Telehealth: some pertinent issues

by Charles Wright on July 5, 2011

Australia’s latest telehealth initiatives are a fantastic advance for patients and practitioners, and who knows, they might have the fortuitious consequence of encouraging specialists, who with some remarkable exceptions have for too long been behind the technology curve, to embrace computers and communications with more enthusiasm.

But one thing we might take on board is the design of telehealth tools and practices. The video below of an elderly Parkinson’s sufferer commenting on the relief she and her family gained through tele-consultations indicates what’s likely to be achieved.

The Mobile Health blog raises some pertinent issues arising from the interview, although I’m not sure it quite appreciates the fact that this was more of a review of benefits than a formal consultation.

Nevertheless, as Australia moves forward in telehealth, it’s surely worthwhile to consider “a multitude of problems that are typically encountered when patients and doctors connect over video in a way that hasn’t been effectively designed …. and don’t do things such as waste expensive clinicians’ time asking basic questions, waiting for answers and documenting them, sometimes into paper-based records, when there’s a helper available and ensure the doctor and the patient maintain eye contact.

Any other suggestions?



Brendon Wickham July 5, 2011 at 12:06 pm

At the recent HISA Telehealth Conference, Dr Sabe Sabesan had a lot of useful advice for effective telehealth consultations. One of his topics was about communication skills, in which he made the following points for consideration:
1.Dealing with technology itself
2.Greeting, consent and ensuring privacy
3.Explaining to patients and check everything is ok to start
4.Use of duo video systems and other ways for interactive discussions (eg use of white board or technologies)
5.Explain why physical exam by the specialist is not necessary, when it is not necessary.
6. Keep checking positions
7. Keep in mind eye contact

Dr George Margelis July 21, 2011 at 4:47 am

The introduction of telemedicine consultations had had its issues. The biggest concern is the lack of any standardisation around the technology to be used. Unfortunately some vendors have been promoting solutions that are not really suitable for desktop video conferencing. As a result some doctors may find themselves buying a piece of proprietary hardware that will sit in their office gathering dust.

With PCs now having more than enough power to run good quality video conferencing applications, and coming with built in cameras, large high resolution screens, and stable operating systems it makes much more sense for clinicians to use these devices rather than dedicated video conferencing units. The software can be easily updated if required, cloud based services can be easily accessed, and if better solutions become available it is highly likely they will be made available for an industry standard PC.

David Doherty August 9, 2012 at 10:58 pm

Hi Charles,

I originally posted this on July 5, 2011 at 6:02 pm

But it still reads “Your comment is awaiting moderation” so I thought I might resubmit it:

Hi Charles,

RE: “I’m not sure it quite appreciates the fact that this was more of a review of benefits than a formal consultation”

I’m very aware of the use case and actually I think it’s even more revealing that this was a review rather than a consultation.


The quality of the feedback given to the specialist will be much lower if it is collected by the specialist himself – particularly as in this case the service is being afforded by a charity. Electronic tools enable patients to be surveyed quickly, cheaply and can be designed to help patients give more honest answers than they would give in person.

Value for money

This consultation was paid for by charitable fundraising (by the Presbyterian Home that the patient attends for her video consultations) . The services being offered to this lady were under consideration – hence during the video consultation the specialist informs the lady that she will be continuing to receive the service. In my opinion the risk of this service being taken away from such a vulnerable patient highlights the importance of designing services to ensure we get value for money and maximise the value of all available specialist clinician time.

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