The opportunity for Australian telehealth standards

Eucalyptus has called for some time for more regulation in the Australian telehealth sector. Specifically, we have called for government-endorsed safety and quality standards to be implemented for online telehealth clinics.

But what does that look like in practice, and how should we think about this gap that currently exists in the Australian regulatory landscape? And how might the UK provide a model that we could adopt?

Why do we have standards?

We should expect that our health services will provide safe and high quality care. If they don’t, there’s a risk of patient harm and poorer health outcomes.

The reasons why we have high expectations for our hospitals and GP clinics apply equally to online telehealth clinics.

So how do we ensure that those expectations are met? We define minimum standards of safety and quality, and then we facilitate their implementation by way of one or both of these options:

• regulation — laws that are compulsory to abide by, with professional consequences (or fines etc) if they are not met. Compliance is usually only tested in response to a complaint or something going wrong.
• accreditation — a document setting out standards which is usually voluntary to comply with, but there may be incentives (eg, government payments). Compliance is proactively tested by an independent accrediting agency.

Unsurprisingly, just because accreditation standards exist does not mean that health services will necessarily comply with them.

What are the main categories of standards?

Imagine attending an in-person consultation with your local GP. Although you probably won’t notice, there are lots of regulation- and accreditation-based rules flying around during your consult.

Those rules apply to different aspects of your interaction with the doctor, their decision to prescribe you medication, and their record-keeping of your medical history. It is useful to place these rules into three major categories:

1. Practitioner-based rules — these broadly ensure that the doctor is providing good care to their patient.
   • They ensure the doctor is thinking about things such as: Have I explained my proposed treatment to the patient, and obtained their consent? Do I have enough experience to diagnose this particular condition? Am I keeping thorough records of the patient’s history?
2. Medication-based rules — these apply to the medicines the doctor may prescribe.
   • These ask questions of the doctor such as: Is this medicine designed for the purpose for which I’m prescribing it? Do I need to get an additional authorisation before I can prescribe this? Do I need to make extra precautions clear to the patient?
3. Clinical system-based rules — these apply less to the doctor personally and more to the overall GP clinic, or the clinical system within which the doctor is practising. But they still impact the safety and quality of each individual consultation which takes place in that clinic.
   • These rules ask questions such as: Is there an escalation pathway so a doctor can get a second opinion from a more senior clinician? Is there a way to check and record when doctors make mistakes and reduce their likelihood in the future? Does the clinic have a secure database to store patients’ medical records? Is patient and other feedback taken into account to provide continuous education to doctors?

Where is the gap?

Let’s focus on category 3 from the previous section.

There are already accreditation standards, covering these topics, for both hospitals and GP clinics. Those standards are —

• for hospitals (and day clinics): the National Safety and Quality Health Service Standards, which are effectively compulsory since you can’t get registered as a hospital if you don’t comply with them.
• for GP clinics: the Standards for General Practices, published by the RACGP. They are voluntary, but compliance helps GP clinics become eligible for certain government payments.

However, there are no such standards applying to online telehealth clinics like Eucalyptus.

We think this is a big problem.

The closest document that we can find in Australia is the EQuIP6 protocol published by the Australian Council on Healthcare Standards, which is not telehealth-specific and is not formally government-endorsed. Eucalyptus voluntarily got itself accredited to these standards, and as far as we know, we are the only telehealth platform in Australia to have done so.

But until there are government-endorsed safety and quality standards for online telehealth clinics, there is no good way for patients to know whether their clinic is going to provide them with safe and high quality care.

What can we learn from the UK?

Although the UK health system is not always held up as a world leader, it does a pretty good job of regulating telehealth.

Proactive, transparent regulation

One way they do this is by having different regulators for the ‘category 1’ (practitioner) rules and the ‘category 3’ (clinical system) rules from the diagram above.

For example, all doctors in the UK are regulated by the General Medical Council, which enforces its own rules ensuring that doctors provide good care to patients. But then a separate regulator — the Care Quality Commission — regulates the health services provided by doctors and the telehealth clinics in which they operate. The CQC proactively inspects telehealth clinics, prepares reports outlining whether the clinics meet safety and quality standards, and then publishes those reports on its website. This is a rigorous and transparent approach to regulating telehealth.

This means that telehealth clinics are forced to meet minimum expectations.

Best practice incentives

In addition, there is then a further incentive for telehealth clinics to not just meet minimum expectations, but strive for best clinical practice. This comes in the form of the National Institute for Health and Care Excellence, or NICE.

This is an independent government-funded body which (among other things) recommends certain health services to be funded by the NHS. It undertakes detailed analysis of a health service’s patient outcomes, published research, errors and adverse events, and financial efficiency.

Eucalyptus’s Juniper clinic was proud to obtain NICE endorsement for its weight management program in early 2024.

What should we do in Australia?

There are three main steps we should take to ensure we have a safe and high quality telehealth sector in Australia:

1. Finalise a document setting out minimum safety and quality standards — this could be done by the Australian Commission on Safety and Quality in Health Care (the main government body responsible for making healthcare standards).
2. Decide whether to make them compulsory, or instead voluntary (and incentivised) — one type of incentive could be access to Medicare or other government payments.
3. Create a new regulator, or expand an existing one, to review and enforce compliance — proactive regulation with transparent compliance reporting, as in the UK, would be a very effective approach.