Medicare confirms validity of electronic referrals

The Medicare benefit payable is dependent on a referral from another practitioner for certain services provided by specialists and consultant physicians.
 
Confusion has existed for years regarding the ‘acceptable evidence’ required if the referral is sent electronically; in particular, what constitutes a signature on these documents.
 
However, GP and digital health expert Dr Oliver Frank, a leading advocate for the digitisation of healthcare in Australia, believes he has finally found the answer to this long vexing question.
 
‘Medicare says if a specialist has received a referral and is going to claim at the higher rate, that referral must be signed,’ he told newsGP.
 
‘My question to Medicare was, “GPs are already sending referrals by the secure messaging systems but there is no actual legally valid signature on it. Does that matter?”’
 
According to Dr Frank, this seemingly simple question resulted in an extended period of correspondence with the Department of Health (DoH), before he finally received a satisfactory response.
 
‘It is sufficient for an email referral to simply state that it is “signed electronically by [provider name]”. However … such an electronic signature will only be effective if the person receiving it (in your scenario the specialist) accepts the signature in that form,’ a DoH staff member wrote in an email to Dr Frank.
 
‘Some specialists may insist on hardcopy referrals or some patients may be advantaged by having a hardcopy referral that can be taken to their choice of specialist. 
 
‘But, unless there is something unusual, specialists are likely to accept email referrals from GPs, particularly in circumstances where such arrangements have been trialled and no problems have come to light.’ 
 
Dr Frank said this is good news, especially for GPs who prefer to conduct all work, including correspondence with other specialists, within their own clinical software.
 
But despite the advantages of secure messaging systems, Dr Frank believes some GPs remain hesitant about converting to entirely digital communication due to other existing issues related to the use of clinical software.
 
‘We often need to attach images of various kinds on referrals or with any other message to another health professional, but as far as I know none of the secure messaging systems allow that to be done,’ he said.
 
‘It’s quite a big limitation and is going to stop lot of GPs and other people from universally adopting secure messaging.
 
‘Many GPs and certainly many other health professionals are still sending referral letters and replies to other messages about patients through ordinary email like Microsoft Outlook, but they shouldn’t because of privacy issues.’
 
Another issue is a lack of certainty around whether messages have actually been received by the intended recipient.
 
‘Currently, none of the clinical software actively notifies doctors about whether the message has arrived or not,’ Dr Frank said.
 
‘I don’t want to know that it went through okay. I’m going to assume it did, but the moment the clinical software provider knows that it failed, I need to know. It’s very important from a clinical care point of view.
 
‘It’s also important from a legal point of view. If I think I’ve referred a patient but the message failed and the patient, for whatever reason, didn’t do anything about it and their condition worsened I could be in big trouble.’
 
A third issue is that many clinical platforms are not compatible with one another, leading the Australian Digital Health Agency (ADHA) to push software developers to improve interoperability.
 
Eliminating paper-based messaging in healthcare is a priority of the National Digital Health Strategy, and the ADHA has offered $30,000 to software vendors to help fund developments that will allow health professionals to securely send information across differing platforms.
 
This development remains ongoing, but Dr Frank believes that should software advance to the point where GP concerns are satisfied, it will only be a matter of time before the transition away from paper-based communication is complete.
 
‘When all three issues have been sorted out, so I know I can write to anybody using any other system, I know that I can attach things I need to attach, and I know it’s going to tell me if it fails, then I think we can much more confidently say to GPs, “Switch off the fax – throw it away”,’ he said.

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