Innovating and adapting out of necessity
In part one of a three-part series, Barry Nguyen, APAM, gives an overview of telehealth as it sits in the Australian physiotherapy landscape.
Since the beginning of the COVID-19 pandemic, telehealth is likely one of the most talked about topics within the physiotherapy profession. In addition to telehealth startups and health IT companies adapting and scrambling to quickly build and launch fit-for-purpose telehealth solutions for physiotherapists, the Australian physiotherapy industry has truly come together as a tight knit community and is moving at full speed into the digital age.
We are innovating and adapting out of necessity, not choice. Strict social distancing policies, economic uncertainty as well health risks associated with the virus has forced this innovation upon physiotherapists to serve their patients through alternative delivery methods—specifically though videoconferencing.
Before the pandemic, telehealth was not mainstream within the physiotherapy profession. It was primarily used when physiotherapy services were difficult to access, such as in remote regions, and explored by a few entrepreneurial mavericks.
Now with third party payers including private health insurance companies, compensable bodies and Medicare temporarily funding our services, this can be an opportunity to prove that telehealth objectively produces excellent patient outcomes.
Hopefully, telehealth physiotherapy third party funding will be here to stay once this pandemic is resolved, complementing existing in-person physiotherapy services.
More information in relation to clinical evidence and research, government policy, third party payers, privacy and security, and insurance matters can be found on the telehealth page on the APA website.
Telehealth physiotherapy is generally delivered in four ways. Synchronous or live video is a real-time interaction between the therapist and client in a one-on-one or group session.
This method is often used for physiotherapy assessment and treatments, as well as to conduct supervised group exercise classes. This model is often applied with a fee-for-service based payment.
Asynchronous or store-and-forward involves the secure transmission of health-related pre-recorded materials such as clinical notes, text messages, X-rays, medical reports and history, videos and images. This model is often used for subscription services.
Remote patient monitoring (RPM) is the remote monitoring of health parameters such as the client’s movement quality, range of movement, pain levels during movements, blood pressure and steps per day.
Mobile health or mHealth is generally an app that can be downloaded to a mobile or tablet device. The app should assist with the management of chronic diseases, give clients access to digital therapeutic programs, and provide personalised health education as well as public health promotion and alerts.
Key benefits of telehealth physiotherapy can include:
- providing access to clinical expertise and specialised health information for those who are in need of physiotherapy services without physical access
- potential in breaking down geographical barriers of receiving clinical expertise
- saving the client (and practitioner) time and money associated with costs of travel, parking
- providing more flexibility in terms of environment and hours for the practitioner’s lifestyle needs
- potential to reduce the relative operating costs of a traditional clinic and provide improved remuneration
- eliminating the health risks associated with physical contact such as the spread of illness
- can be a useful educational tool for physiotherapists to prescribe information to the community using advanced digital media tools which enhance communications
- according to an emerging body of clinical research, telehealth physiotherapy can be just as effective as, or even more effective than, traditional in-person consultations for a wide variety of physiotherapy clinical specialties.
Key disadvantages and risks telehealth physiotherapy can include:
- both client and practitioner must have access to reliable, high-speed internet connection
- removes the touch aspect of physiotherapy, which can be argued is a part of a physiotherapist’s DNA and can be critical in building rapport with clients for enhancing trust, empathy and confidence in the practitioner
- possibility of uncertainty for both practitioner and client in the effectiveness, quality and safety of various conditions treated successfully by physiotherapists in person
- potential cost in training staff and investing in telehealth infrastructure, such as high-speed internet access and high- quality cameras, to ensure an optimal client experience
- potential risk in re-educating and encouraging clients that telehealth can be just as effective, or even more effective, for certain conditions, particularly for clients who traditionally expect hands-on treatment from physiotherapists
- potential risks associated with the safety of the client environment where there is limited supervision in performance of certain movements, where hands-on support and feedback may be critical for assessment and treatment potential risks associated with cybersecurity in terms of data security and privacy concerns.
There has been recent negative press regarding data security and privacy risks associated with practising telehealth with consumer-grade videoconferencing software such as Facetime, Google Hangout, Skype and Zoom (preview.tinyurl.com/yc62v7x6)
For physiotherapists considering telehealth it is important to self- reflect and have a thorough understanding of your clinical scope of practice and limitations to providing a service via a telehealth mode. Conduct some surveys and market research with your existing client base on the idea of introducing telehealth.
Their feedback is critical in terms of how you will design your telehealth service and applicable business model. Make sure you check that your professional indemnity insurance covers you practising telehealth, and understand the associated geographical constraints as well as other potential regulatory considerations.
When researching telehealth videoconferencing tools, make sure you are well informed of the benefits versus risks.
Be as practical as you can so the platform you choose is fit for the purpose for your clinical workflow and service delivery model. For example, some videoconferencing platforms allow group meetings, which can enable you to run group exercise classes, albeit in a less private and secure manner. Other clients may need one-on-one video consultations where there will be sensitive personal health information provided.
Understand client-informed consent obligations as a health practitioner. It is important to explicitly inform clients regarding the associated telehealth risks with your chosen mode of delivery, software platform used as well as clinical considerations. If the client confirms this method, note that you have obtained patient consent formally in the clinical record. This is known as an opt-in agreement.
>> Part of two of the three part series will provide a general overview of the various telehealth physiotherapy-related technology solutions and tools available in the market.
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