News

What do GPs need to consider when setting up telehealth?


David Adam


9/04/2020 3:27:26 PM

Usability, security, privacy, cost and integration are all important factors, GP and former IT administrator Dr David Adam writes.

Graphic representing telehealth.
Above all, practice staff and patients need to be able to use the technology you choose.

COVID-19 has required practices across Australia to transition to telehealth in an exceedingly short period of time.
 
Developments expected to take years have suddenly been thrust upon us as part of the Government’s response to the pandemic, leaving some practices scrambling to successfully establish brand new systems in a very short space of time.
 
As many have discovered, there are no easy answers. The Electronic Frontiers Foundation provides a sound explanation for some of the security aspects of communicating remotely, but this is only one piece of the puzzle.
 
Above all, practice staff and patients need to be able to use the technology you choose.
 
For example, tools like healthdirect Video Call require no installation or signup, but do need a relatively modern browser – and communicating that concept with the less technically-literate can be a challenge.
 
Conversely, many older people have been video-calling their grandkids for years and are familiar with platforms such as FaceTime or Skype, but these come with their own issues and may not be suitable for all consultations.
 
Security is of upmost importance, and in this day and age it is unusual for services to not offer some degree of encryption.
 
At a minimum, the communication between clients must use transport encryption, just as most websites do – especially commerce and banking.
 
Other services advertise ‘end-to-end encryption’, which means the service provider cannot interfere with the connection in any way. However, this is actually a difficult technical proposition, and sometimes just as hard to verify that it is in place.
 
End-to-end encryption is mostly useful to protect against government eavesdropping and major service provider compromise. Remember also that the phone system is not end-to-end encrypted.
 
Security is important because just like a standard consultation, privacy is paramount – for both patients and practitioners.
 
Many platforms require a mobile phone number to activate and connect, which can risk exposing your personal information. One tip is that a cheap prepaid mobile service can be purchased to activate the service, and then the practice’s Wi-Fi used for the actual calls themselves.
 
I would also advise against most ‘meeting’ applications, as these are generally designed to get multiple people into the same session, which is the opposite of what you want. This includes tools like WebEx, Microsoft Teams and GoToMeeting.
 
Free services such as Zoom (which I would also recommend against) can be tempting as cost is always a consideration, especially for small business.
 
The RACGP’s telehealth guide encourages caution with free services, as they may not meet security and privacy requirements. However, this sensible warning seems to have become gospel, which isn’t entirely warranted.
 
Although it’s true that low-cost options may make money by selling information (which may be quite private, such as call location and identification), many free services are simply run as a loss-leader. Companies may pursue this route to encourage uptake and purchase of add-ons (eg Skype), or because they have not quite figured out how to make money from the service yet (eg WhatsApp).
 
healthdirect Video Call costs money, but some Primary Health Networks (PHNs) are paying for it on behalf of practices. Having a paid agreement in place might also make it easier for you to gain the attention of the provider when it comes to getting help and support.
 
Whatever platform you choose, integration with clinical software is a must.
 
Some packages offer to integrate with your appointment book to ease the burden on receptionists and practitioners. Crucially, the effectiveness of these systems can vary and there are few options currently available for the Australian market, so research is required (a number of Australian eHealth experts are also working hard on this, so the landscape may change).
 
Of course, none of these systems will work without the appropriate technology to support them. Anecdotal reports suggest webcams and laptops are currently harder to come by than personal protective equipment.
 
If you are going to ask practitioners to use their own phones, laptops or desktop computers, you will need to make sure you preserve the privacy of their contact details and that their personal devices meet the same standards for security you expect from your practice equipment.
 
Likewise, practices must be prepared should there be some kind of failure with the technology.

There is currently massive demand for all online services. Microsoft, for example, has reported a seven-fold increase in the use of its video chat platform in Italy.
 
As such, doctors and practices should have contingencies in place should the chosen service experience technical issues. For example, you might have some accounts with a free service set up to use in case your chosen service is down, while the telephone can be another option if you need a fall back.
 
With all that being said, here are a couple of platforms I would personally recommend considering:

  • healthdirect Video Call – this is a platform paid for by the Australian Government and some PHNs. It requires no software installation or patients to sign up for an account, but does require them to have a new version of a modern web browser installed and working. You can contact your PHN to see if they have this option available.
  • Skype – this is a platform well-tested and anecdotally more popular with some of our senior patients. You can create a new account without disclosing your mobile number, and there are versions available for all devices.
  • WhatsApp – this is another popular platform and features a number of strong security features. It is quite easy to use but requires a smartphone and mobile number, and also risks exposing the practitioner’s personal number unless using a separate subscription for this service. 
I personally recommend not using these platforms for health consultations:
  • Most ‘meeting’ applications like WebEx, Microsoft Teams and GoToMeeting. As previously mentioned, these are generally designed to get multiple people into the same session, which has privacy and security implications.
  • Zoom – this product and the company behind it have come under scrutiny, not just because of security and privacy issues, but also how they have handled them. While open disclosure and root cause analysis are familiar concepts to healthcare professionals, they are often poorly understood in technical organisations.
For those seeking more information, the RACGP’s telehealth guide covers some of the other steps practices need to take, such as verifying patient identity for all consultations.
 
These are important regardless of the technology you choose, and I would encourage everyone transitioning to telehealth to utilise all of the resources it contains.
 
Log in below to join the conversation.



coronavirus COVID-19 privacy telehealth



Login to comment

Dr Bram Singh   11/04/2020 8:21:17 AM

Thanks for the update. 🙏


Dr Kim Saw Kuin Tam   11/04/2020 11:32:48 AM

I found David Adams ' suggestions to be very helpful.


Dr ABM Shahidullah   12/04/2020 2:52:57 PM

useful timely given information and guide very helpful


Dr Philip Ian Dawson   15/04/2020 12:27:22 PM

We have long had a skype account in the practice name which we use for teleconsulting with remote specialists, patient in a room in the practice all set up. We have recently used Zoom and Teams for medical meetings, they work well. I wonder why you think Teams is not good for a one on one? Seems secure, we have an office 365 subsciption and login, patient needs just to click an emailed invitation. We would use a practice email not a personal one.
We have played with GPCONSULT which crashed, overloaded, I believe, and susccessfuly used doxy.me, as recommended by our IT support. Do you have any opinions on that one? I did a google search and there are at least another 10 mainly Will have a look at the Health Direct one. So far mostly we do phone calls, and after looking at the phone bill I am restricting the office phone to ringing landlines only, using my mobile (with caller ID blocked) to ring mobiles as its much cheaper ( and I doubt I will get over the included $600 a month of calls!


Dr David Adam   17/04/2020 6:40:54 PM

Hi Philip,

My concern with Teams is that it is designed to make it as easy as possible to get lots of people into the same room as you. We have seen with Zoom that it is hard to get the settings right to prevent people joining your meeting and the workflow with Teams can be similarly tricky.

If you are still getting charged for phone calls by the minute I strongly suggest renegotiating your phone contract!

Hope that helps,

David