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‘Telehealth services use information and communications technologies (ICTs) to deliver health services and transmit health information over both long and short distances. It is about transmitting voice, data, images and information rather than moving care recipients, health professionals or educators. It encompasses diagnosis, treatment, preventive (educational) and curative aspects of healthcare services and typically involves care recipient(s), care providers or educators in the provision of these services directed to the care recipient.’

Australian Government Department of Health

Telehealth was propelled into an unanticipated trajectory with the emergence of COVID-19. As of October 2021, 78.3 million telehealth services were delivered to 15.6 million patients in Australia.

The concept of telehealth has been around for many, many years, and advances in technology have expanded its application. But how did we respond to the acute need for it, and where are we at now, over 12 months later?

What happened in 2020?

Telehealth in the form of virtual consults surged with the lockdown of the world due to the pandemic. To that extent, it was a ‘clinical governance’ approach to manage an emerging risk, in the face of a novel infectious agent. Virtual consults, while already possible, were no longer a choice in the face of this risk, but a necessity. As with many professional services, healthcare workers were thrust into a remote working environment where possible - and adapted.

In terms of high-level governance, the Australian Government encouraged this approach by implementing temporary changes to the Medicare Benefits Scheme (MBS) and expanding funding to telehealth consults - first in a limited fashion (to patients and practitioners with COVID-19 or at risk of it), and then more broadly. The changes first came into force on 13 March 2020. Conditions around these item numbers have evolved, and their temporary timelines extended, in a continued response to the pandemic - although there is suggestion from the Federal Government that telehealth is here to stay.

The data as of April 2020 reflected that 36% of GP consultations in Australia took place via telehealth, and this was sustained until August 2020. In respect of mental health services subsidised by Medicare, telehealth services accounted for 33 % of these consults. A range of other services supported by telehealth also saw an increase in attendance, such as allied health.

While pre-pandemic studies supported the clinical benefits of telehealth, it was not widely used. Not only were Medicare-funded telehealth services available only for very limited circumstances, but it was still an unfamiliar concept to consumers and practitioners alike. Now, it has become a way of life.

A year later, what we’ve yet to learn

With over 56 million Medicare-funded telehealth services conducted from 13 March 2020 to 21 April 2021 to 13.6 million patients, telehealth is now set to play a role in broader reforms to primary care, while recent extensions to MBS telehealthcare sector more broadly to include specialist consults. But what, if any, clinical governance implications are there?

There is still much to learn. We know that telehealth has successfully supported the GP management of chronic disease, and also maintained access to private specialist consults. Telehealth has a range of benefits - with accessibility, convenience and efficiency being some of the key advantages. However, do these benefits come with a cost to quality and safety? This is an important question that has not yet been adequately addressed.

For example, it is unclear what impact telehealth has, if any, on the accuracy of diagnosis - the inability to perform a complete physical examination poses an obvious risk. While some physical assessment is achievable (perhaps by novel methods), there are some aspects which simply aren’t possible, such as examination through palpation, or smell - and observing other more subtle signs like fine tremors, or body language. To date, there is little known about the effectiveness of telehealth for the purpose of diagnosis.

Good clinical governance must be evidence-based, yet there are many facets of telehealth that need further research. While consumer acceptance of telehealth seems high, some key questions (identified by the US-based Society to Improve Diagnosis in Medicine) relate to technology (such as internet access, which can be a particular issue in rural and remote communities), the clinical experience and environment (including human connection), measuring effectiveness (including safety and quality), and ‘forecasting’ non-clinical issues such as funding, liability, and privacy. Other considerations include training and education, workforce engagement and support, review of clinical practice guidelines in the context of telehealth, consumer support and outcomes, sustainable funding to support a broader range of telehealth options, infrastructure and interoperability, and integrating telehealth into routine care.

The telehealth ‘movement’ appears to have been successful from a consumer perspective overall, and to that extent supports consumer-centred care. However, clinical governance must also be evidence-based in terms of safety and quality, yet many facets of telehealth are still in need of further research. Our experiences throughout the pandemic offer a basis for such research, and we should embrace this opportunity to learn, in a journey of continuous improvement.

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All accessed on 7 October 2021

Australian Government Department of Health, accessed at: Department of Health | Telehealth

Australian Digital Health Agency, accessed at: https://www.digitalhealth.gov.au/initiatives-and-programs/telehealth

T Nesbitt. ‘The Evolution of Telehealth: Where Have We Been and Where Are We Going?’ in ‘The Role of Telehealth in an Evolving Healthcare Environment, Workshop Summary’. Institute of Medicine for the National Academic, The National Academies Press, 2012. Accessed at: The Evolution of Telehealth: Where Have We Been and Where Are We Going? - The Role of Telehealth in an Evolving Health Care Environment - NCBI Bookshelf (nih.gov)

A Taylor et al. ‘How Australian Health Care Services Adapted to Telehealth During the COVID-19 Pandemic: A Survey of Telehealth Professionals’. Front. Public Health, 26 February 2021. doi.org/10.3389/fpubh.2021.648009. Accessed at: https://www.frontiersin.org/articles/10.3389/fpubh.2021.648009/full

‘COVID-19 Temporary MBS Telehealth Services’, Australian Government Department of Health. Accessed at: MBS online - COVID-19 Temporary MBS Telehealth Services

‘Universal Telehealth extended through 2021’, Ministers Department of Health. Accessed at: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/universal-telehealth-extended-through-2021

‘The first year of COVID-19 in Australia: direct and indirect health effects.’ Australian Institute of Health and Welfare. Accessed at: The first year of COVID-19 in Australia: direct and indirect health effects (aihw.gov.au)

J Moffat and D Eley. ‘The reported benefits of telehealth for rural Australians’. Australian Health Review 34(3) 276-281. doi.org/10.1071/AH09794. Accessed on 7/1021 at CSIRO PUBLISHING | Australian Health Review

‘Universal Telehealth extended through 2021’, Ministers Department of Health. Accessed on 7/10/21 at: https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/universal-telehealth-extended-through-2021

J Moffat and D Eley. ‘The reported benefits of telehealth for rural Australians’. Australian Health Review 34(3) 276-281 doi.org/10.1071/AH09794. Accessed at CSIRO PUBLISHING | Australian Health Review

The first year of COVID-19 in Australia: direct and indirect health effects.’ Australian Institute of Health and Welfare. Accessed at: The first year of COVID-19 in Australia: direct and indirect health effects (aihw.gov.au) ‘Improving TeleDiagnosis: A Call to Action: Final Project Findings.’ Society to Improve Diagnosis in Medicine, 2021. Accessed at: Diagnosis and Telemedicine - Society to Improve Diagnosis in Medicine

J Isautier et al. ‘People’s Experiences and Satisfaction With Telehealth During the COVID-10 Pandemic in Australia: Cross-Sectional Survey Study.’ J Med Internet Res 2020;22(12):e24531. doi: 10.2196/24531. Accessed on at: Journal of Medical Internet Research - People’s Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study (jmir.org)

M. St Clair, D. Murtagh D. ‘Barriers to Telehealth Uptake in Rural, Regional, Remote Australia: What Can Be Done to Expand Telehealth Access in Remote Areas?’ Stud Health Technol Inform. 2019 Aug 8;266:174-182. doi: 10.3233/SHTI190791. Accessed at: https://pubmed.ncbi.nlm.nih.gov/31397320/

E Thomas et al. ‘Building on the momentum: Sustaining telehealth beyond COVID-19’. Journal of Telemedicine and Telecare 0(0) 1-8. doi: 10.1177/1357633X20960638. Accessed at: Building on the momentum: Sustaining telehealth beyond COVID-19 (telehealthvictoria.org.au)

R Bashshur et al. ‘Telemedicine and the COVID-19 Pandemic, Lessons for the Future;. Telemed J WE Health. 2020 May; 26(5):571-573. doi: 10.1089/tmj.2020.29040.rb. Epub 2020 Apr 8. Accessed at: https://pubmed.ncbi.nlm.nih.gov/32275485/