It may have only been a month since the Royal Australian College of GP’s announced (in what we think is a move that should/will be emulated by their contemporaries around the world) their plans to roll out a suite of national e-health solutions and services with the Australia 3G Mobile Operator Telstra. So it’s great to see that their collaborative efforts are paying dividends with Prime Minister Julia Gillard (who is currently fighting for reelection) pledging to invest in a $392 million plan to modernise the health system – at the centre of which will be funding for “online consultations and videoconferencing“.
While recognising that online and video consults aren’t a substitute for in office consultations RACGP President Dr Chris Mitchell points out the capacity these have to save patients and GP’s time while supporting the ability for “GPs to provide high-quality care to the local communities that they serve”.
Dr Andrew Pesce Federal President of the AMA was a little more sceptical. Whilst recognising how “the investment would allow rural doctors to overcome the tyranny of distance and would help some patients to avoid the need to travel long distances and incur significant costs to access medical care” he commented that it should “only be used as an adjunct to normal medical practice“. This surprises me as I struggle to believe that using modern communication technologies can ever be considered supplementary to proper care. Whilst still decades ahead of many of his contemporaries I think Dr Pesce would be better regarding it as just another essential part of the practice of medicine – just as you would consider any communication tool that can improve a Doctors ability to safely care for patients.
One big upside of the introduction of new initiatives is the online discussions that these open up and this one over at 6minutes (HatTip to TelecareAware) has encouraged some very interesting contributions from those who oppose and favor the new investment plans:
Stephen Scholem’s “baloneymeter” is off the chart as he dismisses the importance of taking a history (in any discipline outside of psychiatry):
“Come on people. Let’s get real. History alone is not enough for a proper consultation, except just maybe for psychiatry. Skype is not adequate to diagnose even a rash. This proposal rates 99.8 on my baloneymeter”
In my opinion an up to date accurate history is not only a prerequiste for safe informed care but it also provides the perfect place to document the advice given in video consultations which is a big plus for the Patient, Doctor and any one who will be involved in offering follow up care. It’s worth being mindful that in primary care poor documentation and history taking is by far the leading cause of errors that cause major harm to patients.
As for the value of modern multimedia connectivity, I wonder if this commentator is aware of the findings of this 2008 Austrian Hospital Dermatology investigation into the use of camera phone images to diagnose dermatological disease in which they found over half of patients could be treated remotely? Not only have todays mobiles moved on somewhat from the devices used in this 2007 study but new technologies (such as HD Video recording) have enabled incredible new possibilities.
Russell Wiseman (GP Sunshine Coast) asks if “anyone bothered to ask the medical defence insurers if they’ll cover anyone engaged in remote tele medicine?“. I wonder if he’s aware that North Sea oil rigs have been practicing medicine with similar limitations for decades? Or how private companies such as MedAire have provided remote emergency support to thousands of patients who have fallen ill when 20,000 ft up in the sky or miles out to sea? The NHS Direct faced similar problems and despite the fact that it doesn’t use electronic medical records, offer patients documentation and uses unqualified staff it’s still got a very low reported adverse incident rate. Where there is a need there is a way and with the RACGP and Telstra collaboration it’s pretty safe to say you can be sure that medical defence insurers have this one covered already.
Russell Wiseman’s next comment is really interesting: “I know if I was the insurer my answer would be no, there’ll be an insurance premium increase if you want to be that“. Back in 2005/6 we met with sceptics of 3G Doctor who said exactly this. But by supporting remote consults with information gathering tools and follow up protocols (eg. a written report with every consultation) you might be surprised to find that the medical indemnity insurers will appreciate that the risks remain the same or are even reduced. In the UK for example Doctors registered with the MDU and MPS can offer advice through the 3G Doctor service at their normal GP rates.
Robert Allan’s comments reveals very valid concerns about how government telehealth plans can lead to outsourcing of Doctor/Nurse consults to emerging markets. To my mind there are as many positive as negative arguments to this. For example isn’t it preferable for a poorer nation to have it’s Doctors and Nurses able to remain in their home country (contributing taxes and to the development of the native education and healthcare system) than to migrate in order to take unpopular medical jobs abroad?
Alex Hope gets enthusiastic about a 3G Video Consultation demonstration he’s had from Aboriginal health workers using Telstra’s “Next G” network: “What an improvement over the phone that was, for managing a presentation of an infected swollen foot“. Thanks Alex for sharing this, one of my colleagues (who saw practice as a Doctor out in Meekatharra) was delighted to learn how her colleagues are also now utilising 3G Video technologies… we look forward to finding out more on this development.