Telehealth consultations

Telehealth consultation obligations

The National Boards have the same expectations of practitioners using telehealth to provide patient services as they do when delivering services face-to-face.

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

• all MBS items for allied health services require a valid referral to the relevant allied health professional from an eligible medical practitioner;
• if prescribing medications pursuant to the MBS via telehealth, have an established clinical relationship with the patient, unless an exemption applies;
• obtain informed financial consent from patients prior to providing the services, providing details of fees including any out-of-pocket costs;
• 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.

Prescribing medications

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

Further, practitioners must inform the patient of arrangements for prescriptions and documentation, as well as complying with all state, territory and federal prescribing laws for both the patient and the doctor, whilst ensuring the practitioners contact details are on the prescriptions for any pharmacist queries.

Of note, in relation to compliance with state laws, Queensland Health has recently issued further clarification in relation to telehealth, requiring medical practitioners or nurse practitioners (rather than registered nurses) be on site (and not remote) at any clinic where Schedule 4 medications are ordered and administered. NSW Health has confirmed it has adopted the same position. In contrast, Victoria's Department of Health has confirmed that nurse-led business can apply for a permit to obtain, possess and use certain substances and medications, such as botox.

Key takeaways

Recent media reporting suggests the provision of scripts via telehealth is a growing area of concern for the health industry.

Telehealth is a growing area of practice 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.

Further information

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