The World Health organization (WHO) defines eHealth as the secure and cost-effective use of computer-based information and communications systems to process, transmit and store data and health related information. [1] mHealth, which is a component of eHealth, refers to the medical or public health practice supported by mobile devices (ie. mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices). Collectively, eHealth and mHealth fall under the broader umbrella of Digital health. [2] Figure 1 shows the relationship of digital health, eHealth, and mHealth.
![Figure showing the relationship of digital health, eHealth, and mHealth. The World Health organization (WHO) defines eHealth as the secure and cost-effective use of computer-based information and communications systems to process, transmit and store data and health related information. [1] mHealth, which is a component of eHealth, refers to the medical or public health practice supported by mobile devices (ie. mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices). Collectively, eHealth and mHealth fall under the broader umbrella of Digital health. [2]](/portals/5/palliAGED-Images/mHealth-eHealth-DigitalHealth.png)
Figure 1: Digital health, eHealth, and mHealth [1,3]
eHealth utilisation by General practitioners
Computers are commonly used in Australian general practice. Over 97% of GPs use computers for clinical purposes, and over two-thirds (70%) using electronic medical records exclusively. The Royal Australian College of General Practice (RACGP) outlines that the use of technology in the Australian general practice setting primarily relates to information management. [4] As such GPs use computers to manage clinical and non-clinical information. In the context of general practice, information is collected, stored, and shared; while this information is also utilising in clinical decision making. [4] General practices use an online portal developed by the Australian government called Health Professional Online Services (HPOS) to manage services, payment, and other government programs including the My Health Record. Management of patient’s clinical data, however, is done using one or more Clinical Information Systems (CIS). Various specialised computer software are available to general practices for clinical data collection, storage, and transfer.
In addition to using computer-based technologies to manage patient data and patient flow, many General practitioners engage in telephone or video mediated consults, known as telehealth approaches.
Telehealth
Telehealth services refer to the use of information and communication technologies to deliver healthcare service and share health related information. Some examples of telehealth include: use of telephone or video-conferencing system for consultation; and using email or messaging services to share photographs of wound. Over 30% of Australian GPs use telehealth services. [5] Almost half those who do not use telehealth are keen to engage in this modality if supported with adequate funding. [5] Currently the Australian government subsidises telehealth consultations carried out by eligible health professionals (GPs, and some non-specialist medical practitioners) to patients living in rural and remote communities.
The value of telehealth services is apparent in the context of current health crisis: COVID-19, where limiting face-to-face contact is the key to minimising the spread and impact of this disease. In a bid to help contain the rapid spread of COVID-19, on 13 March 2020, the Australian government expanded its existing telehealth guidelines so phone or video consults provided by eligible health professionals to all of their patients could be bulk billed. Ninety two additional MBS items were introduced to facilitate remote consultations for care providers/recipients affected by or at risk of COVID-19 infection.
Telehealth during COVID-19
In response to the COVID-19 outbreak, temporary Medicare Benefits Schedule (MBS) items for video (telehealth) and phone consultations were introduced on 13 March 2020. Under this scheme, consultation via videoconference or telephone provided by eligible health professionals to eligible patients could be bulk-billed under the Medicare Benefits Schedule (MBS). While these measures were useful, the need for expansion of telehealth became apparent very quickly with rapid increase in number of COIVD-19 cases across Australia.
To ensure access to primary health services are accessible to all Australians during the COVID-19 pandemic, the Australian Government announced the extension of Medicare-subsidised telehealth consultation services provided by GPs and other health professionals on 29th of March 2020. This extension allowed GPs and other eligible health professionals to bulk-bill telephone or video-conference consultations carried out with all of their patients/clients. In addition, this extension package also includes doubling the bulk-billing incentive for GPs, and the introduction of a new incentive payment to help general practices stay open to provide face-to-face services for patients with conditions that cannot be treated via telehealth.
The range of services GPs can now provide over phone or video have also grown to include mental health treatment, chronic disease management and Aboriginal and Torres Strait Islander health assessments, as well as services to people with eating disorders, pregnancy support counselling, services to patients in aged care facilities, children with autism, and after-hours consultations. The recent changes also allow other medical practitioners, including Nurse Practitioners, Midwives, Psychologists and other allied health professionals to bulk-bill telephone or video consultations carried out in relation to the above-mentioned services. The Table below outlines all the COVID-19 MBS Telehealth items following the 30th March 2020 update.
The MBS telehealth item numbers applicable to consults carried by all eligible health professionals are available from the MBS Online website or as a downloadable pdf.
Download MBS telehealth item numbers (145kb pdf)
Resources on telehealth for GPs
Guidance on telehealth for COVID-19
The Royal Australian College of General Practitioners (RACGP) has recently published some helpful guide and flowcharts aimed at helping practitioner setup and provide effective telephone or video-consultation in Australia. The document titled ‘Guide to providing telephone and video consultations in general practice’ aims to provide GPs and practice teams the necessary clinical, administrative, and technical considerations when introducing telehealth for the first time. Whereas the document titled ‘Telephone and video consultations in general practice: Flowcharts’ complements the above mentioned ‘Guide’ and aims to provide GPs practical tips on setting up telehealth, and what to do before, during, and after a telehealth consult. These documents can be accessed freely on the RACGP website.
A recent publication in the BMJ [6] provides a set of guiding principles on selecting the mode of consultation (telephone or video-conference), and carrying out remote consultation on cases of ‘query COVID-19'. The infographic (Figure 2) summarises the publication.
Source: Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ. 2020 Mar 25;368:m1182. doi: 10.1136/bmj.m1182.
What else is happening in the eHealth/digital health space
The Royal Commission
Innovative use of technology in the aged care space has also been a topic of interest to the current Royal Commission into Aged Care Quality and Safety. The commission held two workshop hearings in Adelaide from March 16-17 covering research, innovation and technology that can and should be utilised in aged care and how to apply new practices in the sector.
The report titled ‘Review of Innovative Models of Aged Care’ was prepared by the Flinders University for the Royal Commission and published on January 2020. This report notes that there are opportunities to utilise telehealth communication and monitoring for improved access to care for those who are less mobile, or living in rural and remote areas of Australia. [7]
Aged Care Industry Information Technology Council (ACIITC)
The ACIITC aims to support the aged care industry in providing high quality care to their clients via efficient use of technology. The Technology roadmap published by the ACIIT in 2017 outlines how technology can be used to underpin the delivery of aged care services and ensure independence, choice and control for consumers.
The Australian Institute of Digital Health (AIDH)
The AIDH is Australia’s leading organisation in health informatics and digital health, with a mission to promote connected health system and a connected and digitally competent health workforce. The AIDH published a white paper titled ‘What is Digital health and why does it matter?’ on February 2020. This white paper presents a strong case for why the healthcare sector needs to realise the potential of digital technology.
Major current eHealth initiatives across Australia Digital health
Page updated 11 May 2020