acknowledge the benefits of telehealth consultations and promote the safe and responsible use of technology to facilitate consultations.
The Board acknowledged the benefit for people in rural and remote communities with limited access to medical facilities, as well as some disadvantaged patients. However, the guidelines suggest that the standard of care provided through telehealth consultations can be limited in certain circumstances due to an inability to complete physical examinations.
On this basis, the guidelines recommend that where a physical examination may be required, practitioners should request a face-to-face consultation with the patient. If this is not possible, the guidelines recommend that a video consultation be undertaken, as opposed to a telephone consultation.
Further, the guidelines suggest that practitioners must use their discretion when prescribing medication through a telehealth consultation. The Board recommends conducting a combination of in-person and virtual consultations to ensure the practitioner is completely aware of the patient’s requirements. The guidelines instruct that if a practitioner is to conduct a telehealth consultation, the standard of care provided must meet the same standard of safety and care as if it were an in-person consultation.
Prescribing medication
The guidelines make it clear that prescribing medication to a patient without a direct consultation (whether that be an in-person consultation or a telehealth consultation via video or telephone) is not good practice and is not supported by the Medical Board of Australia.
The guidelines recognise that in some circumstances, it may be appropriate for a practitioner to prescribe medication to a patient without a consultation. However, this situation may only arise where the practitioner is the patient’s usual medical practitioner, and they have access to the patient’s medical and clinical records.
If acting outside these parameters, the practitioner would need to be able to explain why this was appropriate and necessary in the circumstances.
Next steps
The law and regulations relating to telehealth are complex and constantly evolving.
Once the guidelines become effective on 1 September 2023, all medical practitioners in Australia will be required to adhere to them. The guidelines will be reviewed by the Medical Board of Australia as required, which will likely occur every five years.
The integration of telehealth into Australia's healthcare system holds tremendous potential for improving healthcare accessibility, efficiency, and patient outcomes. Organisations across various industries can leverage the power of telehealth to transform their services and enhance customer experiences. Whether it's technology companies developing innovative health platforms, insurance providers integrating virtual care options, or wellness and health organizations offering remote consultations, the potential is vast. Embracing telehealth opens up new horizons for improving access, reducing costs, and revolutionising the way services are delivered.
Telehealth is clearly here to stay for a range of medical professionals and will continue to be subject to oversight by the Medical Board of Australia and other professional standards bodies.
