Clampdown on asynchronous patient telehealth prescribing

Jolyon Attwooll

20/12/2022 4:04:24 PM

The Medical Board of Australia has signalled a tougher stance in its revised telehealth guidelines, which are currently out for public consultation.

Elderly woman on telehealth consultation
The Medical Board of Australia is set to tighten prescribing guidelines.

Doctors will be explicitly warned not to prescribe to patients with whom they have never consulted in real-time if revised guidelines published by the Medical Board of Australia (MBA) are confirmed.*
The 19-page Draft revised guidelines: Telehealth consultations with patients document is currently out for consultation, after an earlier round of feedback was sought in May this year.
In this latest draft version, the MBA has sounded a clear note of caution for telehealth prescribers.
‘Prescribing or providing healthcare for a patient with whom you have never consulted, whether face-to-face, via video or telephone is not good practice and is not supported by the Board,’ the revised guidelines state.
‘This includes requests for medication communicated by text, email or online that do not take place in real-time and are based on the patient completing a health questionnaire but where the practitioner has never spoken with the patient.’
The Board also signals that those suspected of flouting the guideline could be targeted.
‘Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and management of the patient was appropriate and necessary in the circumstances,’ the guidelines read.
In a college submission developed for the first round of consultation earlier this year, the RACGP said it ‘supports the prescribing of medicines that contribute and take place as part of holistic, continuing, person-centred care’.
Noting that this would mostly be provided by a patient’s usual GP or general practice, the college flagged its unease about the use of on-demand telehealth services that do not follow that pattern.
‘The RACGP has raised concerns about on-demand telehealth services that bypass a patient’s usual general practice, thus creating fragmentation and risking continuity of care,’ the submission read.

‘The RACGP's position statement on on-demand telehealth services outlines further risk such services pose to patient care.’
Recently, the Department of Health and Aged Care (DoH) confirmed that the so-called 12-month rule will continue to be waived for COVID patients until the end of 2023.
The rule means patients need to have seen their GP, or attended their general practice, in the past year to be eligible for telehealth consultations.
Patients require a COVID-positive result from a PCR or rapid antigen test from the past seven days to qualify for the exemption.
While noting that telehealth gives ‘great opportunities’ for healthcare, the authors of the MBA guidelines state that ‘it is not appropriate for all medical consultations and should not be considered as a substitute for face-to-face consultations’.
‘Practitioners should be continuously assessing the appropriateness of the telehealth consultation and whether a direct physical examination of the patient is necessary,’ the document reads.
Many of the other changes highlighted in the consultation document are wording and editing changes to the MBA’s previous guidelines for ‘technology-based consultations’, which were published in 2012.
Under the revised advice, telehealth is defined as healthcare involving ‘the use of information and communications technologies [ICT] to transmit audio, video, images and/or data between a patient and a healthcare provider’.
According to the MBA, the definition includes video, internet or telephone consultations, digital photography, remote patient monitoring and online prescribing.
There is also now a section on international telehealth, with the MBA stating that medical practitioners will need to be registered with the Board and meet ‘all relevant registration standards’ if they are treating patients in Australia, regardless of their location.
‘You may also need to meet any requirements of the medical regulator in the jurisdiction you are based,’ the MBA draft advice states.
‘If you are in Australia and consulting with patients who are located outside of Australia, you should be registered in Australia and establish whether you are required to be registered by the medical regulator in the country where your patient is located and comply with legislative requirements in that jurisdiction, including for prescribing and professional indemnity insurance.’

*Editor's note: An earlier version of this article suggested that the MBA would warn against prescribing during first-time telehealth consultations. This was a based on a misinterpretation of the draft guidelines and the article has been clarified to reflect that.
The revised MBA guidelines were released for further consultation last week and are open for feedback until 17 February 2023. The document can be found on the MBA website.
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Dr James Alistair David Freeman   21/12/2022 6:54:44 AM

Australia is just shy of 8 million sq km. Telehealth makes sense. We were doing it before RFDS was an acronym. Despite that, I spent $5million in personal funds and private equity + 10 years of my life trying to make it happen at GP2U. My investors and I effectively gave up because it is easier to nail jelly to the ceiling than make a profit with the ever changing rules.

Dr Y   21/12/2022 12:41:53 PM

Australia has a shortage of 11,000 GPs. Patients wait weeks for a GP appointment or in many communities have no GP access at all. Should we not be viewing online health services as a vital part of our health system? Patients can access a doctor in a safe and accessible way for simple medical requirements such as prescription renewals and common conditions such as UTI. This provides safe early intervention that can be followed up by the regular GP for definitive management. Should we not be asking : What is the impact of medication non-adherence on our health system? Should we not be supportive of services that improve access to health care? Should we not be supportive of health services that prevent avoidable emergency department presentations and hospital admissions? Are we really saying it's better to run out of medication or present to an emergency department - that this is better healthcare than accessing a registered doctor online? I think we know what patients would say.

Dr Henry Arthur Berenson   21/12/2022 5:50:49 PM

What about doctors over 70 or immunocompromised who are shielding from covid?