MEDICUS MARCH 2016

F E A T U R E

Doctors should be aware of the extra risks and obligations associated with remote health service delivery, says the Medical Indemnity Protection Society (MIPS) Telehealth – am I covered?

E ach year in what is arguably Australia’s most remote outpost, Antarctica, a sole doctor provides healthcare to up to 75 expeditioners keen on trekking to the South Pole or the summit of Mount Vison Massif – the highest peak in Antarctica. While healthcare is still provided in person during extensive health checks prior to the adventurers heading out to attempt their ambitious goals, much of the doctor’s practice must be carried out over the phone. Once trekkers are miles from the relative safety of bases such as Mawson station, the only communication is usually via a satellite mobile phone. In Australia, remote communities are using the phone, Skype, Facetime and other video conferencing solutions to facilitate telehealth. This emerging method for delivering healthcare has a number of additional requirements and guidelines, and doctors need to ensure they are covered for their intended telehealth practice. For this reason, it is important for doctors to be aware of the extra risks and obligations and what their indemnity insurance policy covers. In a telehealth consultation, the location of the patient rather than the doctor is deemed to be where the healthcare is provided. For this reason, Australian doctors need to consider practice registration requirements at their location and the location of the patient. Unless specifically provided for, or agreed to by their insurer, practitioners should not assume they are automatically protected for telehealth provided to a person, especially if they are outside Australia. It is recommended that practitioners approach their insurer/medical defence organisation (e.g. MIPS) for confirmation that their intended telehealth practice fits within the boundaries of their cover. Practitioners should also seek confirmation of indemnity coverage from their insurer/MDO if their employer does not provide indemnity for such practice or for any private practice outside of their employment. Additionally, practitioners should also seek confirmation if there is no intention to conduct face-to-face consultations or where the patient, or the practitioner, will be located outside Australia. Some fundamentals to note when considering this type of healthcare delivery: • Practitioners must be appropriately registered at the location of the patient and qualified and experienced in the health services they provide. • Telehealth is not an excuse for a lesser standard of patient care.

• Practitioners are expected to undertake telehealth consultations and practise

o in accordance with the Medical Board Guidelines on technology-based patient consultations o in accordance with relevant college guidelines and standards o in accordance with Medicare’s guidelines for telehealth (where applicable). It is MIPS’ view that telehealth is a method of patient interaction that should augment, rather than replace, conventional practice. Where specialists are connected to people in remote areas that otherwise would not have access to a specialist, is perhaps where telehealth is used at its best. Patients who are seen regularly by a practitioner and only occasionally via telehealth for chronic stable conditions is also of less concern and lower risk to the parties compared with patients seen exclusively via telehealth. Telehealth has some significant shortfalls. Some medical diagnoses can be more difficult if consulting using telehealth compared with in-person consultations, even with the additional benefits of video conferencing. MIPS has approved cover for telehealth for a number of psychiatrist members who intend to use a regular video call to maintain contact with patients with chronic but stable conditions who move away temporarily from the specialist’s geographic location of practice and where transfer of care to a local practitioner is not possible or not desirable. There are also a number of GPs who see and treat patients in person but conduct follow-up consultations appropriate for the condition treated via telehealth to eliminate lengthy travel time for patients in rural areas. Telehealth ventures that are cavalier, entrepreneurial, focus more on profits and convenience of practitioners over the standard of care for patients or to facilitate ‘revolving door’ medicine are a recipe for disaster. MIPS supports telehealth as an additional tool to improve patient care, however in accordance with its Constitution, MIPS may determine not to extend membership benefits (which includes insurance cover) for some novel telehealth practise proposals on the grounds that they constitute irregular practice that places members and their patients at considerable risk and is an inadequate and/or inferior substitute for usual consultation practices.

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