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Three months of lockdown did more for remote healthcare than 10 years of discussion.
The huge surge in telehealth during the COVID-19 lockdown helped protect providers and patients. So what insights and lessons can both sides of the healthcare equation take from the experience?
Australians didn’t only embrace online shopping as COVID-19 shut down personal interactions – telehealth also rocketed in availability and popularity.
Until March 13 this year, only people living outside major cities qualified for a Medicare-subsidised telehealth consultation. All consultations had to be by video and were generally provided by specialists rather than GPs. Then, as part of a $1.1 billion package to reduce the impact of COVID-19, the Federal Government began to expand the subsidies. And, by 23 June, 72,509 health care providers had delivered 16.13 million telehealth services to 7.48 million patients.
“Telehealth had been available in a limited form for a decade or so before the pandemic triggered a massive surge in its use,” says Clinical Professor Meredith Makeham, Chief Medical Adviser of the Australian Digital Health Agency (ADHA) and a practising GP.
“By helping to protect both providers and patients, it’s been a very important part of the strategy for providing quality healthcare in the face of the pandemic.”
Telehealth – broadly defined as doctors and patients interacting over a digital device – is often thought of as a video consultation but, so far, regular phone calls have proved more popular.
“We can see from the item numbers that the vast majority of consultations in general practice have been audio only,” Makeham says. “This is not ideal – doctors can gather a great deal of clinical information when they can see the person they’re assessing – but it’s certainly helping to meet a need in a very difficult period.”
Whether voice-only or by video, it’s the online digital tools that provide the full telehealth experience.
“With MyHealthRecord, for example, a doctor can refer to the patient’s key health information during the consultation,” Makeham says. “And some GPs are already writing electronic scripts and sending them to the patient by text or email. The patient then forwards this to a pharmacy to be dispensed and delivered, so the whole process can happen very quickly and without [the patient] leaving home.”
Tested successfully in Anglesea, Victoria, in early May, electronic prescribing should be available across Australia by September.
Last year’s NAB/Medfin Australian Consumer Health Survey found that convenience is far more important than many practitioners recognise.
“Even before the pandemic, it appeared that patients would be driving patient-centric care,” says Kate Galvin, Customer Executive, NAB Health. “Now that so many have experienced telehealth for themselves, they might be more likely to choose a remote consultation whenever that’s appropriate. It’s not just more convenient, it can keep you from being exposed to contagious illnesses like colds or flu as well as COVID-19.”
NAB was quick to ensure that all Medicare items for telehealth services were enabled through HICAPS, NAB’s health payments claiming system.
“We contacted every provider to let them know we could help with processing these claims,” Galvin says. “And, in a first for the industry, we also worked with the private health sector to enable telehealth claims for some privately-funded allied health consultations.”
Galvin has also seen an increasing focus on patient preferences across the healthcare sector.
“Pharmacists, for example, are embracing electronic prescribing along with other opportunities, such as providing flu shots,” she says. “One major pharmacy chain is even offering 24-hour video consultations with qualified doctors.”
Experiences with telehealth during COVID-19 could also encourage patients to manage their care more proactively.
In the United States, for example, a survey by Digital Health Management company Wellframe found that 74 per cent of patients with chronic conditions felt motivated by the pandemic to take better control of managing their health.
And, in Singapore, doctors are using the MaNaDr telehealth app to triage patients with COVID-19 symptoms. If they don’t need intensive care, a telehealth doctor checks their symptoms daily. Family physician Dr Siaw Tung Yeng, who developed MaNaDr, told Time magazine that virtual monitoring makes people more comfortable about staying at home.
“The pandemic has changed the way patients relate to their healthcare providers and their expectations of the way services will be provided,” Galvin says.
“Telehealth is helping practitioners meet these expectations with a more patient-centric model of care – and they can also be more proactive in helping people stay well through, for example, regular monitoring. At the same time, telehealth is creating opportunities for providers to become more efficient and, therefore, more profitable.”
Makeham dismisses the idea that cost could be a limiting factor for healthcare providers.
“It’s a myth that telehealth is expensive to set up,” she says.
“Most doctors already use clinical information systems for patient record-keeping and these all provide access to MyHealthRecord. A straightforward software upgrade can provide the functionality needed for electronic prescribing.”
Several conferencing tools are also freely available, though health care providers must prioritise security and privacy.
“Some free tools were designed specifically for telehealth consultations – for example, the Federal Government provided Healthdirect to support telehealth during the pandemic,” Makeham says. “These tend to support a better experience for patients with features like a virtual waiting room and easy access to the consultation.”
The Medicare subsidies supporting telehealth could be withdrawn from 30 September 2020, although the government is prepared to consider an extension. A new Gratton Institute report argues strongly that they should remain in place.
In a follow-up article in The Conversation, Stephen Duckett, Health Program Director at the Gratton Institute, and Anika Stobart, Associate, wrote that the changes to telehealth brought on by COVID-19 should become permanent.
“During the pandemic, telehealth was a no-brainer to protect patients and health professionals from getting sick or making others sick. But given its widespread adoption and success, it is also a no-brainer for telehealth to become a permanent fixture of health care in Australia.”
Makeham adds that various organisations are developing resources to support telehealth over the long term.
“At ADHA, we provide help for clinicians in areas such as secure messaging, electronic prescribing and digital health tools. We need to keep building on the new skills acquired during the pandemic by both health care providers and their patients to develop better, more convenient and more affordable care.”
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