Updated telehealth guidelines focus on real-time consults

After consulting the community and profession, the Medical Board of Australia has issued revised telehealth guidelines that will take effect on 1 September 2023.

Under the updated guidelines:

• Telehealth consultations will continue as an important feature of health care in Australia.
• Real-time doctor–patient consultations remain key to safe prescribing.
• Prescribing via questionnaire-based asynchronous web-based tools in the absence of a real-time patient–doctor consultation is not considered good practice.
   

“Telehealth is here to stay. It plays an important role in health care in Australia and has opened great opportunities to improve access to and delivery of care, including to rural and remote patients and people living with disadvantage,” said Dr Anne Tonkin AO, Board Chair.

“The interaction between a doctor and their patient is an important element in all consultations, including telehealth consultations.”

The standard of care provided in a telehealth consultation must be safe and as far as possible meet the same standards of care as provided in an in-person consultation.

Prescribing or providing health care for a patient without a real-time direct consultation, whether in-person, via video or telephone, is not good practice and is not supported by the Board.

The guidelines specify that:

• This includes asynchronous requests for medication communicated by text, email, live-chat or online that do not take place in the context of a real-time continuous consultation and are based on the patient completing a health questionnaire, when the practitioner has never spoken with the patient.
• Any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and the management of the patient was appropriate and necessary in the circumstances.
   

“A doctor who has not consulted directly with the patient and does not have access to their medical records is unable to exercise good, safe clinical judgement,” Tonkin said.

Under the guidelines, a patient’s usual medical practitioner, or another health practitioner with access to the patient’s clinical record, can prescribe without a consultation in certain circumstances.

The guidelines allow a patient to consult a doctor for the first time using telehealth and for a doctor to issue new and repeat scripts as part of a telehealth consultation. The Board does not expect a patient to have had a face-to-face appointment with a doctor before they have a telehealth appointment.

“Prescribing medication is not a tick and flick exercise. It relies on a doctor’s skill and judgement, having consulted a patient, and recognises that prescription medication can cause harm when not used properly,” Tonkin said.

The Board carefully considered the feedback from customers of asynchronous prescribing companies who argued that their programs were convenient, including when they couldn’t get GP appointments.

“But prescribing medication should not occur in isolation,” Tonkin said.

“Consultations enable a doctor to ask follow-up questions that help identify the best treatment for a patient, including when they have previously been given a script by another doctor,” she said.

The updated guidelines and submissions to the Board’s consultation are published on the Board’s website. There were approximately 770 submissions — more than 650 of them from customers of two asynchronous prescribing companies, at least one of which offered consumers the chance of a $500 prize for completing a survey about their service.

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