Rural doctors are fast adopters of digital health, but its strength will be in complementing – not replacing – ‘flesh and blood’ doctors in country towns, writes the President of the Rural Doctors Association of Australia (RDAA), Dr Adam Coltzau.

During the recent school holidays, I was enjoying some time with my family at the coast when I had a call from ABC TV News. They were keen to interview me live on ABC News 24 to respond to Labor’s election policy announcement regarding elective surgery waitlists.

As I prepared to do the live TV interview, using the coffee machine on the kitchen bench in the hotel room as a makeshift stand for my smart phone (aka TV camera), I marveled at the ability of digital technology to connect us.

Rural doctors genuinely appreciate the ability of digital health to transform access to healthcare in the bush, and are keen supporters of its wider deployment.

Telehealth

In recent years, telehealth has become one of the most visible areas of digital health uptake in rural settings.

It is now possible for doctors in many rural and remote locations – whether they are in their general practice or the local emergency department – to connect with specialist colleagues for real-time advice on the management of various conditions and emergencies.

For junior doctors in particular, this provides significant support at a time in their medical career when they most need it – especially in locations where there may be few other health professionals on-the-ground with them.

In recent years too, the Federal Government has expanded its telehealth measures to enable rural and remote patients with mental health concerns to be treated by distant psychologists and other mental health professionals.

Additionally, in response to the ongoing drought across much of rural Australia – as well as the recent flood crisis in Queensland – the Government has introduced a new telehealth initiative where patients in a number of rural and remote locations can ‘attend’ consults with their usual doctor online via telehealth.

From 1 November 2019, this measure will be expanded so all patients living in Remote and Very Remote areas of Australia (remoteness classification areas MMM 6 & 7) will be able to access consultations with their regular GP via videoconference, and these will be rebateable through Medicare. This is a huge step forward in realising the full potential of telehealth services.

This will save many of these patients having to drive what can be hours into town for short follow-up appointments on things like medication management or chronic disease management, and it also means they can contact their usual doctor if they have more immediate concerns like depression.

Going forward, RDAA is very keen to see GP-to-patient telehealth expanded across more of rural Australia.

Digitisation

The digitisation of x-rays has also made a huge difference in how rural patients are managed. The advent of 24/7 real-time reporting means that complex chest x-rays, for example, can be taken in a rural location and shared with distant radiologists (who can be based in different states or even, with the right credentialing and Australian medical registration, overseas).

This can greatly reduce the time in diagnosing conditions and, in some cases, avoid the need to retrieve the patient to a larger hospital.

This not only makes an enormous difference for rural patients (in terms of management of their condition and being able to remain in their community), but it can also deliver savings for the health system in terms of reducing expensive retrieval costs.

Digital health is also making a positive impact for rural doctors when diagnosing or managing dermatological conditions. Many rural doctors now take photos of patients’ skin rashes and other skin conditions, and send them to distant specialists for their opinion, because dermatology can be a tricky area for making correct diagnoses. With modern adaptive devices, doctors can attach a dermascope to a phone and send the image to the specialist for advice. Similar devices are also available when seeking advice from distant specialists on ear and throat conditions.

Digital health – a tool, not a replacement, for local doctors

Digital health and telehealth can be a fantastic tool in supporting local health services, but it must never be seen as a replacement for the local doctor in the community – there will always be a need to have local clinicians on-the-ground in rural towns, ready to provide both preventative healthcare and also to be there for the emergencies.

At the same time, it will be critical to ensure that the infrastructure is there to support a reliable digital health future. Digital health will only ever be as good as the telecommunications capability built around it, and it will obviously be limited in locations where, even to make a mobile phone call, you still need to stand on a milk crate in the corner of the hospital carpark.

The Rural Doctors Association of Australia is keen to actively progress a digital health future for the bush, and over the past few years we have been closely engaged in the telehealth agenda through the Federal Government’s Review of the Medicare Benefits Schedule (MBS).

Indeed, it was a joint submission we provided with the Australian College of Rural and Remote Medicine to the Federal Government that brought about the new telehealth item for GP-to-patient telehealth consultations in Remote and Very Remote (MMM 6 & 7) communities, and the additional telehealth support for flood and drought-affected communities.

We look forward to working closely with those in the digital health space to help ensure this technology continues to play a key role in making access to healthcare easier for rural and remote Australians.


Dr Adam Coltzau is a Rural Generalist doctor in St George, Queensland.

He can be emailed via [email protected].

Visit the Rural Doctors Association of Australia website at www.rdaa.com.au.