Frequently asked questions about video consultations

Telehealth

'Telehealth' is healthcare provided to a patient from a distance. It's anything that does not involve a health practitioner attending the patient in-person. An in-person consultation is when the doctor and the patient are in the same room for the consultation.

The following are some ways of providing 'telehealth':

• Telephone consultations

• Video consultations

• SMS

• Instant messaging

• Consultations by secure email

Video consultations

We will be using a video conferencing program called ‘Health Direct Video Call’, or ‘Video Call’ for short. This has been developed for telehealth consultations by an Australian company (COVIU) with Commonwealth government funding.

‘Video Call’ telehealth consultations are encrypted and secure using these technologies: 'Web real time communication, browser-to-browser connection, and end-to-end encryption'. ‘Video Call’ is compliant with the Australian Privacy Principles.

'Video Call' enables you and me to see and hear one another in 'real time'.

Video call also enables us to share relevant photos, PDFs, other files, and text messages. This is secure. The photos, PDFs, other files, and text messages can be downloaded (e.g. to your clinical record), but they are deleted from 'Video Call' at the end of the consultation. 'Video Call' does not store photos, PDFs, other files, or text messages which have been shared.

‘Video Call’ does not store any personal information or any consultations. This ensures your privacy.

No data related to you, your attendance, or the consultation are stored on servers or 'in the cloud'. Once the 'Video Call' is ended those data disappear - as if the call had never occurred.

Click here for a detailed description of ‘Video Call’’s privacy and security features.

WITH 'VIDEO CALL', you don't need to...

• Download any programs or apps

• Set up an account or sign in

• Pay anything (but there may be a fee for the consultation)

WHEN YOU ATTEND A 'VIDEO CALL' YOU CONSENT TO:

o Participating in a telehealth video consultation

o Bulk-billing for payment for the consultation (no out of pocket cost), or

o Payment of the fee for the consultation

Currently, Dr Baird's video consultations are on Wednesday afternoons and Friday afternoons. Information about availability is on the Clinic's website.

ACTION REQUIRED

You will get a text message when your consultation is ready to start.

When you get the the text message, please click 'Video Call Setup' to get to the online waiting room (or 'call queue') for your 'Video Call' video consultation.

Once you have entered the online waiting room (or 'call queue'), you will be connected to the virtual (online) consulting room. The consulting room is private: The only person in the consulting room is Dr Baird; the room is soundproof; there are no cameras in the room, except for the webcam for the video call.

If there will be any delay after you have entered the waiting room (or 'call queue'), Dr Baird will send a notification to you in the waiting room. This will let you know the reason for the delay, and the expected duration of the delay. You can go away from your computer or use your computer for other activities during the delay. Once you have received the text message to go to the online waiting room, Dr Baird tries to avoid waiting room delays, and to keep any delays as short as possible.

DETAILED INFORMATION

(SEE ALSO: 'HOW TO ATTEND A 'VIDEO CALL' VIDEO CONSULTATION')

• Book an appointment online, by phone (9525 5200), or in person at the St Kilda Medical Group, for a video consultation ('standard' - up to 15 minutes; 'long' - up to 30 minutes)

• Check that you have the latest versions of the relevant web browser:

1. Chrome (PC (desktop, laptop, or tablet), Mac*, Android) - Firefox, or Microsoft Edge will also work - or

2. Safari 12+ (Mac*, iOS (iPhone, iPad), iPadOS)

3. * You can use Chrome or Safari with a Mac

• Check that your camera (webcam) and your microphone are ‘unblocked’

• For your privacy, sit somewhere where you can be alone (or with your child/children, or other relative, if relevant), and where you won't be disturbed

• Preferably, your background should be plain (eg a white wall); there should be no lights or windows behind you (these will make you appear dark in the video); if the room is dark, switch on an overhead light

• Put your computer, laptop, tablet, or phone on a table or desk, so that the video doesn't move around

• If using a tablet or a phone, put the device in a horizontal position so that the video is 'landscape'

• (Optional) Click here to run a 'Precall Test'. This will check and verify that your device, settings, and network connectivity are okay for a video consultation. Close the 'Precall Test' window after running the 'Precall Test'.

• You will get a text message if your consultation will be delayed by more than ten minutes after the scheduled appointment time.

• You will get a text message when your consultation is ready to start.

• When you get the the text message informing you that your consultation is ready to start, please click 'Video Call Setup' to get to the online waiting room (or 'call queue') for your 'Video Call' video consultation.

• Click on the ‘allow camera’ button and on the 'allow microphone' button (if displayed)

• Click ‘Start a Video Call’

• Enter your name, phone number, and date of birth where indicated

• Tick to accept ‘Terms of Use’, ‘Privacy Policy’, and ‘Cookies’

• Click ‘Continue’ to enter the 'virtual waiting room' (the 'call queue'); if you decide that you don't want to have the consultation, click 'Leave the waiting room queue' at the bottom of the page

• Cameras and microphones do not operate in the virtual waiting room. Your name will be entered in the waiting room (or 'call queue'). Other patients in the virtual waiting room cannot see your name, phone number, date of birth, or video image, and you cannot see their personal details or video image. If you go to the virtual waiting room, and you don’t have an appointment, or your appointment is at another time, you will be sent a message, and your name will be deleted from the waiting room.

• You can change the waiting room music (volume, style); you can stop the music (press the pause (||) button)

• Dr Baird will connect you to the 'virtual consulting room' when ready for the consultation

• If you have been waiting in the waiting room for five minutes or more, then this means that Dr Baird has been delayed due to previous consultations that have run over their allotted time, or due to other unscheduled issues. In this case, there's no need to wait in front of the screen. Leave yourself in the waiting room. You can use other programs on your computer, or you can move away from the computer. Dr Baird will send you a text message when he has transferred your status from the waiting room to the 'virtual consulting room'.

• If the start of your consultation is likely to be delayed by more than 10 minutes, you will be informed of this by text message as soon as it's known that there is likely to be a delay.

• The virtual consulting room is private, secure, and soundproof. Only you and I can see and hear one another in the consultation.

• At the end of the consultation, the consultation is deleted from the Video Call system. Neither the consultation nor your personal details are stored on any server or in any file. No record is kept of any files, images or text messages that were shared between you and me during the consultation. However, if appropriate, and with consent, files, images, or text messages can be securely downloaded to your clinical record or to your computer or device.

• I will enter notes for the consultation in your medical record during and after the consultation

• Please inform me if you are going to record the consultation. Legally, you can record the consultation, but the recording must be for personal use only. Legally, you cannot show or play the recording to anyone else, and you cannot send it by email, or upload it to websites or social media. (Please note that the legislation for recording consultations is complex, and that it is different for different States and Territories).

• The video consultation will start; you and I will see and hear one another in 'real time'

• I have two screens: One displays the 'video stream' (you), the other displays your clinical record, a browser, and clinical resources. During the consultation, you may see me looking from one screen to the other, or looking down to read or to write notes

• Relevant photos, PDFs, and other files can be shared securely in the video consultation; photos, PDFs, and other files 'disappear' when the call is finished - they are NOT saved on a server or 'in the cloud'. There is also an option for you to send me text messages, and for me to send you text messages (this is secure, and the text 'vanishes' when the call is finished. If you wish to keep the text messages, please copy and paste the text messages into a document before the call ends)

INFORMATION LEAFLET: 'How to use 'Video Call''

VIDEO (optional): 'How to use 'Video Call''

TROUBLESHOOTING GUIDE FOR 'Video Call'

Pre-consultation check. I will:

• Confirm your identity (name, date of birth, Medicare number, phone number)

• Check that you have your phone with you (if you're not using it for the video consultation). If the video call fails, I will phone you, and we will continue the consultation by phone

• Ask you to tell me your location (this is necessary, in the unlikely event that the emergency services need to be called in relation to the consultation)

• Check that you (or the patient, if you are not the patient) do not have symptoms that require urgent medical attention (one or more of: severe pain, feeling out of breath, feeling faint, feeling drowsy, serious injury)

• Confirm that you are alone, and that you are in a quiet, private room (you will need to tell me if anyone else is present, and they must be within view of the camera throughout the consultation)

• Obtain your consent for a consultation by video (accepting that there are limitations to a video consultation as there can be no direct physical examination)

• Obtain your consent for the fee (if any) for the consultation

• Ask you if you have any symptoms of COVID-19 (one or more of: fever, chills, cough, breathlessness, sore throat, runny nose, loss or change of sense of smell), or if you have had contact with someone who has COVID-19. If you have symptoms of COVID-19, or you have had contact with someone with COVID-19, then the consultation will be about assessing the severity of your respiratory illness (if any) and referring you to a COVID-19 Screening Clinic/Coronavirus Assessment Centre, or to hospital.

During the consultation, I will:

• Check if the reason or reasons for the consultation are not appropriate for a video consultation, in which case, I will ask you to arrange an in-person consultation, or to go to hospital, as appropriate.

• The time required to address the reasons for your consultation may exceed the time booked for the consultation. In this situation, you may be asked to book another appointment to address the reasons that cannot be not covered in the consultation.

• Refer to your medical record which is displayed on a separate screen next to my video screen and webcam

• Ask to do an 'indirect physical examination' as appropriate, to check, for example, your colour, your breathing rate, any rashes or skin spots, etc. If you have the relevant equipment, I may ask you to check your temperature, your pulse, and your blood pressure. I may ask you to show me any areas of concern, eg, areas that are painful, swollen, or red. I may ask you to do movements of your joints or your limbs to check for symptoms and function. I may ask you to send images or sound files that are relevant to your symptoms (these can be sent securely in the video consultation)

• Ask questions about 'red flag' symptoms which may indicate serious disease

• Discuss with you a management plan, including 'safety nets' for actions to take in the event that symptoms get more severe, or new symptoms develop

At the end of the consultation, I will:

• Check if there's anything else you would like to discuss (it may be necessary to arrange another consultation to address this)

• Discuss with you a 'follow up' plan for review of your symptoms, and/or for management of any ongoing disease, and/or for preventive activities. The 'follow up' plan may involve making an appointment to see another GP for assessment and physical examination. It is essential that you follow this advice.

• Discuss the arrangements for payment of the fee (or for bulk billing). After the consultation, please phone St Kilda Medical Group (9525 5200), to make payment (by credit card via phone), or to confirm bulk billing (for patients who are eligible for bulk billing)

Please refer to Fees for information about fees and about bulk-billing

• Please refer to the 'Quick Start' page for step-by-step instructions

Any questions or any problems?

If there are any problems with setting up or using the video call, please phone St Kilda Medical Group (9525 5200)

• A PC, desktop, laptop, tablet, Mac, or Smartphone (iPhone or Android) with camera (webcam), microphone, and speaker, or with camera (webcam) and headset. The microphone and speaker may be 'built in' (eg laptop, tablet, smartphone), or you may use an external microphone and/or an external speaker. A headset may be 'speaker only' or it may have speaker and microphone function.

• Camera and microphone need to be ‘unblocked’ so that ‘Video Call’ can use them. If your camera and/or microphone are 'blocked', this can be changed in ‘Settings’. In Chrome, you do this as follows:

• Settings (click on three vertical dots at top right of screen) >> Privacy and Security >> Site Settings >> Camera/Microphone (unblock)

• Up to date version of a web browser: Chrome (PC, Mac, desktop, laptop, tablet, Android) or Safari (iPad, iPhone, Mac). You can use Chrome or Safari with a Mac.

• A quiet, private room where you will not be interrupted. If there is another person in the room (eg support person, relative, child) then that person must be in view of your camera at all times

• The room should be well lit, preferably with overhead lighting. If possible, avoid lighting from behind you, as this will darken the video image

• It can be helpful to have some items and equipment available for the 'Video Call' consultation. Please look at the last question in the FAQs

Our video consultations are secure, encrypted, and private.

Some video consultations will be bulk-billed, which means that they are free, with no out-of-pocket cost.

Mental health consultations, mental health treatment plans, mental health treatment plan reviews, and consultations for focussed psychological strategies will be bulk-billed.

However, some patients will pay a fee.

The fee for a standard video consultation is $--.

The fee for a long video consultation is $--.

The Medicare rebates are $39.10 and $75.75 respectively.

Payment is by credit card by phone. When your consultation has finished, please phone the Receptionist at St Kilda Medical Group (9525 5200), to make payment, or to confirm bulk-billing as appropriate.

Standard video consultations run for up to 15 minutes; long video consultations run for up to 30 minutes. You can select 'standard' or 'long' when you make your appointment.

Extended video consultations run for more than 30 minutes, and they are appropriate for problems that are one or more of: multiple, complex, and emergencies. A standard or long consultation will be converted to an extended video consultation by your doctor, if necessary. You can book an extended video consultation by phoning Elwood Family Clinic, ((03) 9531 6766). Fees for extended video consultations are available from the Receptionist.

Do not arrange a video consultation for any of the following problems:

· chest pain,

· severe breathlessness (unable to talk normally),

. unconsciousness or reduced consciousness,

. drowsiness,

· feeling faint,

· injuries or poisoning,

· bleeding,

· drowsiness,

· seizure,

· weakness of the face or of one or more limbs,

· altered speech,

· or a sick infant or child (floppy (infant), limp (child), lethargic, drowsy, skin is pale and/or blue, hands and/or feet are cold to touch, purple rash, working hard to breathe, vomiting, fever (over 38C), inconsolable).

In any of the above situations, call 000 for an ambulance.

Do not arrange a video consultation for any of the following problems:

POSSIBLE COVID-19

If you have the symptoms or a respiratory infection (one or more of: cough, sore throat, breathlessness, runny nose, sneezing, loss of sense of smell, pains in muscles and joints), and/or a fever (38C or above), please do not arrange a video consultation, and please do not attend the Clinic.

These symptoms may indicate COVID-19.

Please phone the National Coronavirus Helpline, 1800 020 080, or the Victorian Coronavirus Hotline, 1800 675 398, for advice on action required (which may include: go to a COVID-19 Screening Clinic; go to a GP Clinic that carries out testing; go to a GP Respiratory Clinic; go to hospital; call 000). Both Coronavirus numbers are 24/7.

You can phone the St Kilda Medical Group if you have any of these symptoms. You will be asked questions and advised appropriately as above.

Patients who have respiratory may be seen at St Kilda Medical Group after discussion with a GP. Infection control precautions including full personal protective equipment for the GP and staff are required. Patients who have respiratory symptoms can have a telehealth consultation (by video or by phone). Telehealth consultations are also available for patients who are in quarantine, and patients who have mild COVID-19 who are in isolation. Patients who have COVID-19 are managed in conjunction with Alfred Health.

HEALTH ISSUES THAT REQUIRE PHYSICAL EXAMINATION AND/OR PHYSICAL TREATMENT, WILL REQUIRE AN IN-PERSON CONSULTATION, FOR EXAMPLE:

• Any health issue that requires minor surgery (eg excision of skin spots, or 'cryotherapy' (freezing treatment, eg, for warts)

• Vaccination

• Wound management (including removal of stitches)

• Eye or vision symptoms

• Ear symptoms

• Medical examination for insurance, employment, etc

Here are some examples of appropriate reasons for a telehealth video consultation (this list is not exclusive):

• Minor illness

• Review of chronic disease (eg diabetes, asthma, high blood pressure)

• Review of medications

• Developing management plans

• Mental health, including treatment plans

• Discussion about results and reports

• · Repeat prescriptions

• · Lifestyle advice

• · Travel advice

All of my consultations are telehealth ‘Video Calls’.

If you are unsure if your health issue is appropriate for a video consultation, please phone the receptionist at St Kilda Medical Group (9525 5200).

Prescriptions

Prescriptions will be sent to your phone or your email address as an ePrescription (also known as an 'electronic prescription'). An ePrescription is an online link to a 'QR Code', which is the 'token' for your prescription. You can print the token if you wish, but it's much easier just to use it on your phone. Your pharmacist scans the token from your phone (or from a printed copy of the token). This enables the pharmacist to download your prescription details from a secure portal. The pharmacist can then dispense the prescription. The pharmacist will send you another QR Code for any repeats that have been authorised. Alternatively, you can forward the online link to the QR Code to your pharmacist by email. Sounds complicated ... but works very well. With ePrescriptions, there are no paper copies of prescriptions. One limitation of ePrescriptions is that it's 'one item per QR Code', so if you need several items, you will be sent several QR Codes (the QR codes display the name of the medication). This will be changed in future, so that multiple medications can be prescribed with one QR Code.

There is detailed information on ePrescriptions on the Australian Digital Health Agency website here.

Consultations for repeat prescriptions are not just about issuing the prescription. The consultations are an opportunity to review symptoms, appropriate use of medication, and any preventive activities that may be due.

Referrals and requests for investigations

Wherever possible, referrals will be sent to specialists and allied health professionals by secure electronic transmission.

Requests for diagnostic imaging tests and pathology tests will be sent to you through the Video Call as PDF documents. As such, they are encrypted, secure, and private. They disappear when the they are deleted from the Call, or when the Call ends. Referrals, or copies of referrals, can also be sent to you this way. Eventually, pathology services and imaging services will develop secure portals so that requests can be sent to the relevant service directly.

Requests and referrals will only be sent by fax or email with your consent.

By agreeing to a request or a referral being sent by fax or email, you are consenting to this.

No equipment is essential.

It's helpful to have a pen and paper to jot down notes if necessary.

If you're taking multiple medications (eg three different medications or more), it's helpful to have your medications (in their packs or containers) and to have your prescriptions, so that these can be checked if necessary

A basic examination (no equipment required)

A basic physical examination is possible by general observation via video - for example:

• general appearance,

• colour,

• movements/abnormal movements (eg tremor) (if any),

• spots and rashes (either by video directly, or by sending a photo),

• breathing rate.

It is also possible to do some examination of the 'musculoskeletal' system and the nervous system by asking you to do certain actions, and observing you while you do this. (The 'musculoskeletal' system is your joints, muscles, ligaments, and tendons).

Some patients know how to check their pulse. For those patients who do not know how to check their pulse, I can demonstrate how to do this, and patients can then attempt to check their pulse. However, a patient's pulse check may be incorrect, so I would be cautious in interpreting this.

Equipment that's helpful, but not essential

It's helpful, but not essential, if you have:

• a thermometer to check your temperature, or to check your child's temperature. 'Ear' thermometers are easy to use, and they are accurate.

• a tape measure.

• scales (to check your weight)

• a torch (to illuminate areas for examination, for example, throat, spots on skin)

• a high-resolution camera with macro function (for close-up photos of skin spots)

• a 'blood pressure monitor' to check your blood pressure. These can be purchased from pharmacies. The blood pressure cuff should measure the blood pressure at the upper arm, not at the wrist. There are several brands available. All are reputable, with accurate monitors. They cost around $150. A popular brand is 'Omron'.

Recommended equipment for patients with diabetes

Patients who have diabetes should have a blood glucose monitor with test strips. It's not necessary for patients who do not have diabetes to have a blood glucose monitor. If it was necessary to check the blood glucose level for a patient who does not have a blood glucose monitor, the patient would be asked to attend St Kilda Medical Group (or a hospital, or a pharmacy).

Recommended equipment for patients with respiratory disorders

Patients who have respiratory disorders (eg asthma, chronic obstructive pulmonary disease) should consider getting a 'pulse oximeter'. This device gives an indication of the oxygen level in the bloodstream. Pulse oximeters can be purchased from pharmacies. They cost about $100.

Recommended equipment for patients with heart disease and/or high blood pressure

Patients who have heart disease (eg coronary artery disease, angina, previous heart attack, heart failure), and patients who have hypertension (high blood pressure) should certainly consider getting a blood pressure monitor (see above) for home monitoring of blood pressure, and for use in video consultations.

Smartwatches

Some smartwatches, and other 'wearables' have multiple functions for physical measurements, for example, temperature, pulse rate, pulse rhythm, breathing rate, and oxygen level ('oximetry'). This information is helpful in clinical assessment. However, their accuracy is not known, so one should be cautious about interpreting the data.

Legally, you can record the consultation, even without my consent, provided that the recording is for your personal use only. This means you can play back the recording for yourself only. It is illegal to play back the recording to anyone else. It is illegal to send the recording by email, or to upload it to websites or social media.

If you wish to play back the recording to someone else, or to send it by email to someone, or to upload it to websites or social media, you need my written consent for this. I will need to know the purpose for which you intend to use the recording, and any consent may include limitations on its use. If the recording is shown to others (with my consent), it must be the original - it must not be altered in any way.

You can make an audio-recording, or a video-recording.

The quality of recording WebRTC video streams is poor using any of the standard web or browser based recording functions.

Please note that although you can record the consultation without consent, I request that you inform me if you will record the consultation. This needs to be documented in your medical record.

The consultation is always regarded as a private conversation.

Please note that the legislation for recording consultations is complex, and that it differs between States and Territories.

Advantages

Convenience:

o no need to travel to St Kilda Medical Group

• no need to find a parking space

• no parking fees or parking fines

o no need to arrange transport (eg private car, taxi)

o no need to arrange assistance for those who need help to get to the Clinic (eg relative or friend)

o less of a problem to get medical care for those who have difficulty with mobility

o timesaving and cost-saving (no need to travel, park car, etc)

o can attend the video consultation from anywhere (home, overseas, etc)

· Social distancing is observed as you can stay at home for the consultation

· No risk of transmitting infection to others (public transport, patients in waiting room, receptionists, GPs) and no risk of getting infection from someone.

. Not necessary for you or me to wear a face mask. We can see each other's facial expressions. Communication between two people is better with unmasked faces than with masked faces. Lip-reading is possible.

. Compared to a phone consultation, a video consultation is better for rapport, assessment, care, and management

· You and I can see one another (compared with a phone consultation)

· I can examine you by observation (eg appearance, breathing rate, movements, spots and rashes)

· You can provide self-measurements (eg temperature, blood pressure, blood glucose, data from smartphone apps) and photos

. Relevant photos, PDFs, and other files can be shared securely between doctor and patient

· A support person (friend, relative) can be present in the video consultation, either with you in your room, or somewhere else

. A video consultation can be a 'virtual home visit'. In the background, I will be able to see part of the room that you're in for the video consultation. If appropriate, and only with your consent, you may conduct a 'virtual tour' of your house with your device so that I can see areas of your home environment that may be affecting your health. For example, stairs, steps, and other hazards. This is particularly relevant for older people and for people who have problems with mobility or balance. Older people, and people with mobility or balance problems must conduct any such 'virtual tour' with a young person who is fit and healthy (to avoid the risk of falls).

. I use 'Video Call' for video consultations. This is not 'bandwidth hungry or data hungry'. 'Video Call' works well with upload and download speeds of at least 350Kbps. Data usage for a 30 minute video call is about 450MB.

· Video consultations are suitable for patients of all ages. If the patient is a child, a parent must be present with the child (except if the child is deemed to be a ‘mature minor’).

. So, video consultations are suitable for ALL patients in general practice, with the limited exceptions as described in disadvantages and in arrange a video consultation . Video consultations may be particularly suitable for people who have difficulty getting to the Clinic for an in-person consultation (for example, elderly people, people who have work commitments, people who are at their workplace, people who are travelling, and people who are immunosuppressed (to avoid the risk of getting infection from other patients at the Clinic)).

Disadvantages

. You and/or I may have difficulty with the technology for a video consultation

· Direct physical examination* is not possible

· Physical treatment is not possible (eg vaccination)

· Not appropriate for serious illness

. Early follow-up and review may be necessary to monitor symptoms, due to the potential limitations of not having a direct physical examination* (for example, on the same day, on the next day)

· A follow-up face-to-face consultation with another GP may be required for physical examination or physical treatment (for example, immediately, later on the same day, on the next day)

· There is a fee for a video consultation for some patients

*Direct physical examination is any physical examination by a doctor that involves physical contact with a patient.

For example: Using the stethoscope to listen to the heart or the chest; pressing with the hand on the abdomen to check for lumps, swellings, and tenderness; using the tendon hammer to test knee reflexes; moving joints to check for movement and tenderness; or using a special light to examine the ears or the eyes.

Indirect physical examination is any physical examination by a doctor that can be done remotely by observation (by video consultation).

For example: General condition, colour, rashes, skin spots, mental state, speech, limb movement, and breathing rate.

It is possible to teach a patient how to check their pulse, and how to check for abdominal tenderness.

If the patient has appropriate equipment, temperature, blood pressure, oxygen level, and blood sugar level can be checked.

Some aspects of neurological and locomotor examination can be done indirectly (that is, examination of the nervous system and examination of joints and muscles). The doctor can ask the patient to move their limbs, their facial muscles, and their joints, and the doctor can observe this.