Keeping up the momentum in a digital space
The sudden and deeply impactful ramifications of COVID-19 restrictions on physiotherapists, their practices and their patients has seen a huge push to move consultations online. However, there are benefits to having access to telehealth services provided you are well informed.
The way in which practitioners and business owners reach their clients has changed drastically in recent months. From face-to- face consultations to online treatment— telehealth has become the predominant way in which patients are able to access their practitioners, and for physiotherapists to be able treat their clients from a distance during the COVID-19 restrictions.
Consultations via telehealth can be used not only to ensure adherence to the social distancing restrictions set in place in the wake of COVID-19, but also for physiotherapists to reach clients inremote communities or treat patients living with disability or mobility issues. While telehealth is considered by many to be a safe and effective way of assessing and treating patients through a secure, online, audiovisual connection, there are also long-term benefits to being familiar with telehealth practices moving forward that will continue to be useful once social distancing restrictions have been relaxed.
While the use of telehealth has increased exponentially as physiotherapists, practice owners and patients scramble to keep their connections active and treatment progressing; it is imperative that practitioners and patients have a clear and open understanding of how telehealth works logistically, as well as the limitations and the benefits the service can provide.
Before commencing a telehealth consultation, the onus is on the practitioner to ensure the patient understands how treatment will be delivered and how it will continue to provide benefit. With the future being so uncertain, it is understandable why some patients would choose not to commence telehealth physiotherapy consultations. It is important to remember that a patient is accustomed to face-to- face treatment, transitioning to online is not always a given.
In the telehealth space, physiotherapy clinics must continue to adhere to national privacy laws surrounding patient information, as well as maintaining the privacy policies set out by each individual clinic. The handling of confidential patient information must continue to be safe and secure—this is a major concern from patients when being treated through telehealth.
In order to maintain patient privacy, a secure online platform is required. There are many free services that are being used, for example Zoom or Skype, but there is lack of security that comes from using a free platform—or any platform that was not specifically designed for use by healthcare professionals. Information provided in the APA telehealth guidelines state that, ‘If the video software you use to convey sensitive information is, or can be, intercepted, unencrypted or hacked, you can be seen to have failed your duty’ in ensuring the privacy of your patients.
Further to this, ‘you can’t be excused from using a poor-quality video platform simply because it would be inconvenient, time-consuming or would incur a reasonable cost to switch to a more secure platform’. Failure to maintain this level of privacy may have legal ramifications. For more information on this, see the telehealth guidelines on the APA website.
In saying this, there is a great need for practice owners to perform their own research into what platform will work for their clinic, while also being in the best interests of the patient—specific to the kind of service the clinic provides, be it strengthening exercises, postural correction, patient diagnosis or a combination of all three.
APA Musculoskeletal Physiotherapist Karen Finnen has been running a purely online physiotherapy practice successfully for the past eight years, and she expresses how important it is to understand the platform you are using not only on a security level, but the technical aspects as well.
‘You don’t want to be wasting your time or the patient’s time by fiddling with unfamiliar software’. She advises to download some free trials and test which one best fits with your needs. She also recommends running test sessions with non-clients from both the practitioner and patient side of the conversation, so you know exactly what the service is like for your client.
Karen has presented a series of videos on the APA YouTube channel, providing information on how to transition to telehealth and offering useful tips for getting started and being sustainable.
The benefits of telehealth extend to being able to record parts of the session, for example, the patient performing specific exercises for future reference, answers to questions that are frequently asked by the same client and so on. Linking back to privacy, permission from the patient needs to be granted before any of the session is recorded—but this is a helpful tool to watch with the client and offer corrections or encouragement in a way that can be viewed by the patient and practitioner at the same time, as well as for future reference for the patient.
Once there is an established platform, the next step is assessment and treatment of patients. Although it may be unfamiliar, there is research available that indicates physiotherapy treatment delivered via telehealth may be as effective as a hands-on consultation. There are many aspects of telehealth consultations that are the no different than face-to-face appointments, Karen says. She likens being a physiotherapist to that of being ‘like a detective’, stating that ‘being hands-on is only a small part of what we do’.
When it comes to third-party payers, it is advisable that patients first contact their provider directly to ensure they are covered for telehealth. However, most third-party payers—including the majority of private health insurers, compensable bodies and Medicare—have agreed to fund telehealth services for allied health during this national emergency. There is no guarantee that third parties will continue to fund telehealth once clinics are able to open business as usual—so it is important to ensure you are providing safe and effective service to help build the argument that telehealth is a service that does deserve to be funded full-time. In the ideal post-COVID-19 world, telehealth will be used in conjunction with physical appointments to provide the best possible treatment to allied health patients nationwide.
When treating patients through telehealth, just as in a physical location, practitioners need to ensure that their indemnity insurance covers the treatment they are providing. Information available on the APA’s telehealth information page states, ‘the APA professional indemnity insurance policy will cover you to practise physiotherapy services online to Australian- based clients, provided your advice is considered within your scope of practice’. For practitioners with other insurers, it is important to contact the insurer to check if you are covered for telehealth.
Having this service in your practice’s repertoire could help expand your client base; keep patients who, after moving, wish to stay with the same practitioner; and organise follow-up appointments with patients living with disability or mobility impairments.
The future of telehealth funding for third party bodies relies on the trial by fire and the successful adoption of this service by practitioners.
>> Go to australian.physio/telehealth for more information.
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