Frequently asked questions

Yes. This will need to be explained to the consumer, carer(s) and other provider(s), if required.

Generally, a practitioner should be satisfied that an examination or observation using a method such as videoconferencing can be carried out with sufficient skill and care to form a clinical opinion. The practitioner should be competent in communicating over the relevant medium (in this case, videoconferencing) and using any remotely controlled devices involved, as well as understand the possible limitations of the process. Such limitations could include an inability to do a hands-on assessment where required, lack of appropriate technology or potential issues with the quality of images or audio and video links.

There may be alternative ways or people available who can provide support at the consumer end to assist in ensuring that it is clinically appropriate.

Consumers should be assessed on a case-by-case basis and on the basis of their functional capacity, rather than on their condition or diagnosis. Where a consumer is assessed as not having capacity, it may still be possible for them to participate in a virtual care consultation with their parent, guardian or person responsible present.

Although technically it is possible to provide virtual care in this case, it is not recommended. A clinical consideration would need to be made to determine the reason for such a consultation. Other factors to be considered include the length of time the consumer is away for and the possibility to transfer care to a local provider.

Providing advice in the event of an emergency or supporting continuity of care of a consumer receiving treatment overseas would be considered appropriate and a part of normal expectations.

In these circumstances, the focus should be on ensuring appropriate consent is obtained. Ask your local team about legal requirements. The consumer’s needs must be prioritised and this matter should be treated with the utmost sensitivity. The consumer may not wish to be transported to another facility to have an assessment, so virtual care may support them to access this service close to home under the guidance of an experienced clinician. Access to appropriately trained and qualified senior doctors, such as someone skilled in collecting samples/evidence within the time required, to provide a specialised assessment is paramount.

Consumer brochures are applicable regardless of the modality. There are no special requirements for clinical services delivered virtually. Clinicians may need to consider how they can provide the brochures to the consumer if their service does not include an initial in-person consultation. These may need to be emailed or sent via post to the consumer or to the secondary service provider to give to the consumer at the time of consultation.

Providers should document the virtual consultation in the consumer record. Where there are multiple providers in one district, it is reasonable for each provider to review and note that they have reviewed the entry and add any further detail. It is expected that clinicians across district boundaries should register the consumer and document notes in the consumer record. Alternatively, consumer documentation can be provided by another district and uploaded into the local file to support a clinical note.

This is a risk for the facility and healthcare professionals. It would be difficult to later prove that the diagnosis or treatment was reasonable if it was based on an image or other record that was not kept.

All images should be uploaded into the eMR. Images are not to be kept on personal devices. MedSync is a new tool built within MS Teams that enables photos and videos to be uploaded securely into the eMR.

Seek advice within your district about receiving and storing sensitive images, such as medico-legal, as the first step.

Generally, if the images are received or taken as a part of clinical assessment and treatment, they form a part of a consumer’s medical record and, as such, should be added to the consumer’s medical record. This is important to ensure all clinicians can access the information and that the information is appropriately stored.

Each district has a different process of storing images in the medical record. Contact your local medical records or health information services team for more information.

Yes, appointment details should be treated as personal health information, as they will form part of the consumer’s healthcare record.

When sending consumer information via SMS, only minimal detail should be included to prevent its unauthorised access.

Generally, if your organisation has a defined process for sending appointment details via SMS from a system that has been assessed as compliant with your organisation’s information security settings, it would be considered acceptable. It would not be considered acceptable if this was occurring from a personal mobile phone even if the details were generic.

The Privacy Manual for Health Information advises:

9.2.4.2 Use of Short Message Service (SMS)

SMS may be used for communication with patients for administrative purposes, for example, to confirm an appointment, to request that the patient contacts the health service, etc.

Where patients agree to being sent their test results by SMS, health services are increasingly using SMS as a standard practice of communication with patients, including, for example, Sexual Health Services.

Even where SMS communication is standard practice, patients should, if they request it, be given other options to receive information or results.

An electronic health system that includes SMS functionality for appointment confirmation or delivery of results will typically have been through a formal assessment process, such as eHealth’s Privacy and Security Framework (PSAF).

As with SMS, a minimal amount of personal health information should be included in emails to consumers.

Refer to your district for the approved local processes. Section 9.2.5.2 of the Privacy Manual for Health Information provides advice regarding emails to users outside the NSWHealthNet domain.

In general, NSW Health communication needs to be from an @health.nsw.gov.au email address.

Check if your district has a product in place that may be available to use for communicating with consumers.

If connecting to a carer who is located with the consumer, verbally confirm with the consumer that they are happy for them to be present for the consultation and check if anyone else may be present.

If a carer is joining from a separate location, connect to the consumer first and confirm they are happy for the carer to participate in the consultation. Once consent is provided, add the carer into the consultation.

Record in the consultation notes that the carer joined the consultation, and that verbal permission was provided for this.

The workflow to discuss this with the consumer first will vary depending on the platform being used. Your virtual care manager or lead can help with this.

Refer to local processes for directions about the recording of carer details and any issues relating to guardianship.

The quality of earbuds varies. Some provide high-quality sound and reduce or cancel out background noise, while other do not.

The device chosen should provide clear audio. If it does not, alternative options should be implemented. This may include postponing the consultation or transferring the care to in-person.

All districts will have a MOU/SLA or relevant contact template to use. Inclusion of virtual care as a model of delivery in the MOU/SLA should include an outline of how virtual care will be used to support the provision of care and compliment in-person services. Some additional requirements may include the clinical pathways including escalation, inclusion and exclusion criteria, technology to be used, process to report technology issues and training and education expectations of clinical staff.

Your virtual care manager or lead will be able will be able to provide advice on adjustments to support service implementation.

Credentialling and delineating clinical privileges are not normally required for advice between practitioners of different districts or cross-boundary services, where the advice does not involve the direct treatment of a consumer. For example, if a practitioner telephones a second practitioner from a cross-border service to seek advice regarding a consumer, the second practitioner is not generally required to be credentialled by the health organisation of the first practitioner. More information is available in the NSW Health Policy Credentialing & Delineating Clinical Privileges for Senior Medical Practitioners & Senior Dentists PD 2019_056.

Registration

The Health Practitioner Regulation National Law (National Law) for the registration of medical practitioners means that registered practitioners can now legally practice in all jurisdictions in Australia. Refer to the Medical Board of Australia website for more information.

The Medical Board of Australia expects that medical practitioners:

• providing medical services to consumers in Australia will be registered with the Board regardless of where the practitioner is located
• consider the appropriateness of a technology-based consultation for each consumer’s circumstances
• comply with the requirements of the National Law as in force in each state and territory and the Board’s registration standards, codes and guidelines, including the Professional Indemnity Insurance Registration Standard, which requires that a medical practitioner is covered for all aspects of their medical practice
• who conduct technology-based consultations with a consumer who is outside Australia establish whether they are required to be registered by the medical regulator in that jurisdiction (e.g. the General Medical Council for a consumer in the United Kingdom)
• ensure that their consumers are informed in relation to billing arrangements for consultations and whether the consumer will be able to access Medicare or private health insurance rebates.

Conduct (misconduct)

Conduct complaints and investigations are managed in the jurisdiction in which the conduct in question occurred. For example, a practitioner whose principal place of practice is in NSW who misconducts themselves when providing advice to a consumer while at a conference in Melbourne would have that matter dealt with in Victoria. Medical defence organisations may have views as to whether they would help a practitioner respond to a conduct issue in another jurisdiction.

Performance (impairment)

If a health practitioner has an incident being dealt with as a performance issue or a health issue, it would be managed in the jurisdiction of their principal place of practice.

Negligence claims

Consumers can commence claims in the jurisdiction where the incident occurred or where they reside. There needs to be a connection between the claim and where it is filed. This means that if advice is provided outside NSW, consumers may be able to choose which jurisdiction to bring their claim. Some jurisdictions can award higher amounts of compensation than others, and this would be a consideration. Generally, any claims against NSW Health professionals should be filed in NSW courts. This is so they can be managed by local lawyers according to NSW laws, thereby saving costs. The insurance cover for claims in other jurisdictions would need to be investigated/considered.

Insurance

The existing insurance arrangements for NSW Health staff are as follows:

• All employee doctors, including Level 1 Staff Specialists (including when treating private consumers), and Level 2–5 Staff Specialists are covered by the legal liability section of the Treasury Managed Fund Statement of Cover (version 4.1.1) (TMF) when treating public consumers.
• Relevantly, sub-clause 4.1(a) of the TMF provides that the TMF covers all sums which the TMF Agency becomes legally liable to pay by way of compensation and damages in respect of claims, caused by an occurrence, in connection with the activities of that agency worldwide and happening during the period of cover. Sub-clause 4.1(c) extends this cover to an employee of a TMF Agency, subject to the exclusions in clause 4.3.
• Where such an employee is delivering services within the scope of their employment, acts reasonably in the circumstances and makes full and frank disclosure of all relevant circumstances, they will likely be covered by the liability section of the TMF, subject to the exclusions in clause 4.3.
• For Level 2–5 Staff Specialists exercising rights of private practice and who have entered into a contract of liability coverage for indemnity under the TMF, there is indemnity in respect of services provided to private rural and/or paediatric consumers in or at public hospitals or as part of other services provided by the public health organisation.
• For visiting medical officers (VMOs), indemnity for particular services will depend on their specific contract of liability coverage. Note that the TMF will not cover any claim that does not fall within the terms of coverage set out in the contract of liability coverage between the LHD and the VMO.

Outside Australia

Technology is now more mobile than ever before and consumers are increasingly accessing services on their personal devices, meaning their location may not be known before they connect.

In general, there appears to be an unquantifiable legal risk in that a practitioner needs to ensure that providing services to a consumer located in another country does not breach any legal requirements of that country. However, the legislation varies globally. For example, a practitioner may need to comply with the registration requirements of the medical regulator of the jurisdiction in which the consumer is located before delivering medical services to the consumer. Issues of liability and choice of law/jurisdiction may also arise.

The legal risks with providing services overseas are impossible to quantify and so this is not recommended without a thorough review of such services and the incorporation of explicit advice about this in policy. This may include considering whether the virtual care is clinically necessary or whether there are alternative options, such as rescheduling the appointment or advising the consumer to seek the advice of a local practitioner at their overseas location. It would also be advisable to develop a protocol where a preamble is used when a consumer signs into a service. This should state that the advice is provided to the consumer on the understanding that they are in Australia and the consumer must let the practitioner know if this is not the case.

This is an employment/code of conduct issue that the district would need to manage with staff.

No. Clinicians have a duty of care to their consumers regardless of the care delivery modality. However, the precise nature of the duty owed to the consumer might vary depending on the circumstances and whether advice is provided by video. Clinicians must ensure that they ask the right questions and give the right, or at least reasonable, answers, and are mindful of any impact the technology is having on their ability to do this. There might be some increased risks, some decreased risks and some new risks, as with any new service method.

Services are funded in a variety of ways. The funding of the service is rarely impacted or different when providing care virtually. Your manager, virtual care manager or lead and finance team will be able to provide further advice.

Note that Medicare rules and regulations do change, and it is important to stay across these to where Medicare funding is accessed.

Privacy compliance responsibilities remain the same for both in-person and virtual consultations. Considerations in regard to the location of the participants, including the private provider must be taken into consideration. For example, an external provider may join the case conference from their practice and may not have the door closed or may join from another space where you can see people walking in the background. Where privacy is a concern, the case conference should stop to address the issue. Support can be provided to any provider as a priority to ensure privacy is maintained.

From a technology perspective, clinicians should use appropriate platforms, as outlined in the eHealth Videoconferencing Platforms Guideline (NSW Health network or VPN required).

It is generally unlawful under the Surveillance Devices Act 2007 (SDA) to use a device to record a private conversation to which a person is a party (see section 7 of the SDA). Under the SDA, it is unlawful to publish or communicate private conversations that have been unlawfully recorded or recorded in contravention of Part 2 of the SDA.

Consider reporting any instances via IMS+ (NSW Health network or VPN required) for local management.

There is currently no standard approach to referral management across the state. However, there is a new digital solution (known as Engage Outpatients) in progress to support the management of referrals between GPs and outpatient clinics.

It is more common for private specialists or general practice to provide consumers with ePrescriptions or eScripts. Unfortunately, NSW Health facilities do not have a state solution to digitally provide scripts.

If the consumer needs a referral or a prescription, it is best to write the referral or prescription and email/fax it to the consumer/provider or send it via post. If the referral/prescription is needed urgently, it can be emailed or faxed to the consumer or their local imaging/collection/pharmacy with the paper copy posted.

Alternatively, if the consumer is participating in a virtual consultation and their GP is present, the GP can write the referral or prescription.

No, being on the VPN does not make unsupported platforms secure/appropriate for the delivery of clinical care consultations.

See the eHealth Videoconferencing Platform Guideline (NSW Health network or VPN required) for what platforms can be used and example use cases.

Secure file transfer solutions are used in NSW Health. These solutions allow NSW Health employees to share files using secure protocols and encryption to safeguard data in transit. It is best to check with your local IT team regarding what secure file transfer solutions are available within your LHD/SHN. Your virtual care manager or lead or Privacy Contact Officer will be able to provide further information.

With the advancements in digital health, fax machines are on the decline. Regardless of the tool, privacy and security remain the highest priority and it is recommended to use a secure messaging platform. There are a number of tools provided to NSW Health staff to support internal and external communication of personal health information.

Staff should follow local protocols and the NSW Health Privacy Manual for Health Information, Section 9, when transmitting personal health information.