The COVID-19 pandemic has seen an explosion in the use of videoconferencing technology. Suddenly the webcam has become an essential (home) office tool and people are writing articles about the need to ensure that your videoconferencing background conveys the right impression.
In terms of the health sector, we’ve seen health practitioners, from doctors to physiotherapists and OTs, rapidly adopt the use of videoconferencing platforms to engage with patients and provide advice. This type of practice – where telecommunications and virtual technology is used to deliver health care outside of traditional health care facilities – is broadly called telehealth.
There is nothing new about telehealth of course, but what is notable here is the sheer number of practitioners who have adopted it and the speed with which they have done so. It’s a no brainer in many ways – after all, seeing patients is a health practitioner’s bread and butter. But telehealth isn’t always appropriate and it’s not entirely risk free. It’s essential that practitioners understand how to meet their professional and legal obligations in the brave not-so-new world of telehealth.
Remember the basics
First and foremost, you’re still providing health services so the basics still apply. Your patients still have the rights set out in the Code of Health and Disability Services Consumers’ Rights – that means you must be sure you can provide services of an appropriate standard via telehealth. Not every problem can be dealt with remotely. If the patient’s request or clinical needs appears straightforward, you have access to their medical records and you’re confident there is no need to examine them, then you’re generally good to go.
If physical examination is likely to provide critical information about the patient, however, you shouldn’t do a remote consultation. Remote consultation is also unlikely to be suitable if you’re unsure about the patient’s capacity to decide about treatment. It’s also worth being cautious if you’re not the patient’s usual health professional, – particularly if the treatment needs monitoring or a follow up.
It’s worth checking to see if the Board or Council that you are registered with (e.g. the Physiotherapy Board), or your professional body has a statement on telehealth because that’s the standard you’ll be held to if something goes wrong. The Medical Council updated its Statement-on-Telehealth in early March 2020 in response to the COVID-19 pandemic. The Nurse Executives of New Zealand Inc, Psychologists Board and Allied Health New Zealand have also published guidance, and most of the medical colleges have too (see here).
The Health Information Privacy Code still applies too. You wouldn’t do a consultation in front of a waiting room full of people, so while it’s probably ok for the family cat to listen in, make sure you can’t be overheard by anyone else. It’s also important to be aware of the risks of the videoconferencing platform you’re using – and tell your patients about them. Most platforms aren’t 100% secure, so make sure that you’re using the most up to date version of the platform, use the additional security the platform offers, and ask your patients to do the same.
If you provide services via telehealth, you need to get informed consent not just for the treatment you’re providing but for the way you’re providing it. In order for your clients to give informed consent they must be properly informed of the risks and benefits specific to telehealth. For example, consultation via telehealth might allow the patient to be assessed while the COVID-19 pandemic restrictions are in place or avoid travelling across town for an appointment, but assessment via video link has limitations and there are additional technological and confidentiality risks. We also think it is a good idea to tell patients that you are more dependent on them telling you all the relevant information than you would be in a face-to-face consultation.
If you plan to record the consultation, you must inform the patient in advance and obtain consent. Tell them why you want to record it and how the recording will be stored. Document details of the patient’s consent and remember: the recording will form part of the patient’s medical record, and should be treated in the same way as other medical records.
Any other tips?
Document, document, document!
Just as with face-to-face consultations, you must make careful, contemporaneous notes of the consultation, any assessment and management plan. In telehealth, that may mean writing notes, recording video or taking screenshots. Most importantly – make sure you document your consideration of whether you need to see the patient in person, and why you decided to go ahead with a telehealth appointment instead.
Adopting technology can open doors and increase access to quality health services – but it can also create new issues and raise questions you’ve never thought about before. The team at Claro is here to help you navigate this not-so-new frontier.
For further information contact Aisling Weir.
This article is intended to provide a summary of the subject covered only and is necessarily general and brief. It is not intended as legal advice and nothing in the article should be relied upon without getting specific professional advice.