Telehealth

The terms ‘telehealth’ and ‘virtual care’ are often used interchangeably.

This guidance uses ‘telehealth’ to describe a consultation that uses technology as an alternative to in person consultations between a patient and a practitioner. It can include video, internet or telephone consultations, sharing digital images and/or data, and prescribing medicines or other therapeutic or assistive devices (for example orthoses or glasses) or mobility aid.

‘Virtual care’ is used as a broader term for services provided by practitioners to patients through digital communication channels such as telephone, video conferencing, remote patient monitoring, websites and mobile applications (apps). Increasingly, virtual care includes apps and wearables, some of which are medical devices regulated by the TGA.

Virtual care and telehealth do not refer to the use of technology, such as voice-to-text notes, automated predictive apps, or similar, during a face-to-face consultation.

National Boards support the responsible and safe use of telehealth and recognise the opportunities telehealth offers for access to and delivery of healthcare.

Practitioners can use telehealth if:

• they are appropriately skilled and competent
• it is safe and clinically appropriate for the health service being provided, and
• it is suitable for the patient.

National Boards have the same expectations of practitioners using telehealth as when practitioners are delivering services face-to-face. When providing telehealth, practitioners must practice in accordance with all the relevant Board’s regulatory standards, codes and guidelines.

The individual practitioner, not their employer or business, is responsible for the healthcare provided via telehealth. When working in a telehealth delivery-based business, practitioners should assess the framework for delivery of care to ensure it is not being compromised by commercial considerations or practitioner convenience.

Practitioners should:

• Recognise that telehealth is not appropriate for all consultations as the lack of in-person interaction can limit the ability to provide safe and effective care. Practitioners should carefully consider whether telehealth is an appropriate method to provide care. A consultation may require a more fulsome examination and/or observation of the patient than is possible via telehealth, or a particular treatment methodology may not be appropriate to deliver via telehealth.
• Be aware that prescribing via telehealth will not always be appropriate – see specific guidance for prescribers below.
• Understand the technology platform being used, how it captures and stores personal information, and how patient privacy is managed. The chosen technology must meet clinical requirements, patient needs, and comply with relevant privacy legislation and other requirements (e.g. MBS telehealth arrangements). Any use of technology (like artificial intelligence or chatbots) to simulate patient conversations about care in place of conversations with a practitioner, should be considered carefully. Read more about the use of technology.
• Be transparent with patients and prospective patients about any conflict of interest, such as any financial interest in any medicine, product or service they may be endorsing for financial compensation or selling.
• Understand that, when providing healthcare across borders there may be different requirements that apply, including but not limited to, legislative and insurance requirements. Practitioners must ensure they have appropriate professional indemnity insurance (PII) arrangements in place for all aspects of practice, including telehealth consultations.
• Regularly assess and reflect on their knowledge, skills and competency to use telehealth and undertake relevant CPD when required.

Practitioners should:

• Identify all practitioners present and confirm the identity of the patient.
• Provide an explanation to the patient of what to expect from a telehealth consultation, including if the consultation will be recorded or an AI scribe used.
• Ensure information is provided to the patient in a way they understand, and that informed consent is obtained (including for the use of any AI scribes).
• Assess (and regularly re-assess) whether telehealth is safe and clinically appropriate for the patient or whether good care can only be provided by the patient and practitioner being in each other’s physical presence.
• Advise patients if the limits of technology mean practitioners are unable to provide the service, and facilitate access to alternative care arrangements (e.g. a face-to-face consultation).
• Protect the patient’s privacy and confidentiality. Ensure the patient is accessing telehealth technology from an environment that adequately protects privacy and confidentiality, and consider whether anyone can overhear the consultation and confirm the patient consents to this.

Practitioners should:

• Ensure they effectively communicate with and adequately assess the patient to establish their presenting condition and any relevant information such as social and family history, current treatment, and health and medication history.
• Take all practical steps to meet the specific language, cultural, accessibility and communication needs of patients, including by using translating and interpreting services where necessary, and be aware of how these needs may affect understanding.
• Support the health and safety of Aboriginal and Torres Strait Islander patients by ensuring they engage in culturally safe practice for all telehealth consultations.

• Be conscious of any specific care needs. E.g. the importance of relationships with the relevant Aboriginal Community Controlled Health Organisation and their referral pathways when providing care to Aboriginal and Torres Strait Islander patients.
• Use evidence-informed practices to reflect the standard of care expected in a face-to-face consultation, as much as possible.
• Ensure they maintain clear and accurate records of the consultation, in accordance with relevant legislative and any other requirements. More information about managing health records is available on the Ahpra website.

Practitioners should:

• Where indicated and appropriate either handover or follow up the progress of the patient.
• Where indicated and appropriate and with the consent of the patient, inform other relevant health practitioner(s) of the treatment or advice provided, including any medicines or other assistive technologies prescribed or provided.
• Ensure their contact details are up to date and available for contact by other practitioners if needed.

Practitioners who prescribe medicine via telehealth should:

• Be aware of and comply with relevant state, territory and jurisdictional legislative requirements for prescribing medicines. This is particularly important for registered health practitioners who prescribe medication to patients in different states or territories, which may have different legislative or regulatory requirements.
• When appropriate, comply with the use of government health and prescription monitoring services such as Prescription Shopping Programme, My Health Record, HealthNet, Real Time Prescription Monitoring platforms.
• Be aware National Boards do not support or consider it good practice to prescribe medicine or other assistive technologies (for example orthoses or glasses, or mobility aids) for a patient that a practitioner has never consulted, whether face-to-face, via video or telephone. This includes requests for medicine or other health services communicated by text, email or online that do not take place in real-time or are based on the patient completing a health questionnaire where the practitioner has not formally consulted with the patient. The Boards do not consider an online chat to be a synchronous (in real time) consultation.

Any practitioner who prescribes for patients in the above circumstances may be asked to explain how the prescribing and management of the patient was appropriate and necessary, and how they assessed that the patient was a suitable candidate for any treatment provided.

More detailed guidance on prescribing via telehealth is available in the following:

• Joint statement - prescribing and dispensing medicines
• Professional responsibilities when prescribing medicinal cannabis
• The Pharmacy Board of Australia - Medicinal cannabis supply - Meeting your professional responsibilities