The use of telehealth consultations increased significantly around and in connection with the COVID-19 pandemic.
The Medical Board of Australia (Board) has recently introduced new guidelines in relation to telehealth consultations with patients1. These changes came into effect on 1 September 2023 and complement the Board's Good Medical Practice: A Code of Conduct for Doctors in Australia.
The following is a guide to conducting telehealth consultations following these changes to help ensure compliance with the Board's expectations, as well as other authorities.
What is a telehealth consultation?
The Board defines a "telehealth consultation" as a consultation which is facilitated by the use of technology, including telephone, video or online consultations, transmission of images/date or prescribing medication. It is distinct from an in-person or face-to-face consultation between a patient and medical practitioner.
Whilst in some cases, telehealth can improve continuity of care or compliance for some patients, the Board cautions against telehealth consultations routinely replacing in-person consultations. There are clear reasons why as it can impact on the quality of the interaction and restrict examinations.
Conducting a telehealth consultation
Practitioners should ensure that the consultation is conducted in a private and quiet space with reliable access to technology.
Practitioners should also:
- Ensure that they have secure access to all relevant clinical records for the patient
- Inform the patient of the billing arrangements in place and obtain financial consent
- Have a "back-up plan" should technology fail so the appointment can be continued or rescheduled.
- Explain to their patient who they are and what their role is with respect to the patient's healthcare
- Confirm the patient's identity
- Assess the appropriateness of the use of telehealth. If telehealth is not appropriate, practitioners should make arrangements for the patient to be seen in-person; and
- Inform the patient of any arrangements to be made, including but not limited to, referrals, investigations and or prescriptions.
- Keep an accurate and comprehensive record of the consultation
- Ensure appropriate hand-over and or follow up arrangements are in place; and
- Where it is necessary, and with the patient's consent, discuss with the patient's usual practitioner of the outcome of the consultation.
The Board does not support prescribing medication to a patient in the absence of real-time consultation, however real time direct consultation does include via video or telephone, so the concern relates to prescribing medication via text, email, live-chat or other online platforms based on health questionnaires where a practitioner has not spoken with the patient.
The Board emphasises that practitioners must exercise their skill and judgement when prescribing medication to their patients, and to be able to explain how the prescribing and the management of the patient was appropriate and necessary if asynchronous prescribing is provided.
Conducting telehealth consultations while overseas
When a practitioner is overseas
If a practitioner is outside Australia when they are conducting a telehealth consultation, the Board expects that practitioners will be registered with the Board and meet their registration standards.
The Board also expects that practitioners will meet their regulatory requirements within their jurisdiction.
When a patient is overseas
If a practitioner consults with a patient who is outside Australia, practitioners must determine whether they are required to be registered in the country from where the patient is located, and whether any legislative requirements must be complied with.
Services Australia (Medicare) recently confirmed changes to meet expectations bulk billed benefits in accordance with the Health Insurance Act 1973 (Cth), which requires patient consent.
Early in the pandemic, the requirement for a medical practitioner to obtain written consent was temporarily replaced with verbal consent. However, now the preferred method of obtaining consent for bulk billed telehealth consultations is in writing (via specified forms or by email). Verbal consent is still available, but only by competing certain forms.
It is no longer considered appropriate to record a patient's verbal consent in clinical records to comply with the consent requirements for bulk billing telehealth consultations.
Telehealth consultations allow flexibility of practice and can promote healthcare through compliance and accessibility.
Practitioners should continue to familiarise themselves with, not only the guidelines, but with the appropriate Medicare Benefits Schedule item numbers which relate to telehealth consultations and ensure that they are compliant with the expectations of the community, Board and statutory billing obligations.
1 Medical Board of Australia, Guidelines: Telehealth consultations with patients effective 1 September 2023
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.