At Eucalyptus, we take our commitment to patient safety extremely seriously. If you’d expect your local GP clinic to be accredited against quality and safety standards, wouldn’t you expect your telehealth platform to be accredited too?
Perhaps surprisingly, compulsory accreditation is not currently required in either face-to-face or digital healthcare settings in Australia.
But what is the point of quality and safety accreditation in any healthcare setting? It’s important here to separate out two different types of standards:
- those applicable to the individual health practitioners — professional rules setting out the principles that practitioners should follow in their provision of healthcare, which could be reviewed by the regulator relevant to their health profession; and
- those applicable to the clinic, or the telehealth platform, as a whole — organisation-wide rules governing the systems within which the health practitioners operate, eg, relating to the clinical governance framework in place, the mechanisms of recording and retaining health records, and the review or auditing of the health services provided in that organisation.
Currently, uniform standards exist in Australia (and are compulsory) in category 1 but not in category 2.
Standards for individual health practitioners (category 1)
Health practitioners in Australia, such as doctors and nurses, must be registered with the Australian Health Practitioner Regulation Agency alongside a profession-specific agency (eg, the Medical Board of Australia for doctors). Those regulators publish a number of documents setting out what health practitioners should and should not do, and the practitioners must comply with these rules.
For instance, the Medical Board has published Guidelines for Telehealth Consultations which describe some principles for the mode of telehealth delivery (ie, the choice between telehealth and in-person consultations), and the things to keep in mind while undertaking a telehealth consultation with a patient.
But those guidelines do not, and are not intended to, say anything about (eg) the clinical governance framework within which the practitioner operates. In this way, they really only tell half the story in terms of the quality and safety of the overall model of care being adopted.
Standards for clinics or telehealth platforms (category 2)
In the case of community GP clinics, the Royal Australian College of General Practitioners has published the Standards for General Practices, a nationally recognised set of guidelines for clinics to follow.
Accreditation under this scheme is voluntary, but around 85% of GP clinics in Australia do so. GP clinics can obtain incentive payments from the federal government if they do get accredited, but patients can still access Medicare rebates for consultations at GP clinics even if they are not accredited.
However in the case of telehealth platforms, there is no nationally recognised set of safety and quality guidelines.
The closest that we have been able to find so far is the EQuIP6 Standards for Healthcare Support Services which are published by the Australian Council on Healthcare Standards. These were not specifically designed for telehealth platforms like Eucalyptus, but they are internationally respected and they cover a lot of the same ground that (we strongly believe) a telehealth-specific set of standards should cover.
As far as we know, Eucalyptus is the only telehealth platform in Australia to be accredited to these (or, indeed, any) quality and safety standards.
Why we need telehealth standards
The benefits of external assessment of the bona fides of your health services may be self-evident, but they are worth repeating.
Why is it not enough that all the health practitioners working in the GP clinic, or on the telehealth platform, are individually regulated themselves? Part of the issue is the form of that regulation: it is almost entirely reactive. In other words, if there is a problem with a doctor’s practice, the regulator will not know about it (and therefore be able to do anything about it) unless it is told – usually, in the form of a complaint from a patient.
The other issue is that this regulation focuses on the individual doctor rather than the team or system within which they are practising. And we know that that team or system can have a considerable impact on the quality and safety of your practice (even if you are complying with your own individual obligations) – for instance, if you are being supervised or if your consultations are being audited by your peers.
That is the purpose of a clinical governance framework – to create layers of clinical review and improvement, which can only be effectively implemented at a system-wide level – which is one facet of a clinic or telehealth platform that an accreditation scheme should consider: ideally, proactively, before the clinic or platform is permitted to operate.
Next steps
So where are we at in the journey of telehealth accreditation in Australia?
We understand that the Australian Commission on Safety and Quality in Health Care is currently drafting Virtual Care Standards which, when complete, will solve the problem of an absence of nationally recognised accreditation rules for telehealth platforms in Australia. But they may be two years away from completion, and they are unlikely to be made mandatory.
It is worth keeping in mind that other countries are far ahead of Australia when it comes to regulating telehealth platforms. In the UK, for instance, all providers of online telehealth must comply with rules set out and enforced by either the Care and Quality Commission or the General Pharmaceutical Council.
In the meantime, we think that Australian regulators and the government need to consider adopting proactive oversight mechanisms to improve the quality and safety of all facets of healthcare, including telehealth. This should involve an incentive (or disincentive) model to improve the adoption of standards in the private sector.
Ultimately, without the right types of checks and balances in place, patients are placing a high degree of (possibly misplaced) trust in the operators of telehealth platforms to facilitate the provision of high-quality care.
Authors
