Telehealth-only standards in spotlight

A new set of ‘National Telehealth Standards’ has been launched by Patients Australia, and while the group says it is the result of ‘extensive consultation’, GPs have raised concerns about its legitimacy.
 
The standards were developed by the Australian Telehealth Standards Consortium (ATSC), a group made up largely of telehealth companies and insurers including Medibank, HCF, BUPA, Updoc, Healthengine, Wesfarmers Health, Healthdirect, and Eucalyptus.
 
The 34-page document ‘sets out clear expectations’ around clinical governance, patient safety, informed consent, continuity of care, advertising, technology and data security, and accreditation.
 
However, Dr Rob Hosking,  RACGP Expert Committee – Practice Technology Chair, points out that the standards are not endorsed by the college, nor by any standard-setting or regulatory body.
 
‘We should congratulate this group for trying to regulate themselves, but just calling these standards doesn’t make them standards,’ he told newsGP.  
 
‘Standards set by RACGP go through a rigorous process.’
 
Patients Australia says the document will support clinicians, providers and policymakers in defining what ‘trustworthy telehealth’ looks like in practice.
 
‘Patients Australia will work with governments, regulators, health services and industry to support awareness, uptake and policy alignment with the National Telehealth Standards,’ it said.
 
‘This includes positioning the standards as a practical reference point for policymakers as telehealth continues to evolve as part of Australia’s health system.’
 
While the Australian Health Practitioner Regulation Agency publishes telehealth guidance for individual clinicians, no officially endorsed government standards exist for telehealth-only providers, with the industry expanding dramatically in recent years.
 
There have been increasing calls from telehealth companies pushing for officially endorsed standards.
 
Last May, Eucalyptus published its ‘Telehealth best practice principles for Australian online providers’, pointing out ‘incredibly inconsistent’ clinical governance standards in the industry.
 
‘But until there are government-endorsed safety and quality standards for online telehealth clinics, there is no good way for patients to know whether their clinic is going to provide them with safe and high-quality care,’ they wrote.
 
The Australian Commission on Safety and Quality in Health Care has also confirmed it is not currently developing standalone virtual care standards.
 
Instead, it pointed to its National Safety and Quality Digital Mental Health Standards.
 
‘The Commission is developing a new national model for clinical governance for the acute sector to provide best practice guidance for health services, which will incorporate digitally enabled care, including virtual care,’ it told newsGP.
 
‘In developing the National Safety and Quality Health Service Standards (third edition) the Commission is considering requirements to support safe and quality use of digital tools and technology in delivering healthcare.’
 
Dr Hosking, meanwhile, points out that RACGP members working in bricks-and-mortar practices are likely to be the nation’s biggest overall providers of telehealth and points to the college’s own telehealth principles.
 
‘We provide telehealth as part of our routine care,’ he said. ‘Because every GP is doing it numerous times a day now, and that’s part of our job.’
 
The Patients Australia standards say virtual care providers ‘must enable and encourage secure information sharing by supporting uploads to My Health Record and timely communication with a patient’s usual GP’.
 
‘When patients withhold consent for this information sharing, practitioners must consider and document concomitant clinical risks, exercise heightened prescribing caution and may decline treatment where risks outweigh benefits,’ it continues.
 
For Dr Hosking this does not adequately address the issues surrounding fragmentation of care, and he emphasised the critical importance of telehealth companies communicating with patients’ regular general practice.
 
‘If medicines are prescribed, if we don’t know about it, there’s potential for serious interaction and adverse events,’ he said.
 
‘It could be medicines we’ve already tried using perhaps, and we know that the patient shouldn’t or couldn’t take, and yet they’ve forgotten and they’ve rung up somebody for convenience and got a prescription for it.
 
‘We’ve got to be careful that we don’t confuse instant access and convenience for good quality medicine and good quality care.’
 
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