Significant telehealth-only reforms taking shape

A plan to compel telehealth-only services, to share patients’ medication information by default aims to be in place by 2027, as the latest phase of My Health Record reforms gets underway.
 
The Federal Government is now seeking input on its proposals in a consultation launched this month, saying online prescribing is an ‘established and increasingly visible component of healthcare in Australia’.
 
It says the process will inform plans for online prescribing services to share prescribed and dispensed medicines-related information to My Health Record by default, regardless of whether MBS funding is involved.
 
The consultation, which is not looking at services that combine face-to-face and online care, is aimed broadly at consumers, healthcare providers, health organisations, and medicines safety experts.
 
It also specifically calls for practitioners’ views on the likely practical impacts of its proposals, which it plans to put into practice in 2027.
 
‘This includes implications for clinical decision-making, care coordination, workflows, and any benefits, challenges or unintended consequences,’ it states.
 
It follows a commitment by Federal Health and Ageing Minister Mark Butler in January to a system that gives patients, prescribers and pharmacists ‘a complete picture of a patient’s medicines history’.

At the time, Minister Butler cited the advocacy of Alison Collins, whose daughter Erin died by overdose after stockpiling medications prescribed through multiple digital health platforms.
 
‘The need for more consistent medicines-related information sharing is especially clear where health care is being delivered in the context of online prescribing services, including models where providers may not interact directly with patients,’ the Department of Health, Disability and Ageing (DoHDA) consultation paper states.
 
‘Safety risks may increase where online prescribers do not have timely access to, or do not adequately review a patient’s medical and medicines history prior to prescribing.
 
‘These risks are heightened in fragmented models of care, reinforcing the importance of strong information-sharing arrangements to support safe prescribing practices.’
 
The RACGP is drafting a submission to the consultation, which closes next month.
 
Dr David Adam, a GP and member of the RACGP Expert Committee – Practice and Technology, said the college response will emphasise the need for strong clinical safeguards in a time of rapid change.
 
‘We’ve seen a big rise in those online, telehealth-only services,’ he told newsGP.
 
‘Many of those people providing those services are our members.  
 
‘In line with our position statement on telehealth, we are very clear that it’s not a substitute for in-person care.
 
‘Many of us have had patients who have received treatment through one of these services when it’s been difficult to find out what that treatment is.
 
‘We’re all aware of it happening.’
 
In January, Minister Butler also said a National Medicines Record would be developed using ‘existing digital health capabilities’, such as electronic prescribing, the Active Script List and My Health Record.
 
The consultation focuses on Schedule 4–8 prescription medicines, while sharing details about over-the-counter medicines, including pharmacist-only medications such as high-dose pain relief, will not be mandatory or by default.
 
‘Medicines of particular interest include (but are not limited to) antibiotics, contraceptives and high-risk medicines such as opiate analgesics, psychostimulants and medicinal cannabis,’ it states.
 
Dr Adam recognises the need for change but also stresses the importance that reforms reinforce continuity of care.
 
‘We’re always supportive of initiatives that improve clinical safety, and improve GPs’ access to information,’ he said.
 
‘Uploads to My Health Record don’t replace communication with your usual prescriber.
 
‘We would expect that these services do their best to communicate with their usual GP.’
 
DoHDA estimates 250,000 people in Australia are hospitalised and around 400,000 present to emergency due to medication-related harm each year, with around half of those cases considered preventable. 
 
It puts the cost of medication-related harm to the health system at $1.4 billion annually.
 
The initial tranche of sharing-by-default reforms for pathology and diagnostic imaging tests came into effect earlier this year, following recommendations made by the Strengthening Medicare Taskforce.
 
Changes have also been made to reduce the timeframe for results to be uploaded to My Health Record.
 
The consultation runs until 7 July, with DoHDA stating it expects legislative changes to be finalised by the end of the year.
 
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