Volume 23, Number 2 - July 2020

Telehealth Platform Review

By
Robbie Tyson

MND (APD), GradCertDE (CDE), BHMS, GradDipEd (PD/HPE)

Credentialled Diabetes Educator and Accredited Practising Dietitian

Lynk Health (Proprietor) & Diabetes NSW/ACT

robbie@lynkhealth.com

Introduction

Telehealth has been in use for more than 20 years in Australia, traditionally with clients at home or in a hospital to increase access to specialist health services in rural and remote areas.1 The International Organization for Standardization (ISO) defines telehealth as the use of telecommunication techniques for the purpose of providing telemedicine, medical education, and health education over a distance’.2

Telehealth, or the delivery of health services from a distance using technology may use one or more of the following mediums; video conferencing technology, online platform, telephone or even email. The importance of telehealth use at this present time is to maintain health services and reduce the likelihood of the transmission of COVID-19 by limiting person-to-person contact.1  The greatest benefit may be to people who need to access health services during the outbreak and not necessarily those  with COVID-19.1  For people not infected with COVID-19, especially those at higher risk of being affected (e.g. older adults with pre-existing medical conditions), telehealth can provide convenient access to routine care without the risk of exposure in a congested hospital or in medical practice waiting rooms.Telehealth can also enable health professionals to provide continuity of care during the outbreak period.

Barriers to telehealth

Prior to COVID-19 and outside of emergency situations, the overall uptake of telehealth has reportedly been slow and fragmented.Willingness of clinicians is one reason for this, as they find it disruptive, complex and it requires new learning or consultation methods which clinicians haven’t had any formal training in.

Funding for telehealth has traditionally been for medical consults delivered by video consultations for people living in rural and remote Australia  or in the form of temporary MBS funding during natural disasters or medical emergencies.  However, the uptake of MBS funding offered for clinicians to provide mental health services over video conferencing during severe droughts and the bushfires of 2019  was  limited.3  The recent MBS telehealth expansion we have seen was initially bulk bill only for the allied health MBS item number 93000.4  That has since changed and charging a gap for this item number is permitted, making it a more feasible option for private practitioners.

Re-organisation of the health system was also reported as a barrier for the use of telehealth services which suggests that it is not sustainable to depend on individual clinicians to lead telehealth into expansion.3 Telehealth in Australia in its current state isn’t scalable and for it to be readily available during emergency situations a whole of system approach is recommended.3 This would see the embedding of telehealth into routine service delivery by all healthcare providers.  A whole of system approach with policies and procedures along with the technological infrastructure would enable it to be scaled up during times of need.

Telehealth consultation considerations5

It is important to consider the consultation environment when providing consultations via telehealth.

  • Use a well-lit room either by natural light or ceiling lights.
  • Avoid sitting directly underneath ceiling lights as this can create unflattering shadows
  • Avoid uncarpeted rooms that can cause echoes or feedback.
  • Sit in front of a plain backdrop such as a wall.
  • Avoid sitting in front of complicated or messy backgrounds, as these can be distracting.
  • Keep windows and doors closed to increase your privacy and reduce unwanted noise.
  • As a courtesy to the remote participants introduce any off-camera meeting participants request permission for their presence.
  • Prepare the person for the consultation by reassuring them that the session will be confidential and not recorded.

Privacy

It is important to ensure your clinic has clear policies, procedures and risk management protocols to ensure compliance with privacy and confidentiality legislation .6   Consider the following:

  • Use a suitable room – ensure passers-by/residents cannot hear the consultation.
  • Obtain informed consent – discuss how you are going to safeguard their privacy and confidentiality.
  • Keep hard copy of client notes in a locked filing cabinet.
  • Encrypt electronic client folders and files.
  • Consider a virtual private network (VPN) for a home or clinic network. A VPN enables a secure connection with data packaged in a way that renders the data unreadable.
  • Avoid using public Wi-Fi when providing online consultations and sending client sensitive emails – attackers can access public Wi-Fi as there is usually no VPN

In 2018 stolen credentials were the main cause of data breaches for healthcare workers. Attackers gain access to data in a number of ways. Phishing is a primary delivery method, but eavesdropping on insecure (unencrypted) connections is also often used by hackers, mainly in places that offer public Wi-Fi. Stolen credentials from eavesdropping is often from employees or contractors connecting to the network without encrypted data connections.

Further information on privacy can be found in the ADEA Telehealth Guidelines.

Telehealth platforms

There is now a wide range of online video consultation platforms, however it is important to choose one that is fully secure and has stringent security measures in place.  Some platforms use servers that are outside of Australia which means any health data captured with these platforms is stored offshore.  Telehealth platforms that are bundled with practice management software should always use servers located in Australia to ensure all client-sensitive data is encrypted and located within this country.

Key Features

Bundled Platforms – Some telehealth platforms provide a solution for video conferencing with integrated practice management software.  This would suit those that prefer an out of the box platform to streamline appointment booking and storage of electronic medical records.

Participant Limits – Although he majority of CDE telehealth sessions wouldn’t breach the caller limit for most telehealth platforms some free versions may not be appropriate if multiple callers are important to the user.

In App Features – Screen sharing is likely the most desirable for these as often an optimal telehealth session will require sharing of visual aids for education purposes.  Other features such as screen recording will be redundant in telehealth for privacy reasons.

End to End Encryption – Perhaps the most important security feature when considering telehealth platforms as it benefits both parties and ensures all data is safe and secure.

Telehealth platforms side by side

 

Platform

VC & Practice Management Multiple callers Screen sharing Mobile App Calendar Integration End to End encryption Free version
 

Cisco Webx

 

 

VC only

 

 

Y

 

Y

 

Y

 

Y

 

Y

 

Y

 

Knowdiabetes

 

 

Y

 

Y

 

Y

 

N

 

Y

 

Y

 

Y*

 

Health Bank

 

 

Y

 

Soon

 

Y

 

Mobile Optimised

 

Y

 

Y

 

Y**

 

P2P Telehealth

 

 

VC Only

 

Y

 

Y

 

Mobile Optimised

 

Y

 

Y

 

Y***

 

Coviu

 

 

VC only

 

Y

 

Y

 

Y

 

Y

 

Y

 

Y

*Free until September 30, 2020

** Advanced plan free until September 30, 2020

*** Free until 30th July 2020

References

1.

Croakey. Independent, indepth social journalism for health. https://croakey.org/making-the-most-of-telehealth-in-covid-19-responses-and-beyond/ (2020, accessed 28 April     2020).

2.

International Organization for Standardization (ISO). Health Informatics-Telehealth Services-Quality Planning Guidelines, https://www.iso.org/standard/53052.html  (2014, accessed 28April 2020)

3.

Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for     coronavirus disease 2019 (COVID-19). Journal of telemedicine and telecare.

4.

Australian Government Department of Health, Covid-19 Temporary MBS Telehealth Services, http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/0C514FB8C9FBBEC7CA25852E00223AFE/$File/COVID-19%20Bulk-billed%20MBS%20telehealth%20Services%20-%20Allied%20Health%20200420.pdf (2020, accessed 28 April 2020)

5.

Centre for Online Health. The University of Queensland, https://coh.centre.uq.edu.au/files/2049/GDL_AM_ZoomAdvice_20200331.pdf (2020, accessed 28 April 2020).

6.

Australian Diabetes Educators Association, Telehealth Guidelines, https://www.adea.com.au/Tenant/C0000017/Home/COVID-19/20200403%20Telehealth%20Guideline.pdf (2020, accessed 13 June 2020)

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