Telehealth
Policy
We carry out consultations via 
telehealth to deliver medical care when patients and clinicians aren't in the same physical location.
Telehealth may be referred to by other terms such as:
- telemedicine/care
- remote health/care
- virtual health/care.
It may be delivered by:
- phone
- video
- secure messaging/email.
Treatment provided during telehealth consultations should be equivalent to the care provided during an in-person consultation. If the limitations of technology leave the clinician unable to provide care equivalent to an in-person consultation, they should explain this to patients.
The clinician's legal and professional responsibilities are unchanged during a telehealth consultation.
A clinician's responsibilities during a consultation may include:
We establish that a telehealth consultation is appropriate before proceeding. When prescribing via telehealth, a prescriber must ensure the patient has been appropriately assessed and has systems in place to manage their care. If a physical examination is needed, arrange this within an appropriate time-frame.
As well as establishing that a telehealth consultation is clinically appropriate, a practice team member should establish that the patient is able and happy to connect with the practice's platform of choice.
We charge a normal consultation fee for a telehealth consultation.
Privacy and confidentiality
Telehealth consultations should take place in a suitably private environment. This means ensuring that there is no one present who shouldn't be, at either the practice or the patient's location.
Involvement in a consultation could mean that someone other than the clinician or patient is able to:
- see/read information on screens
- overhear a conversation
- access emails or other messages.
Practices should check the integrity of their systems for data security regularly and, where possible, use secure messaging.
RNZCGP recommends that practices outline which secure digital platform they use for video conferencing.
The platform should have end-to-end encryption and be endorsed by established health providers who have completed both Privacy Impact Assessment (PIA) and Cloud Risk Assessment (CRA). RNZCGP encourages all organisations and companies to work towards completing their own PIA and CRA.
For IT security recommendations and maintaining patient privacy at home, see IT Security and Remote Working.
Prescribing via telehealth
Prescriptions issued via telehealth must comply with the same legal standards and good prescribing practice as prescriptions issued during an in-person consultation.
When prescribing via telehealth, clinicians should ensure that:
- they have enough knowledge of the patient's medical history to safely prescribe
- the prescription is in the patient's best interest
- patients requesting repeat prescriptions have in-person consultations at the appropriate intervals.
If the clinician carrying out the telehealth consultation is not the patient's regular doctor, information about the patient's care and prescriptions must be communicated to that doctor.
See also Prescribing and Repeat Prescribing.
Tips for carrying out the consultation
- Prepare for the consultation
- Consider whether your device is fit for purpose and secure.
- Confirm that a telehealth consultation is clinically appropriate for the patient.
- Use a private, well-lit space. For video consultations, consider what the patient may see in the background
- Ensure you have the patient's phone number in case you are disconnected.
- Ensure you can access the patient's clinical record, preferably on a second screen.
- Ensure the patient knows how and when contact will be made.
- Contact the patient
- Check that you are speaking to the right person.
- Check that the patient can see and/or hear you clearly.
- Before proceeding with the consultation
- Record the patient's consent for a telehealth consultation in the PMS.
- Inform the patient if you are going to record the consultation.
- Check that the patient is in a suitable environment, or if they need to go somewhere private.
- Introduce anyone else who is in the room, and explain why they are there.
- During the consultation
Be aware of any issues that might make it inappropriate to continue. For example if:
- the patient has any impairments such as seeing/hearing/cognitive
- the technology isn't working
- the clinician or patient don't understand how to use the technology
- the health problem is too serious
- there are privacy issues/concerns.
- At the end of the consultation
- Summarise key points to ensure nothing has been missed.
- Ensure the patient knows if any follow-up is needed, and how this will happen.
- Ask the patient if there is anything else they want to discuss.
- Document the consultation in the patient record as per an in-person consultation.
- Confirm if the patient is happy to have a telehealth consultation again, and record their preferences.
- Confirm that the consultation has finished and you are going to close the call.
Refer to Telehealth 101: tips and tricks
Ask the patient to come in for an in-person consultation if at any stage you feel this is needed. If the patient declines an in-person appointment, record this in their notes.
When the consultation has finished, be sure to put into place any action required to facilitate continuity of care.
Equity
Telehealth can make healthcare more accessible to patients who experience barriers to visiting the clinic. However, it should be offered as an option which the patient is free to decline.
Barriers to an in-person consultation could include:
- geographical location
- transport cost/availability
- physical/mental condition
- lack of comfort with the practice environment
- lack of motivation to attend appointments
- difficulty of having support people/whānau present.
Resources