In 2011, Karen Finnin had to end a three-year stint running a private practice in East Timor where she treated thousands of expats and volunteers. When Karen and her husband were getting ready to move back to Australia, she felt a duty of care to all the patients she had been treating because there was no longer going to be a physiotherapy service there. ‘I knew that when I left they would have an ongoing need for advice and rehab for musculoskeletal injuries,’ she says, ‘and I decided that there had to be a way for me to manage patients from a distance.’ So Karen said to her husband ‘look all I need is a qualified ear to listen to their symptoms, come up with a diagnosis and give them a rehab plan to follow. They just want to make sure that they’re doing the right thing. So I said, “I reckon we can do that online”.’ And with that, the concept of Online.Physio, Australia’s first entirely online publicly accessible private practice, was born.

Karen says there were always musculoskeletal injuries in need of treatment when she was living in East Timor. ‘East Timor has lots of potholes on footpaths and roads and so between people falling in them and rolling ankles, and people riding their scooters into them and crashing their motorbikes … there were always injuries for me to see.’ Karen identified a need for this type of care after researching how common the lack of quality injury management was, and realised the problem was not unique to East Timor.

When Karen started Online.Physio, the types of patients she was seeing were people in rural and remote areas that might not otherwise have access to a physiotherapist, but then it shifted. Karen says ‘now we see populations of people coming through who work remotely, or work from their computer and are travelling around a lot, which means that they don’t have a consistent clinic that they would visit. And then, there’s the people who just simply don’t want the inconvenience of, for example, finding a carpark, or sitting in a waiting room for a therapist that may be running late, when they can access something from their home or office.

‘The types of patients are generally people who are proactive about their health and might have niggles that are frustrating them. It works very well for post-op and people who have had surgery, and people who are realising they need the correct type of education and rehab plan to get them better,’ she says.

Running a physiotherapy practice completely online means that the patients do not receive any manual therapy and Karen says that the first person she needed to convince about this way of care was herself. Delving into the research evidence and seeing that there had been a lot of great quality research done in telehealth, with overwhelmingly positive results, was important for Karen. ‘The outcomes are the same if not better than in-person care because we are empowering patients and coaching them to do their own recovery, rather than developing a reliance on our manual techniques,’ Karen says. ‘At the end of the day, what is more empowering for the patients? A complex manual technique that is performed on them for a few minutes perhaps once a week, or a manual technique that they are taught to do on themselves and they can then repeat whenever they need to?’

Karen is noticing that a lot more telehealth services are being offered, particularly this year, and says that there is definitely room in the health industry for many different telehealth services because everyone can have a different ‘niche’. ‘Niching and providing a service tailored to a particular target audience is really important. So, is it that you target in a particular geographical area, a particular sport or specialty, or a particular age group? There is room for lots of us,’ she says. Karen hopes to see more people providing great quality telehealth because if there is an abundance of great quality telehealth being provided, the acceptance from patients will happen more quickly; and so too will the push for rebates and reimbursements.

Technology is a crucial component for an online physiotherapy practice and a significant amount of thought and time was dedicated to making the patient experience as smooth and frictionless as possible—Karen calls this the digital patient journey. ‘A big process we went through was to figure out if we custom-develop a software platform for the online consultation, or do we just use the systems that are out there and combine them in a way that provided a smooth digital journey for the patient.’ Karen decided that she was going to aggregate the best existing systems and combine them together using application programming interfaces and automation tools to create a smooth digital experience. Karen says that in so doing that, the cost of entry was much lower. ‘We didn’t have to custom-develop a system, and that also gives us agility because as new and better systems come along, we can just pull that piece out of the puzzle and slot in a new one.’

Karen says that running an entirely online physiotherapy practice has not come without its ups-and-downs and now that it is becoming much more accepted in the health industry, the business is moving into a phase where the insurers, the regulators, and the compensable bodies need convincing that an online consultation is just as legitimate as an in-person one. Karen says they have been through many different challenges but ‘with every challenge there is an opportunity, so we say bring it on.’                                                                                                       

If people are interested in the telehealth conversation, you can join the allied health telehealth Australia Facebook group.