As far as Legal risk is concerned, any clinical, security or other issue that has a negative impact on a client can have legal implications for a healthcare provider because they all impinge on responsibilities such as duty of care to clients, and they need to be fully understood and managed appropriately. Actions that may mitigate risk here include:
• creating a contingency plan for use if a client’ s clinical situation deteriorates further than that which can be managed remotely by the provider
• securing informed consent from the client to the telehealth consultation before it occurs and noting this in the client’ s file
• ensuring that adequate PI insurance cover for the provision of the telehealth service is in place before the consultation occurs
• ensuring that the ATMS Code of Conduct and all other applicable codes are fully understood and complied with
• conducting the telehealth consultation to the same standard as if it were occurring in person( acquiring and documenting informed consent, producing and maintaining complete and contemporaneous records of the consultation and treatment as well as appropriate dispensing records, protecting client privacy, etc)
• ensuring that allowances are made for the recognised limitations of the telehealth consultation
• recording in the client’ s file any observations related to communication difficulties with the client, difficulties imposed by the communications platform, as well as client body language, appearance, temperament and anything else that may be clinically relevant
Supplying medicines
If providers are dispensing their own medicines to clients, these will obviously need to be sent to clients, but this should only occur after the client has been made fully aware of the costs involved and has agreed to them beforehand. When sending medicines, clear and detailed records should be kept of the client’ s consent to receive and pay for the medicines, noting what was sent, when it was sent, the address to which it was sent, how it was sent and any related item tracking numbers. Where clients are given the option of ordering medicines directly from a practitioneronly medicine wholesaler such as Integria( https:// patient. integria. com / MyPatients. aspx), Oborne Health Supplies( www. obornehealth. com. au), Natural Script( https:// naturalscript. com. au), Vital. ly( https:// www. vital. ly), or Ariya health( www. ariyahealth. com. au), etc, similar details should be recorded.
Payment
One other thing to consider is payment for the consultation. It has been the experience of some practitioners providing these services that clients are occasionally resistant to requests for payment for a telehealth service where the request is made after the service has been provided. This may occur because the client isn’ t physically present in the clinic and feels somewhat detached from what’ s occurred but for whatever reason, these interactions with some clients can prove to be challenging. This may be overcome by ensuring that payment occurs before the consultation, via whichever payment method that is preferred by the provider and is convenient for the client. In most cases the best option here is a secure standalone payment system that’ s hosted on the provider’ s clinic website.
Conducting a telehealth consultation
There are a number of things that are worth considering that may help to maximise the effectiveness of a telehealth consultation:
• to improve a client’ s capacity to provide informed consent to engage in the consultation, the transmission of a simple fact sheet explaining the telehealth process( including potential risks, technology requirements and security details, etc) to the client in advance of the telehealth consultation, may aid the client in providing informed consent
• if the technology used employs a visual component, the area that’ s visible behind the practitioner should be clean, uncluttered and won’ t cause distractions, and the sun or some other overly bright light source shouldn’ t be shining forward towards the client
• if the technology used employs a visual component the practitioner’ s attire and appearance should be as if the consultation were occurring face-toface
• the consultation must be conducted in a private and secure area
• both the practitioner and the client must be familiar with the technology that’ s to be used to communicate during the consultation and it should be confirmed that both are comfortable using it, and the practitioner should be confident in dealing with any problem that may arise with the technology, before the telehealth session occurs
• a backup communication platform( the default here is usually the phone) should be available in case the primary telehealth platform fails
• both the practitioner and the client must have access to a stable and fast internet connection. Without this, consultations may suffer from audio dropouts, audiovisual synchronisation problems, pixelation, frozen frames, video but no audio, audio but no video or total session disruption
• note that if a telehealth consultation is to be recorded by a practitioner, the client will need to consent to this before the consultation occurs, and an explanation as to how the recording may be used or disclosed needs to be provided, as well as how and where the recording will be stored, and the recording must be stored with the same level of security as any other sensitive client information
It’ s also important to note that receipts for payment for the consultation should be clearly marked to show that it was conducted via telehealth. Where
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