Following on from our 1 November article Is Australian telehealth alive, dead or just comatose?, it is now officially ‘beleaguered’. As of 1 January, more than eight million people formerly considered distant enough to qualify for telehealth and telemedicine services are now considered ‘urban’ and will no longer qualify due for a (AU) Medicare rebate for internet video consultations with medical specialists started in 2011. According to the article, it seems to affect psychiatric services and other specialist services; also GPs who’ve installed now un-utilized telehealth equipment in clinics. The savings will be (AU) $128.5 million on the $620 million scheme, although it spurred broadband development across Australia. According to a comment on LinkedIn by reader/commenter Dr. George Margelis, “The net effect is that telemedicine in Australia will flounder, because uncertainty is the greatest deterrent in medicine.” Millions across Australia to lose Telehealth rebates from New Year (News.com.au) Hat tip to reader Ellen Fink-Samnick of LinkedIn’s ‘Ellen’s Ethical Lens’.
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Over at GP2U, while we are disappointed with the latest changes to the Australian Telehealth rules they only affect Government funded Telehealth.
There remains broad scope for non Government funded Telehealth such as our user pays Skype2doctor service. https://gp2u.com.au/skype2doctor
James, here in the US we have had serious concerns with the fact that Skype is not secure (and is not HIPAA compliant). Most telemedicine platforms like American Well and MDLive use proprietary video conferencing. How are you coping with the privacy question with GP2U?
Here is more on the security problems US providers in the mental health area have found with Skype:
[url]http://onlinetherapyinstitute.com/2011/03/videoconferencing-secure-encrypted-hipaa-compliant/[/url]
The TeleMental Health Institute has also listed 50 companies claiming HIPAA compliance (another hat tip to Ellen):
[url] http://telehealth.org/video%5B/url%5D
James makes a valid point, private pay telehealth remains as a viable option. However, the Australian national health insurance system was designed to provide equitable healthcare, and I fear we will start to see a two tier system develop. Also I worry that those in greatest need of telehealth, the elderly with limited mobility for example, will miss out on its value. Then when the evaluations are done, they will show that it not effective.
There is scope for the GP2U type services provided by Dr Freeman. However unless telehealth becomes part of the mainstream, and its use becomes more widespread, it will not innovate and grow.
I think we will be seeing less emphasis on security protocols and more on just using the systems in the future. Utilising current infrastructure that people already may have as opposed to specific pieces of kit will have the technology providers saying ‘whoa there horsies’ but in order to keep it cost effective ……
It will be up to the individual weighing up the risks to decide whether this service suits them. If we are to ‘force’ people to use this type of system then that is when we need to provide the relevant kit and protection. Look at the protection we have right now – Doctor’s surgery doors are generally made of hardboard and soft wood – not reinforced steel with soundproofing. Curtains on hospital wards are not special cloaking devices – they are fire retardant sheets that usually have a 35cm gap at the bottom and at least three people in beds within 3m of them that can hear a Cadbury’s Eclair wrapper opening even in the deepest of sleeps.
Watch programmes such as Street Doctors or Embarrassing Bodies and you will see people (some not all) are reasonably OK with sharing with complete strangers so long as it gets results. The mode of transmission will depend upon what is to be transmitted. No Doctor or Nurse will ever say ‘you will die in 3-4 weeks’ over Skype. They may say ‘we have your test results back and would like to make an appointment for you to come in to receive them’. Protocols on what can and cannot be transmitted can be drawn up locally – even a tick box of what the patient is happy to be transmitted.
I actually think what you are suggesting UNATTR is going to be the cause of the two tier system!
You are right people will be prepared as individuals to use equipment they already have like Skype and accept the security is what it is (or isn’t). My Dad would have been happy to use this to submit his vital signs readings to his GP during his recovery from a stroke; he lives rurally, couldn’t drive at that time, trusted his GP and could see the advantage of face to face over skype as well as submitting the data.
However our public sector is extremely risk averse and with the blame claim culture it is going to take a great deal to persuade the NHS and Local Authorities to change on this – they cannot even agree on each citizen having one unique number instead of two – we each have an NHS Number (CHI Number in Scotland) allocated at birth and then we are allocated an NI number at 18 and yet even with these unique identifying references information is still regularly stored on the wrong record because a name is similar.
It is assumed that integration of health and social care will address these sorts of issues … if we were talking a full integration of NHS and Local Authority then it might – but a partial integration won’t achieve it.
I think you are totally right Cathy – it will be two tiered. And I think it has to be in order to survive at all.
Those that are happy to Skype will do, those that are happy to Skype back will do. Those innovative GP Practices that run as a business will want to run this as it is another service to offer; which can only be good. If we waited for a Universal Protocol then we will never get it.
well we now appear to have a Universal Protocol on your ‘handle’ UNATTR … it didn’t take that long to establish really did it – just a little persistence :lol:
I also agree with UNATTR and Cathy in supporting the 2 tier principle.
I think that the second tier will be ideal for DIY telehealthcare including Skype and a lot of fitness apps. I also expect some low-cost products that monitor heart rate, pulse wave velocity, breathing rate and blood oxygen level to be available to work with smart phones and tablets but which are not genuine medical devices. They will, however, be fine to determine trends and to flag up reasons why a GP might want to offer the user the loan of a first tier (and hence expensive) device for a short while which will satisfy the risk-averse commissioners.
GPs wont have the time (nor perhaps the interest) to look at stacks of data if it isn’t absolutely accurate and reliable – but a second tier approach as a filter might be more acceptable, and still gives the DIY health enthusiast some motivation for taking an interest in his or her vital signs and what has an impact on them.