A new app that promises to reduce ED waiting times has prompted concern about fragmentation of care
A new app that promises to save patients a trip to, and a long wait in, the emergency department has prompted concern about fragmentation of care.
My Emergency Dr, an app developed by Sydney Royal North Shore Hospital emergency physician Dr Justin Bowra, promises to give “every Australian urgent video access via your smartphone to an emergency specialist, wherever they live and whenever they call”.
According to trial data from the company, six in 10 patients using the app were able to avoid a visit to the hospital after a video consultation with one of their doctors.
“The doctor will assess you and make a diagnosis, then arrange what is needed, e.g. prescription for medication, referral for an x-ray, or even urgent admission to hospital,” the website said. “The doctor will also email you a summary of the consultation for your GP.”
After the video consultation, doctors also email patients any electronic prescriptions, as well as referrals for x-rays and blood tests.
A company spokeswoman said that all its doctors went through a “extensive in-house training program” and test before they could start working with the app.
More than 40 senior emergency physicians worked for the company, ensuring the wait time was less than three minutes for patients calling day or night, any time of the year, she said.
But RACGP President Dr Bastian Seidel voiced concern the app might lead to fragmentation of care.
At a cost of $100 for the first 15 minutes on a weekday, and $125 per 15 minutes overnight and on weekends, Dr Seidel pointed out it was still more cost-effective to see a GP in person or with a video or phone consultation.
There is no Medicare rebate for consults through the app, although residents of aged-care facilities and those in telehealth-eligible areas can be bulk-billed if the GP has provided a referral in advance.
“Nobody wants to go to hospital for any reason,” Dr Seidel said. “But rather than using an app to get medical advice from an emergency physician who operates on a very limited scope, and typically in a high-tech environment with lots of back up, it would probably be worthwhile having a chat with a GP who is trained to look at a much broader scope.”
There were also limitations in what could be evaluated in a video consult, Dr Seidel said.
“Realistically a huge component, from a GP point of view, and certainly from an emergency physician point of view, is the physical consultation,” he said. “And that is something that doesn’t apply to a video consult.”
My Emergency Dr said the service was “absolutely not” a replacement for a patient’s GPs or the 000 emergency call.
“We simply want to be there at times when your GP can’t be, as our service is available 24 hours a day, seven days a week,” the company’s website said.
The app also warns customers to instead call 000 if the patient is unconscious, has chest pain, difficulty breathing, uncontrollable bleeding, or if they have been in a major accident.
Prescriptions for S4 drugs are sent directly to the pharmacist via the app, and S8 medications are not prescribed at all.