Regulators are stepping in to tighten guardrails around telehealth, warning high-volume prescribing, privacy blind spots and profit-driven models could compromise patient safety.
In the changing healthcare landscape, the Australian Health Practitioner Regulation Agency is taking a more proactive approach and is working with other regulators to monitor emerging areas of practice.
Rachel Griffiths, the regulator’s acting national director for policy and accreditation, told delegates at Informa Connect Virtual Care conference last week that one of those areas of interest is virtual care.
“It does take time for regulatory systems to move with innovation,” she admitted.
As there isn’t a clear regulatory body or government that has oversight of this work, AHPRA and other bodies are stepping up.
“There’s a very active conversation, and I know that a lot of regulators as well as us, are looking at what we can do within our existing frameworks as well as what needs to change,” she explained.
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There is systems infrastructure that needs an uplift.
“And we’re talking about this a lot in that prescribing space, and particularly as well as new professions are moving into prescribing and virtual care. Do they all have access to the right systems and to systems across jurisdictions … are they linked up as well?” she asked.
Some of the concerns AHPRA has is whether profits are being prioritised over patient safety.
“It is something we see when we share data with other agencies – sometimes sometimes there are really high volumes of prescribing.
“Medicinal cannabis space is one area that we’re focused on here, as well as cosmetics and some kind of other areas of single treatment clinics,” Ms Griffiths said.
“This is an area where several regulators are looking at what further guidance we might need to support, ensuring that these conflicts are being managed.”
She said for practitioners, there are some key risks to be aware of when they use virtual care.
First, it’s understanding the platforms and technology they’re using.
“Also, when is telehealth appropriate? The common theme that there’s a consensus that we’re not looking at telehealth alone. We’re looking at hybrid models of care and how it can improve those models,” she said.
Clinicians need to make sure they don’t overlook privacy risks, especially AI and data use.
“It’s an area that we’ve found a lot of practitioners probably aren’t as conscious of. There’s a lot of thinking about clinical risks and not about privacy risks,” she said.
Patient expectations and clinical quality and consultation time is particularly important.
“There’s a concern (whether) a proper consultation is happening and or are all the things happening that you would expect when prescribing is happening?”
This is particularly a concern with non-real time prescribing, particularly for initial prescriptions.
Continuity of care is something that AHPRA sees in its notifications.
“And missed contraindications. That’s partly to do with the digital infrastructure that surrounds healthcare settings and whether all practitioners have that full health record for the practitioner.
“The clinical governance that they’ve set up, is that supporting them to identify those contraindications?” she asked.
Last year, AHPRA released updated telehealth guidance which apply to all professions.
It contained some core messages.
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“They apply to all professions, and it’s taking it back to first principles. It’s about the professional obligations to provide safe care remain the same regardless of the mode of delivery,” Ms Griffiths explained.
Some of the core messages include the obligation to assess and reassess whether telehealth is safe and clinically appropriate.
“Things like identifying yourself, understanding that the technology that you’re using, and making sure you’re upskilling that area is something we’ve also tried to reinforce,” she said.
AHPRA is also working with national boards to explore whether they can develop common capabilities that apply across health professions in digital health.
This will be looking at telehealth, “but also AI and these, if they progress, will be common capabilities that sit within all programs of study for health professionals, but also inform continuing professional development”, she said.
AHPRA is also working with industry to make sure they’re building the right telehealth models.
“Highlighting that it’s really important not to be creating business models that might encourage practitioners to tip that balance of access over quality care and to reinforce their professional obligations,” Ms Griffiths explained.
“We really want to make sure we have these guardrails to support safe telehealth, to make sure that we can realise the benefits of telehealth and support that safe access,” she concluded.
