Telehealth’s primary care use case side-swiped by danger money
We must admit that we are still scratching our heads at Australian health minister Greg Hunt’s recent announcement of a new $180 million package to support COVID-19 care in the community in the future. There are some interesting bits, such as the subsidy for pulse oximeters for positive patients to use at home, and a small amount of money for medical deputising services and district nurses to visit COVID patients at home.
But putting aside the fact that there is simply no excess workforce capacity for nurses to visit people at home, let alone GPs – medical deputising services may be in a different boat – nor can we find a compelling reason behind the announcement that GPs will be paid an extra $25 to see COVID-positive or suspected COVID-positive patients face to face, in addition to existing MBS items.
What on earth is this all about? Is the Department of Health actually trying to encourage infectious people to see their GP face to face, when this is not only entirely unnecessary but positively dangerous? As we have been repeatedly told, most people with COVID will have mild to moderate symptoms and they can very much be managed with basic devices and telehealth in their home for the 14 days they need to be in isolation.
There are numerous examples of how this works in Australia and New Zealand, the majority run by hospital services – see here, here, here and here – but quite a few involving remote monitoring by GPs. This is obviously the future, but for some reason the Department of Health seems to want to encourage in-person visits rather than remote, and none of it makes any sense.
The $25 fee on top of normal MBS items seems to just be a danger money payment, or at the least to pay for PPE, but no one is quite sure what it is all about. In an opinion piece in Pulse+IT yesterday, Coviu CEO Silvia Pfeiffer outlines the confusion in the sector about what this new package means, and questions why it is necessary at all.
Dr Pfeiffer is of course the head of a telehealth company and is keen on promoting it, but we are with her: there are few if any better use cases for promoting the benefits – clinical and financial – of remote monitoring and video conferencing than an infectious disease pandemic that can in the most case be handled at home, with severe cases receiving hospitalisation. It beggars belief that the department wants to ignore this in favour of inefficient, unnecessary face to face consults.
The vast majority should be handled remotely. We have in the past railed against the Department of Health’s decision to restrict MBS-funded telehealth to known patients who have seen their GP in the last 12 months, very much at the urging of the AMA and RACGP, whose members could all see the low-hanging fruit of six-minute consults being eaten up by what they call “pop-up” telehealth services.
Perhaps the danger money now being offered is recognition that the AMA and the RACPG got it wrong, that these very same pop-up services that they so decry could in fact be doing a lot of the leg work of people with mild cases of COVID isolated at home, now and into the future. The pop-up clinics could do it for far less money than in person GPs, and they are geared up already for this model of care. Practice-based GPs certainly aren’t. Then again, pigs might fly.
In other news, the Australian Digital Health Agency has awarded a contract to IT services firm Chamonix to build a mobile channel for access to the My Health Record and other ADHA digital initiatives. This makes sense – Chamonix built the original HIPS product that has linked the majority of jurisdictional health systems to the national one, along with the first mobile app connected to MyHR – and it’s pretty clear Chamonix knows what it’s doing. Chamonix and ADHA are also upgrading the HIPS platform that most of state health systems use to upload to the MyHR to make it useful clinicians using mobile devices at the bedside.
It’s no secret but our cynicism about the My Health Record has always been about why it has taken so long to add contemporary functionality. After all, it is more than nine years since the My Health Record went live and mobile is only getting going now. We do understand the dramas over privacy raised by the opt-out debacle and the strict security concerns that come with private health information kept on mobile devices, but we are also aware of a couple of personal health record firms that have gone out of business or are nearing so due to the over-hyped promises in the past. At least it is being fixed, but we do scratch our heads at the time it has taken. There’s missing the boat, and then there’s missing Noah’s ark.
In other late news, NSW has finally got on the real-time prescription monitoring bandwagon and is starting its first phase of a statewide roll out. We have been very critical of NSW in the past for its reticence in getting on top of this initiative, which has very much been led first by Tasmania and then the real mover and shaker in Victoria. South Australia and Queensland then followed, and our understanding is that the ACT is about to go live with its new system shortly. WA is making moves, and the NT says it will.
But the whole reason behind RTPM is that that the most populous states are the ones with the big problem with prescription drug deaths. We are pleased that NSW has joined the technology party – and we think their clinical advice line for GPs and pharmacists, staffed by pain, addiction medicine and mental health experts from St Vincent’s Hospital, is fantastic – but we are also very much aware that while technology can help alert clinicians to potential problems, technology is not the solution. That lies in massive increases in real support for people with addiction, mental health and chronic pain issues. Technology is a mere tool to be used by actual healthcare professionals.
We also hear this week that HealthEngine has put its public float on hold, apparently because it wasn’t going to raise the money it hoped for. That brings us to our poll question from last week, when we asked whether the uptake of the national booking solution provided by HealthEngine was a good or bad result. Most said bad: 73 per cent versus 27 per cent who thought it was a good result.
Should the $180m community COVID package have been spent on telehealth and remote monitoring instead?
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