Australia

Australian Guidelines for Technology-based Patient Consultations

These guidelines have been developed by the Medical Board of Australia under s. 39 of the Health Practitioner Regulation National Law Act (the National Law) as in force in each state and territory. The guidelines aim to inform registered medical practitioners and the community about the Board’s expectations of medical practitioners who participate in technology-based patient consultations.

 

Background

These guidelines complement the Medical Board of Australia’s “Good Medical Practice: A Code of Conduct for Doctors in Australia” (Good Medical Practice) and provide specific guidance on technology-based patient consultations. The Medical Board of Australia expects medical practitioners to apply the principles contained in Good Medical Practice, and these guidelines, when they consult a patient outside the traditional face-to-face setting.

 

Definition

Technology-based patient consultations are patient consultations that use any form of technology, including, but not restricted to videoconferencing, internet and telephone, as an alternative to face-to-face consultations.

 

Standards of Patient Care

Good Medical Practice describes what is expected of all doctors registered to practise medicine in Australia. It sets out the principles that characterise good medical practice and makes explicit the standards of ethical and professional conduct expected of doctors by their professional peers and the community. Good Medical Practice was developed following wide ranging consultation with the medical profession and the community. Good Medical Practice is addressed to doctors and is also intended to let the community know what they can expect from doctors. The application of Good Medical Practice will vary according to individual circumstances, but the principles should not be compromised.

  • Section 1.4 of Good Medical Practice states:

“Doctors have a duty to make the care of patients their first concern and to practise medicine safely and effectively. They must be ethical and trustworthy.”

  • Section 5.2 of Good Medical Practice states:

“Doctors have a responsibility to contribute to the effectiveness and efficiency of the health care system. …. “It is important to use health care resources wisely …… Good medical practice involves: Ensuring that the services you provide are necessary and likely to benefit the patient.”

The Board expects all medical practitioners to follow Good Medical Practice regardless of the circumstances in which they consult a patient. It is equally valid for technology-based patient consultations as it is for traditional face-to-face consultations.

 

Providing technology-based patient consultations

Medical practitioners who advise or treat patients in technology-based patient consultations should:

  1. Apply the usual principles for obtaining their patient’s informed consent, protecting their patient’s privacy and protecting their patient’s rights to confidentially
  2. Make a judgement about the appropriateness of a technology-based patient consultation and in particular, whether a direct physical examination is necessary
  3. Make their identity known to the patient
  4. Confirm to their satisfaction the identity of the patient at each consultation. Doctors should be aware that it may be difficult to ensure unequivocal verification of the identity of the patient in these circumstances
  5. Provide an explanation to the patient of the particular process involved in the technology-based patient consultation
  6. Assess the patient’s condition, based on the history and clinical signs and appropriate examination
  7. Ensure they communicate with the patient to:
    • establish the patient’s current medical condition and past medical history, and current or recent use of medications, including non-prescription medications
    • identify the likely cause of the patient’s condition
    • ensure that there is sufficient clinical justification for the proposed treatment
    • ensure that the proposed treatment is not contra-indicated. This particularly applies to technology-based consultations when the practitioner has no prior knowledge or understanding of the patient’s condition(s) and medical history or access to their medical records
  8. Accept ultimate responsibility for evaluating information used in assessment and treatment, irrespective of its source. This applies to information gathered by a third party who may have taken a history from, or examined, the patient
  9. Make appropriate arrangements to follow the progress of the patient and inform the patient’s general practitioner or other relevant practitioners
  10. Keep an appropriate record of the consultation
  11. Keep colleagues well informed when sharing the care of patients.

 

Emergency situations

In an emergency, it may not be possible to practise according to these guidelines. If an alternative is not available, a technology-based patient consultation should be as thorough as possible and lead to more suitable arrangements for the continuing care and follow up of the patient.

 

Implementation Date and Review

These guidelines took effect on 16 January 2012. The Medical Board of Australia will review these guidelines from time to time.

 

Related – Australian Inter-jurisdictional Technology-based Patient Consultations

For more information, please visit… http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Technology-based-consultation-guidelines.aspx

Download a PDF copy of the Guidelines for technology based patient consultations (74.5 KB,PDF).

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Australian Inter-jurisdictional Technology-based Patient Consultations

In 2012, the Medical Board of Australia (the Board) issued Guidelines for technology based patient consultations. Additional information is provided for medical practitioners who conduct inter-jurisdictional technology based patient consultations. In this context, jurisdiction refers to countries or regions outside Australia (i.e. consultations which are conducted when the patient or the practitioner is outside Australia).

The Board’s Guidelines for technology based patient consultations aims to inform registered medical practitioners and the community about the Board’s expectations of medical practitioners who participate in technology-based patient consultations.

Telehealth and technology based consultations are increasingly used to improve access to medical services, especially in rural and remote areas. This technology is now being used across international jurisdictions.

The Board’s current guidelines do not include specific advice on inter-jurisdictional consultations. This additional information aims to assist medical practitioners in relation to their registration and liability obligations for technology based patient consultations which are conducted when either the patient or the practitioner is outside Australia.

For technology based consultations to be provided across jurisdictions, the Board expects that medical practitioners:

  • providing medical services to patients in Australia will be registered with the Board regardless of where the practitioner is located
  • consider the appropriateness of a technology based consultation for each patient’s circumstances
  • comply with the requirements of the Health Practitioner Regulation National Law as in force in each state and territory (the National Law) and the Board’s registration standards, codes and guidelines including the Professional Indemnity Insurance Registration Standard which requires that a medical practitioner is covered for all aspects of their medical practice
  • who conduct technology based consultations with a patient who is outside Australia establish whether they are required to be registered by the medical regulator in that jurisdiction (for example, the General Medical Council for a patient in the United Kingdom)
  • ensure that their patients are informed in relation to billing arrangements for consultations and whether the patient will be able to access Medicare or private health insurance rebates.

 

Related – Australian Guidelines for Technology-based Patient Consultations

For more information, please visit… http://www.medicalboard.gov.au/Codes-Guidelines-Policies/FAQ/Information-interjurisdictional-technology-consultations.aspx

Download a PDF copy of the Information Sheet: Inter-jurisdictional technology based patient consultations (194 KB,PDF).

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AMA Position Statement: Technology-based Patient Consultations – 2013

Technology-based patient consultations are increasingly being used by all medical specialties.

Technology-based patient consultations are defined by the Medical Board of Australia as:

patient consultations that use any form of technology, including, but not restricted to videoconferencing, internet and telephone, as an alternative to face-to-face consultations.

Technology-based patient consultations are an appropriate alternative to consulting with a patient in the same physical room when they are used:

  • as an adjunct to normal medical practice;
  • for regular patients of the practice;
  • for patients who have been referred by another medical practitioner;
  • when it is clinically appropriate for the patient’s circumstances.

Used in this way, technology-based patient consultations can improve patient access to care and can enhance efficiency in medical practice.  They complement but do not replace face-to-face consultations, which enable a physical examination of the patient as part of the therapeutic process.  Technology-based patient consultations should not be used in a way that fragments the ongoing care and management of the patient.

When providing a technology-based patient consultation, a medical practitioner should be confident that:

  • the consultation occurs in a private and secure environment to protect patient privacy;
  • the patient is properly identified before commencing the consultation;
  • the patient understands and agrees the arrangements for technology-based consultations;
  • the practitioner reviews the patient’s file and makes a clinical record as they would do in a face-to-face consultation; and
  • the patient is informed about costs and billing arrangements for technology-based consultations.

As with face-to-face consultations, medical fees for technology-based patient consultations should include the indirect costs of providing the service such as:

  • the scheduling of appointments (for the practitioner and the patient to be available at the same pre-determined time);
  • secure IT infrastructure, and telephone and/or data lines;
  • electronic billing arrangements; and
  • arranging follow up services for the patient.

As a medical service, it is appropriate that Medicare Benefits arrangements assist patients with the costs of medical care provided using technology-based patient consultations.

 

For more information, please visit… https://ama.com.au/position-statement/technology-based-patient-consultations-2013

Download a PDF copy of the On-Line and other Broadband Connected Medical Consultations Position Statement

Download a PDF copy of the AMA Position Statement: Technology-based patient consultations – 2013

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