Controversial online-only telehealth startup Eucalyptus has put together an initial proposal for industry-wide standards.
Once perceived as something of a cowboy operator, Australian telehealth corporate Eucalyptus is now calling for a discussion on industry-wide standards.
The startup, which runs online-only clinics Juniper, Pilot and Kin, has released a document outlining what it considers to be best practice principles for Australian online telehealth providers.
Intended as an “initial proposal to support a discussion about industry-wide standards”, it covers patient outcomes, continuity of care, data protection and clinical safety, quality and governance.
Eucalyptus head of public policy Lyndon Goddard told The Medical Republic that, to their knowledge, this is first time that a standards document specific to online telehealth has been produced in Australia.
“Over the last year or two, we’ve been eagerly awaiting progress with the virtual care standard development work from the [Australian Commission on Safety and Quality in Health Care],” Eucalyptus clinical director Dr Matt Vickers told TMR.
“This has not eventuated, and – having not seen any progress and not heard anything from any of the other key stakeholders in terms of progress being made – we felt the time was right to work towards it from an industry perspective.
“[From] what’s come about from various conversations with different stakeholders outside of the commission – government regulators, peak bodies – there’s certainly a need for this.
“Some of our like-minded competitors are also keen on working towards accreditation … and sometimes they’re looking at standards that are inappropriate.”
Best practice principles under the clinical safety banner cover considerations like whether a patient has had a real-time – as opposed to text-based – consultation in the past 12 months, how to verify patient identity and putting in a process to detect and manage accounts connected to the same name, postal address or phone number.
The clinical governance and quality sections outlined internal quality metrics, clinician credentialling, incident management and appropriate remuneration models.
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Potentially inappropriate remuneration models included those which incentivise prescribing or influence treatment decisions; it’s not technically illegal for a company to pay doctors per script written.
“It’s a different risk profile, delivering care entirely virtually,” Dr Vickers said.
“Everything from identifying who patients are, to who is appropriate for treatment, interoperability, continuity of care – all of these elements do exist somewhat in face-to-face environments but not to the same extent.”
Under the continuity of care banner, telehealth clinicians are encouraged to ask patients for consent to contact their regular GP with a clinical update and upload any relevant and appropriate clinical information to My Health Record.
Best practice in data protection and security, meanwhile, involves controlling access to systems containing patient data, testing for vulnerability and penetration and system monitoring.
“I think that the next step is for the industry to support some form of minimum standard that can be externally evaluated, and then to have some kind of regulatory mechanism around it,” Mr Goddard said.
“We know that the existing accreditation regimes that are available for health services are not specific to telehealth services … and we also know that there’s no specific regulation at a company level for telehealth services in Australia.
“That’s an obvious gap, and it’s at odds with the way that other health services in Australia are regulated.”
A spokesperson for the Australian Commission on Safety and Quality in Health Care told TMR that it was continuing to explore how national safety and quality standards could apply to virtual care.
“We recognise the need for a governance framework to support the delivery of virtual care in Australia,” the spokesperson said.
“In recent years, there has been a strong uptick in the use of virtual care services, which includes services delivered via telephone, videoconferencing, remote patient monitoring, website and mobile applications.
“In 2020, the Commission introduced the National Safety and Quality Digital Mental Health (NSQDMH) Standards to support the delivery of digital mental health services.
“The NSQDMH Standards provide a safety and quality framework in which health services can develop effective digital mental health services and support clinicians by expanding care delivery and treatment options.
“For digital mental health service users, the NSQDMH Standards provide guidance and support to help them make informed decisions about the safety and quality of care they are accessing.
“The development of the National Safety and Quality Services (NSQHS) Standards (third edition), to commence soon, will also consider the safety and quality risks when using digital tools and technology to deliver better care.”
Medicare regulation only extends to services where a practitioner has billed Medicare; many online-only clinics work on a private-billing-only model, entirely outside of the Medicare system.
Late last year, AHPRA launched a rapid regulatory response oversight group.
One of its key focus areas is monitoring the rise in health services offering access to specific drugs such as medicinal cannabis and weight-loss medications.
