Page III: A Sydney-based start-up is offering a way for doctors to track and bill their clients for consultations over the phone and by e-mail.
According to Rutland, a spin off benefit of the service is its use as a kind of triage system. -If a patient rings and is coughing up blood, I can ring the emergency department and tell them what they need to know prior to the patients arrival. Or I might need to see the patient and request that they get a chest x-ray prior to coming into the surgery, which saves them coming in and going away again to get a chest x-ray. Or if the patient is traveling in India and runs out of medication, we can post it out," he says.
It also affords Rutland more flexibility when it comes to treating his patients. -If I attend a conference for a week I used to have to cancel all my patients but now I can keep the lines of communication open and ring or e-mail them during lunchtime or after the conference hours," he says.
Relatives of patients can also sign up for the service. -There is traditionally a limited amount of time you can spend talking to relatives, but if you've got elderly people going to see a geriatrician and middle aged parents who don't want to take time off work but want to find out how things went, we can do this via TeleConsult, with the patients permission," he says.
Rutland says it is a win-win situation. -It empowers patients by giving them better access to their doctor out of hours and it maintains my privacy whilst still making me available. It's a time management thing, meaning I can squeeze in an extra patient here and there," he says.
Furthermore, Rutland claims this kind of service will benefit the community too, by preventing unnecessary hospital admissions. -I've treated people who are at home on the understanding that if they deteriorate they will ring me or go to hospital. With a bed in a hospital costing the tax payer around $800 to $1000 per a day, the savings are considerable, he says. -It doesn't stop people needing hip operations, bit it might stop someone with chronic bronchitis being admitted to hospital unnecessarily," he adds.
Patients can also use the service if they want clarification about medical facts they may have researched on the Internet. Some patients follow up a diagnosis by going to the Internet to find out more, but after surfing several sites and finding contradictory information, don't know what to believe. -It's quite appropriate in these circumstances for the patient to phone or e-mail a doctor with the URLs for advice on which facts are correct," says Rutland. In the same way, if a new treatment comes onto the market, the patient can check with the doctor whether it is suitable, and gain advice on why it might or might not be, says Rutland.
In terms of medical indemnity issues, most doctors already talk to patients on the phone and if they don't, then TeleConsult might not be for them anyway, says Rutland. -Each doctor has to be satisfied with his or her own medical defence system," he says.
Tony Andrew runs a General Practice which has 5,700 patients in Cremorne in Sydney, and has been trialling the system for a year.
-John's (Rutland) mother had a bypass operation at the same time as I did, and we were in hospital together. John came across to me and said 'you're a GP aren't you' and outlined his idea for the service, asking me if I'd find it useful. I told him I would," says Andrew.
Andrew says he used to feel -angry" when taking phone calls from patients, but now takes less calls and is -comfier" with the arrangement. -Prior to this I would have to have sent an invoice for $10 or $15 for a call which once posted and processed is not worth my while. TeleConsult happens seamlessly, and the only accounting I get is a piece of paper at the end of the month telling me how much money they've put in my bank account," he says.
-It's not for everything, but for things like follow up results, blood tests, and x-rays for instance, patients don't want to come into the surgery, and it reduces the number of times a patient has to come back to the practice," he adds.
Andrew's patients are informed of the service when they call to speak to him, and he says the service is generally well received. -I don't say, 'you used to ring me for free, but now you have to pay for it', I say 'there is no medicare rebate for this' and that tells them it is going to cost," he says.
According to Dr David Rivett, Chair of Australian Medical Association (AMA)'s Council of GPs, doctors may be put off this kind of service by the fact that Medicare does not offer reimbursement for phone and e-mail consultations yet.
He believes, however that once MediConnect, the government-initiated national electronic system which aims to improve the information about medicines are shared, comes into full swing, it is only a matter of a couple of years before prescriptions are being e-mailed out to patients.
-It will be a huge time saver and make life a lot simpler, but from a consultation point of view a consultation in the flesh is worth a thousand e-mails. Patients tend to put on a hardy front in the flesh even if we can see that they are half dead and it's hard to evaluate that from a written message," says Rivett. -A phone conversation is better because we may be able to hear the pain in their voice or other signals," he adds.
Andrew says the biggest problem at the moment is getting patients into the system. -To do it online is fairly quick but a lot of people are unsure of this still, and to register over the phone takes a while," he says. At the moment when a patient rings up, perhaps in the middle of the night and perhaps not feeling their best, is when they are told they must register with TeleConsult, which involves them ringing another number and registering.
-The best way to do it would be to join everybody up front, as they come into the surgery, as a matter of routine, and that is what we are looking to do," he says.
Andrew charges $4 a minute for a TeleConsult. -It's the same rate as a face-to-face consultation, only it usually takes a shorter time," he says. Patients signed up to the service are mainly senior people in the city, he says, people who don't want to take an hour and a half out of their day to visit the doctor.
-E-mail communication is wonderful," says Andrew. -E-mails could sit in my inbox unanswered for days, but now I get an SMS each time I receive a new request, and I can deal with it at anytime anywhere," he says.
The phone can be disruptive, admits Andrew, but he puts that down to his own failure to record a voicemail which informs patients of the hours he is able to take calls. -If I can't take the call, the patient is asked to leave a message using their keypad, and I get an SMS informing me that a call is waiting and the timeframe within which the patient would like to hear back from me," says Andrew. -It will get better and better as I and the patients get better at using it," he adds.
Richard Harris, Gartner Asia-Pacific vice president, says that if doctors want to offer a paid-for phone or e-mail consultation service, the outsourced or hosted model makes sense, particularly for small clinics and GPs.
-It's quite interesting because for most GPs and small practices, the administration involved with handling phone and e-mail requests is handled by front office staff, who are already pretty well pushed answering phones and dealing with patients in the surgery. A service that systemises, simplifies, and keeps track of calls and e-mails and reimburses doctors automatically, on the face of it, is very attractive and the hosted model is a good way to go," he says.
Harris says that some medical professionals do have a reluctance to hand over things to an outside party but TeleConsult, if marketed right, could be onto a winner. -If the marketing taps into the doctor's network, word of mouth sets in, the company ensure that the system is simple to use, and doctors don't have to think about the base technology, then the likelihood of ramping the service up is good, but it might be a slow ramp," he says. -However I think the hosted model is attractive and we are close to the time when this sort of approach is more palatable to doctors," he adds.
