Telehealth changes threaten to put handbrake on Australia’s $2bn digital healthcare industry

Companies ranging from health titan Medibank to start-up Medmate are concerned the Medical Board’s proposed changes to telehealth will limit access to patient care.

Medmate chief executive Ganesh Naidoo said the Medical Board’s draft telehealth guidelines ignore telecommunication black spots and other difficulties in ensuring real-time connectivity in rural and regional locations. Picture: Nikki Davis-Jones

Key players in Australia’s $2bn digital healthcare sector fear proposed changes to telehealth and other technology-based doctor consultations will restrict access to timely treatment.

The Medical Board of Australia is moving to contain a pandemic-fuelled explosion of telehealth care, which it says “should not be considered as a substitute for face-to-face consultations”.

Under the proposed new guidelines, which are based on recommendations drafted a decade ago, doctors are warned not to prescribe medication to first-time telehealth patients.

Telehealth has made medical care available in regional and remote areas, which have struggled to attract doctors and other health professions. But the burgeoning industry has also sparked controversy after some providers prescribed drugs from new medicinal cannabis products to treatments for erectile dysfunction based solely on phone calls or text-based questionnaires, without an in-person consultation.

Australia’s biggest health insurer, Medibank, largely supports the Medical Board’s intent to ensure digital consultations remain safe but wants it to ensure the practice is not discouraged completely.

Meanwhile start-ups such as Medmate — which uses the gig economy to fulfil and deliver prescription medication — are concerned the changes will restrict innovation in the digital health sector, such as using artificial intelligence to support doctors in an overloaded system.

Andrew Wilson — chief executive of Medibank’s health services division, Amplar Health, which runs a telehealth and at-home care business — said virtual health has removed some pressure from hospitals while increasing access to care.

Medibank’s health services generated a 44.9 per cent increase in segment profit to $45.5m last financial year, off a 13.4 per cent lift in revenue to $321.8m. Meanwhile, NAB estimates Australia’s digital health market is worth about $2bn.

Medibank’s Andrew Wilson says telehealth is not homogenous. Picture: Murray Harris

“Up to 35 per cent of consults through that (Amplar) service are done by video. That’s safe, effective and leads to a significant reduction in people going to emergency departments unnecessarily after hours,” said Dr Wilson, who is also a practising psychiatrist.

“Telehealth is another modality of providing patient care and just like any modality, in any care setting, there are appropriate settings and inappropriate settings. You don’t do joint replacements in a surgeon’s rooms, for example.

“You’ve got to match the clinal presentation with the appropriate care setting.”

Dr Wilson, who offers his patients telehealth consultations, says the system works very well. “It allows me to see people in rural and remote Australia who would really struggle to see a psychiatrist in any other way.

“There’s an access and equity issue here that needs to be considered.”

But Dr Wilson said telehealth was not a “homogenous” service and was split between real time and asynchronous consultation, for example asking a patient to fill out a form or engage in a chat-like text platform.

“They’re not completely analogous. That’s an important distinction. And then there are various types of care.

“The principle that in an ideal world telehealth is most appropriate in the context of an ongoing relationship with a regular doctor. That makes very good sense.

“That said, there are some important caveats to that. And one is where there’s an urgent need or an acute need for a patient to access a medical practitioner, particularly a GP, and there are none available in a traditional face-to-face setting.”

Example of a script sent via SMS on a phone.

Medmate chief executive Ganesh Naidoo said the draft guidelines restricted channels other than voice or video, and ignored telecommunication black spots and other difficulties in ensuring real-time connectivity in rural and regional locations.

“Australia is a country of almost 8 million square kilometres. Many rural and remote regions have unreliable mobile phone coverage. Large areas are frequently impacted by natural disasters such as floods and bushfire,” said Dr Naidoo, who is also a GP.

“It is often very difficult for doctors and patients to have a clear and stable voice or video link to undertake a telehealth consultation in real-time. It is not safe or sensible to restrict modes of communication between doctors and patients.

“A doctor must have the ability to utilise their independent professional judgment about how to safely undertake a clinical assessment. Restricting modes of care discriminates against all patients, particularly in after-hours periods, and unfairly disadvantages rural, Indigenous, and vulnerable groups.”

Dr Naidoo said the proposed changes might also deter tech titans like Amazon and Google from launching other platforms such as AI-assisted doctor-patient communication in Australia.

“The implications of short-term thinking to restrict modes of healthcare communication technology are profound – stifling healthcare innovation in Australia for at least the next five years, a period that will see inevitable changes in healthcare service delivery requirements leveraged by emerging technologies.”

“It will also hinder the ability of ASX-listed pharmaceutical wholesalers to create end-to-end e-commerce solutions for their customers by inserting traditional face-to-face doctor consultations back in the process. It is vital that all forms of communication are available to be used safely and sensibly based on the doctor’s professional judgment.”

In its public consultation paper, the Medical Board said its revised guidelines “recognise that telehealth provides great opportunities for access to, and delivery of healthcare”.

“But that it is not appropriate for all medical consultations and should not be considered as a substitute for face-to-face consultations,” the board said.

“The guidelines provide guidance to support good practice when using telehealth including that the standard of care provided in a telehealth consultation must be safe and as far as possible meet the same standards of care as provided in a face-to-face consultation.

“Practitioners should be continuously assessing the appropriateness of the telehealth consultation and whether a direct physical examination of the patient is necessary.”

Public consultation closes on February 17.