- Telehealth support
- Challenges with video consultations
- Top tips
- Set up
- Temporary MBS Telehealth Item for COVID-19 pandemic response
- Workcover reimbursements
- More information
Remote consultations are an option for providing care. Not all consults need to be face-to-face, and telephone or video is an option that improves access to healthcare for some. While it cannot supersede face-to-face consultations, there are many scenarios where a remote consult can be beneficial (despite the tradeoffs), convenient, and safe. But it may not be simple; there are a lot of factors to take into account. Implementing remote consultations will involve service design (and maybe even redesign).
Your local PHN will be able to support you with telehealth. This page has the websites of each PHN. Go to your PHN's website and look for their Digital Health team's contact details.
Even though it's digital, real-world time and space are significant factors in the success or failure of getting video consultations to work. Scheduling is one of the hardest to solve. How do you guarantee that the person you're communicating with can be accessed at the same time as you are available?
Similar with space. Each person (i.e. the clinician and the patient) needs a room that is free from distractions and protects the patient's confidentiality.
As always, the technology may be fantastic, but if implementation hasn't aligned with your clinic's priorities or if workflow is not taken into account, it will be hard to make it work well. A good method for solving this yourself is to walk through, step-by-step, what the patient will be experiencing.
So, aim to get going as soon as you can, but get your team on board, know why you're doing it, and keep tabs on what's going on so you can constantly improve it.
- For detailed steps to bring the team together and thoroughly test the processes and technology, see the RACGP guide (Flowchart 1).
- Consider using phone rather than video. Phone is quicker and easier to deal with, and is sufficient for most consults.
- For more information, see the RACGP Guide to providing telephone and video consultations in general practice.
- However, being able to see the patient gives more information for clinical assessment, so there are occasions when it's better than phone. If using video, the easiest technical solution is to purchase an iPad (preferably one that can use a SIM card), and set it up with an Apple account for your practice. FaceTime with patients who have an iPhone or iPad. For those using Android, install Skype and WhatsApp.
- The RACGP supports the use of Skype, FaceTime, WhatsApp etc for use in clinical settings (see page 10 of their video consultation guide). If you're using Zoom, there are steps for configuring better security and safety in this guidance.
- The patient may have problems with the technology, so allow time for troubleshooting.
- Use admin/reception team as much as possible (see suggestions below).
- Think about the process to make the scheduling work well. For example, book the appointment as normal, but when you confirm with the patient, tell them to expect a call around that time (as often happens with face-to-face appointments, you may be running behind).
- Block out an hour or so for a GP to take remote consults only. Consider doing this in the morning, so the GP can arrange to see the patient in person later in the day if needed.
- SMS messages can help keep in touch with patients. Consider ramping up your existing service. If you don’t have one, consider choosing a service tailored for primary healthcare. See more advice about SMS messaging.
Whatever technology you're using for remote consultations, you must consider governance, particularly clinical governance, for how the technology will be used safely. Consider what types of service you will provide remotely, what types of consultations, and who in the team is involved. You're already used to phones, but you may need to formalise in a policy how the triage and scheduling is done even for phone. Include remote consultations as a regular agenda item in team meetings so you're sure you're identifying problems and improving the safety and quality of the service. Ensure the entire team is doing the same thing (consistently following the same process). The clinical team will need to agree on triage protocols, and this should be documented and kept up to date.
Download the the checklist, which covers hardware and software in the clinic & home settings, and promotion to patients/clients.
Selecting a video conferencing product
Also see the Top tips above.
While remote consultations can generally work as comfortably as face-to-face, the same courtesies need to be extended, plus some extra ones:
Phone and video
- Take care to give clear pre and post-appointment instructions. This is respectful to the patient and will reduce follow-up calls, time, and confusion.
- Be punctual. If delayed, let your patient know.
- Have a professional, private space with good lighting. Use the self-view feature to adjust the setting if needed. Consider a “Do Not Disturb Sign” on the door to avoid interruptions.
- Set-up the webcam at eye-level – having good eye contact makes the consultation more professional and engaging. However, you don’t have to look directly at the camera.
- Dress how you would if it were a face-to-face consultation.
- If you look away from the screen without explanation, you could appear distracted and unresponsive. Give some warning so the other person knows what to expect.
- In this YouTube video, a UK GP demonstrates common examples of poor "webside manner" and gives tips for improving videoconsultation ettitquette.
When adding a new consultation mode (i.e. remote consultations) you will need to update your triage policy.
Consider who is usually triaging. For example, reception staff or nursing team.
Whoever is triaging will need a protocol for choosing the best option. For example, you will want to avoid a video consultation being booked if the patient should be coming in person to the clinic. The whole team needs to be able to quickly access the triage protocol in case the person who usually does it isn't available.
The triage protocol may need to include referral options if it is not appropriate to be seen by the clinic.
When a remote consultation is appropriate:
- Protecting vulnerable patients – such as older patients or patients with comorbidities
- Medical Certificates or issuing repeat prescriptions
- Mental health consultations, counselling etc.
- Routine chronic disease checkups (particularly if patient has monitoring devices at home)
- Any consultation where the trade off between the patient attending and the patient staying at home favours the latter
- COVID-19 related conditions
Video may be better when:
- Patient is hearing impaired (using chat function)
- Wound management
- It's necessary to sight if patient looks unwell
When not to do a remote consultation:
- Potentially serious, high risk conditions requiring physical examination.
- Where physical / internal examination is required.
- Patient’s ability to communicate is compromised or they don’t have appropriate support person to assist.
- It is not clinically appropriate.
To avoid missed appointments and manage delay/backlogs, you will need to manage scheduling carefully. With extra consultation modes, there is more complexity.
For remote consultations, make sure you've taken extra steps to increase the chance of a successful consultation:
- Confirm with the patient that the appointment is remote and the details:
- Confirm their contact details are correct. If using video, it is particularly important to confirm a back up number, so the consult can revert to phone if the video fails.
- The technology used and the process to follow. If possible, conduct a test call with the patient if it is the first time they have used video. Older patients may need to get help from younger members of their family (but bear in mind many older people are comfortable with online technology).
- Inform the patient of any considerations (for example that they should ensure they are in a private space for sensitive discussions) and record patient's consent.
- If you don't have one already, consider implementing a reminder and/or confirmation process (e.g. SMS notification).
- Find a way in your booking system to differentiate between consultation types, so it's clear which are face-to-face and which are remote.
Your reception/admin team can contribute significantly to a successful remote consultation.
Suggested workflow for admin staff to do before each consultation:
- Call patient an hour or so prior to the scheduled consult.
- Confirm with them:
- That it is still appropriate to wait until the allotted time for the consult. If not, arrange for a nurse to triage for worsening health issues.
- Name, DOB, house address, best contact number, next of kin.
- Remind patient that they will receive a phone or a video call around time of appointment.
- If clinician is using a blocked number, tell the patient that “unknown caller’ will be displayed”.
- If they don’t answer, clinician will try once more, but then after that, the appointment will be “missed”.
- “Arrive” the patient in the patient management software's “Waiting Room”
- Doctor can book follow up appointments or ask reception to do so.
- SMS messages can help keep in touch with patients. Consider ramping up your existing service. If you don’t have one, consider choosing a service tailored for primary healthcare.
- During a public health emergency, the use of email to communicate health information after a telehealth consulation is appropriate (as recommended by the RACGP and the Department of Health). But before doing so, as a professional courtesy, confirm the suitability of email with the relevant providers or identify mutually feasible alternatives.
- Printing options (e.g. for referrals, medical certificates, care plans, results)
- If the doctor is not at the clinic:
- Printed locally and fax/email to relevant provider.
- Printed remotely to reception to be faxed/emailed by admin team (IT support would set up the remote print).
- Many hospitals and some specialist practices use electronic referrals. To reduce need for hardcopy referrals and faxing, find out from your local networks if this is an option.
- Note that documents printed locally and then scanned/faxed must be shredded.
- If the doctor is not at the clinic:
- Doctor can print locally (see Printing options, above).
- Discuss with patient their preferred pathology/radiology provider and send request to chosen provider with a copy sent to the patient. Doctor or admin staff might need to initially contact local pathology and radiology providers to source fax numbers etc (or email address (if acceptable to provider), as they are not normally listed.
- Email the request to the patient (patient will need to communicate the request to their chosen provider through a mutually suitable method).
- Alternatively, contact pathology and radiology providers and work out mutually feasible options.
- ePrescribing is currently not an option, but recent changes to Australian legislation made it possible. Policies and technical standards and systems are being fast-tracked to make it available soon.
- Liaise with your local pharmacies and find mutually feasible options for prescription management. As pharmacists will be dealing with these requests from multiple prescribers, they will be able to offer you more local and innovative solutions. Existing options include:
- Phone order to pharmacist, followed up with prescription posted to pharmacy.
- Setup home printing (see Printing options above), to print locally, sign, and scan (or fax for drugs of dependence). For latest rules on sending scripts, refer to the following bullet point.
- Under temporary COVID-19 arrangements:
- create a separate digital image of each prescription. This can be a photo or PDF that is clear enough and includes the barcode (where applicable) so it can be scanned.
- as covered by your State or Territory's emergency regulations, fax/email/text message directly to the patient's pharmacy of choice, record that a digital image of the prescription was transmitted under an emergency order, and retain a copy of the prescription for 2 years. Note that S8 and S4(D) medicines (drugs of dependence) are not covered by these temporary arrangements and existing regulations apply (e.g. see Victoria's prescribing regulations).
- When faxing/emailing prescriptions to the pharmacy it helps to communicate whether there is an immediate need for the prescription or if it is for a later date to help pharmacists manage influx of faxed and emailed prescriptions.
As of 30 March 2020, telehealth items are available to all Australians. This is stage 4 of the COVID 19 response.
Notes about items
- As of 6 April 2020, practices can apply their usual billing practices to the telehealth items. However, the items must be bulk billed if the patient is a Commonwealth concession card holder, under 16 years old, or is more vulnerable to COVID-19. (For reference, see the MBS fact sheet, the first one listed here.)
- Clinicians are expected to obtain informed financial consent from patients prior to providing the service; providing details regarding their fees, including any out-of-pocket costs.
- Only applies to non-admitted patients.
- Double bulk billing incentive applies 10990/10991 where applicable.
- Nurse item 10997 is not identified as eligible for telehealth.
- Disclaimer: these item numbers are correct per information from MBS Updates. There are some discrepancies between some MBS online descriptors and the matched codes (729,731,732), we are seeking clarification on this matter and will update this information as soon as possible.
Item summary for GPs
|3||91795||91790||$17.50||Attendance up to 5 mins|
|23||91809||91800||$38.20||Attendance less than 20 mins|
|36||91810||91801||$73.95||Attendance at least 20 mins|
|44||91811||91802||$108.85||Attendance at least 40 mins|
|729||92070||92026||$71.55||Contribution to a care plan|
|731||92071||92027||$71.55||Contribution to RACF care plan|
|732||92072||92028||$73.20||Review of GPMP or TCA|
|715||92016||92004||$215.65||Aboriginal & Torres Strait Islander health assessment|
|2713||92127||92115||$72.85||Mental health attendance >20 min|
|2715||92128||92116||$92.50||Prepare MHCP 20-40 min (trained)|
|2717||92129||92117||$136.25||Prepare MHCP 40+ min (trained)|
|2700||92124||92112||$72.85||Prepare MHCP 20-40min (untrained)|
|2701||92125||92113||$107.25||Prepare MHCP 40+ min (untrained)|
|2729||91842||91818||$94.25||Attendance FPS treatment 30 to 40 mins|
|2731||91843||91819||$134.80||Attendance FPS of more than 40 mins|
Item summary for other medical practitioners
|52||91797||91792||$11.00||Attendance up to 5 mins|
|53||91812||91803||$21.00||Attendance 5 mins to 25 mins (metro)|
|54||91813||91804||$38.00||Attendance 25 mins less than 45 mins (metro)|
|57||91814||91805||$61.00||Attendance at least 45 mins (metro)|
|185||91815||91806||$30.55||Attendance 5 mins less than 25 minsregional)|
|189||91816||91807||$59.15||Attendance 25 mins less than 5mins(regional)|
|203||91817||91808||$87.10||Attendance at least 45 mins (regional)|
|231||92101||92057||$57.25||Contribution to a care plan|
|232||92102||92058||$57.25||Contribution to RACF care plan|
|233||92103||92059||$58.55||Review of GPMP or TCA|
|228||92023||92011||$172.50||Aboriginal TSI health assessment|
|279||92133||92121||$58.30||Mental health attendance >20 min|
|281||92134||92122||$74.00||Prepare MHCP 20-40 min (trained)|
|282||92135||92123||$109.00||Prepare MHCP 40+ min (trained)|
|272||92130||92118||$58.30||Prepare MHCP 20-40 min (not trained)|
|276||92131||92119||$85.80||Prepare MHCP 40+ min (not trained)|
|371||91844||91820||$75.40||Attendance FPS treatment of 30 to 40 mins|
|372||91845||91821||$107.90||Attendance FPS treatment more than 40 mins|
Workcover reimbursement rates include telehealth items as of March 2020.
|Item code||Worksafe rate|
Read the Worksafe announcement about the telehealth items for more information about the new rates. An Excel download of the full rates fee schedule is available here.
- The RACGP has resources for implementing video consultations in general practice.
- The RACGP also has a guide to providing telephone and video consultations in general practice.
- Overview and resources from the Digital Health CRC on Governance and legality.
- Hints and tips for clinicians from the Digital Health CRC.