Do you have relevant/specific legal regulations regarding telemedicine practice in your hospital/region/country?
Australia: Yes. Hospital requires approved services (see below). National regulations exist and underpin the funding/reimbursement laws.
Funding with government rebates was restricted to certain patient groups (rural and remote patients and nursing home residents) and matched face-to-face consults. Medical indemnity recommend doctors to record patient consent, potential breach of confidentiality, and unable to fully examine the patient.
Links to the regulations/guidelines include:
https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Technology-based-consultation-guidelines.aspx
http://www.ehealth.acrrm.org.au/telehealth-standards
https://www.racptelehealth.com.au/guidelines/
https://www.racp.edu.au/fellows/resources/rural-health-continuing-education-program/telehealth-technology-workshops/telehealth-for-patient-care
New Zealand: No specific regulations. (except established stroke telemedicine is regulated).
Is there specific reimbursement for telemedicine services (fee for service) or it is included in your clinical care practice without any specific reimbursement?
Any rules or recommendations regarding institutional preferences for time split between physical visits versus virtual?
Australia: Yes, Medicare requires specific conditions based on service and location of the patient (fee for service). To service patients in remote areas, the Medicare rebate is higher. For metropolitan area residents, patients are only allowed to be bulk-billed for private or public services. Reimbursement does not cover the cost of the service, but at least patients cared for by public service do not pay out of pocket. We are moving from fee for service reimbursement to activity based funding (different model of reimbursement). We are not able to bill in private practice for telephone consultations, and thus most doctors will consult with video, unless the system fails on the day.
No preference for time split. However there was instruction to use more digital health services.
New Zealand: No. Largely publically-funded and salaried to reimburse hospital for telemedicine. Similar for private clinics.
Since the COVID lockdown, most insurance companies are paying for teleconsultations..
Neurologists decide on case-by-case basis whether an individual requires a physical visit or virtual. No specific guidelines drawn-up. The general principal is that it needs to be a time-critical problem, and moderate risk of harm to the patient if not seen physically.
How do you use telemedicine? What actual methods - mainly telephone calls?, e mails, text messages, videoconferences? Any specific platform/software?
Australia: Telephone calls, video conferences, nurse/patient emails. In the hospital system, a PD nurse may assist with phonecalls and emails between office visits. Often for remote patients or nursing home patients to minimize travel. Can also coordinate for GP telecare involvement for complex care, especially for rural or nursing home patients.
Specific/preferred platforms: My virtual care and e-health and PEXIP - approved by NSW health and academy of clinical innovation. Victoria public system uses a proprietary platform produced for state government hospitals. For videoconference in private practice (Skype, zoom)
New Zealand:
Combination of all of the above. For Telestroke we use Polycom. For consultations we use calls, Zoom meetings (most popular), Facetime, WhatsApp, doxy.me
The main difficulties or barriers to perform telemedicine? Technological limitations, patient rejection, lack of training how to conduct it. Privacy concerns?
Australia:
Main barriers are overcoming use of technology, (patient and health care worker/clinician); limited examination; and start-up operational issues. Secretarial staff can "check in" with the patient the day before the planned appointment, to ensure they can use the system, correct set-up with lighting, background noise etc., and problem solve any issues.
Privacy/safety issues per hospital but patients less concerned. Some patients lack technology or knowledge of telemedicine. However, almost all patients have a phone (also as back up for video)
New Zealand: Reduced quality of communication/exam. Internet quality is a big limitation- due topoor wifi strength in some areas. Physician concerns for lack of training. Privacy concerns using Facetime or WhatsApp or untested platform. Zoom is preferred by hospital as deemed safer for privacy concerns , and can email patient from a centralised work address. May be challenging for older generation physicians using paper-based system.
With the COVID-19, are neurologists/movement disorder specialists in your country/region using more telemedicine?, which kind? Has this crisis change anything in #1-4?
Australia: Yes. There is a major preference for telehealth- we have transitioned to more than 90% telehealth services for outpatient services. All modes have increased- phone, teleconference and video conferencing platforms.
New item numbers (billing codes) introduced by the government specifically for COVID crisis. Allows teleconference for all appointments if patients or doctor met certain high risk criteria. They are expanding to all consultations, but must be bulk billed, although this was being reviewed as sudden decline in income was prohibitive to some practices.
https://www.health.gov.au/resources/publications/covid-19-national-health-plan-primary-care-package-mbs-telehealth-services-and-increased-practice-incentive-payments
New Zealand:
Yes, using much more telemedicine. Mostly Zoom meetings, but also Facetime and WhatsApp. The crisis has not yet created any formal guidelines, regulations or changes in payment structures, although this may change. Currently getting patients seen is taking priority over strict confidentiality rules.