Revised telehealth guidelines place new obligations on medical practitioners

Since 2020 there has been a significant increase in telehealth consultations precipitated by the COVID-19 pandemic.

The Medical Board of Australia (Medical Board) has issued revised telehealth guidelines which come into effect 1 September 2023.

The guidelines apply to all telehealth consultations, which are defined in the guidelines as:

"Consultations that use technology as an alternative to in-person consultations between a patient and a medical practitioner, and can include video, internet, or telephone consultations."

The guidelines outline that telehealth is not appropriate for all medical consultations and should not be considered as a routine substitute for in-person consultations.

When practical, video consultations are preferable to telephone consultations and telehealth is generally most appropriate in the context of a continuing clinical relationship with a patient that also involves in-person consultations. A mix of in-person and telehealth consultations can provide high quality, accessible, ongoing medical care.

Telehealth consultation obligations

The guidelines explain the obligations on medical practitioners before, during, and after a telehealth consultation.

Before a consultation, the guidelines mandate that a medical practitioner must:

• have a quiet space free of distractions, and ensure others not involved in the patient's care are not exposed to the consultation;
• have access to secure and reliable technology;
• have processes in place to continue or reschedule a telehealth consultation should the technology fail; and
• ensure that the patient has access to suitable technology, is aware they can have a support person present, has been offered an interpreter, is aware of alternatives to a telehealth appointment, and has provided financial consent to the billing arrangements.

During a telehealth consultation, the medical practitioner should:

• identify themselves, explain their specialty, and explain their role in relation to the patient's healthcare. The identity of the patient and any other attendees should also be confirmed, particularly for new patients;
• ensure that the same standard of care applies to a telehealth appointment as would apply to a normal in-person appointment, including informed consent;
• arrange to see the patient in person if necessary; and
• ensure the patient is aware of how to collect or receive referrals, prescriptions, and examination and test results.

After a telehealth appointment, the medical practitioner should make appropriate hand-over arrangements, if necessary, and follow up arrangements when required. The details of the telehealth appointment should also be recorded, including the type of technology used, any technical issues, and whether consent was obtained from participants if the consultation was recorded.

The guidelines also cover the obligations for international telehealth appointments. If one of either the patient or practitioner is overseas, the practitioner must be registered in Australia and establish whether they need to be registered in the foreign country also.

Prescribing medication

The guidelines state that prescribing or providing healthcare for a patient without a real-time direct consultation, whether in person, via video or telephone, is not regarded as good practice.

The Medical Board was motivated to introduce the new guidelines in part to respond to what it perceived to be a practice of providing healthcare and prescriptions to patients without real-time consultations.

A spokesperson for the Medical Board noted that "prescribing cannot be a tick-box exercise and the Medical Board of Australia does not support questionnaire-based asynchronous prescribing, because there is no real-time doctor patient conversation".

This includes asynchronous requests for medication by text, email, live chat, or online outside of a consultation.

The Medical Board recognises that it may be appropriate in certain circumstances for a practitioner to prescribe without consultation, but that any practitioner who prescribes for patients in these circumstances must be able to explain how the prescribing and management of the patient was appropriate and necessary in the circumstances.

Key takeaways

Telehealth has been popular since the COVID-19 pandemic. However, the guidelines make it clear that telehealth is only appropriate in certain circumstances, and when using telehealth, practitioners should be aware of their obligations before, during and after telehealth consultations, as outlined in the guidelines.

Further information

The Medical Board's telehealth guidelines can be found here.

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