‘What we’re seeing is not telehealth’: alarm over doctors using AI and prescribing without seeing patients

Australia’s health regulator is fielding complaints about the use of artificial intelligence during telehealth prescribing, and patients being issued with prescriptions without ever speaking with a doctor.

A spokesperson for the Australian Health Practitioner Regulation Agency (Ahpra) told Guardian Australia the agency had received 550 notifications about telehealth consults and prescribing across health professions since July 2020. Of those, 30% related to complaints about a practitioner not adequately assessing a patient, they said.

In 45 cases, Ahpra identified poor telehealth prescribing practices, prompting the regulator to take action against practitioners.

“In some cases this has led to restrictions preventing practitioners from prescribing or conducting appointments via telehealth,” the spokesperson said.

Concerns raised with health regulators about telehealth included not having to consult or see a prescriber before a prescription was given; prescribing processes that felt managed by an algorithm, or artificial intelligence (AI) process; and medications costing more when dispensed on a prescription provided online or via telehealth.

Dr Elizabeth Deveny, the head of the Consumers Health Forum of Australia, called on the government to address “significant safety concerns” she had about such practices, saying a conversation between a doctor and a patient should occur, “particularly when they’re a new patient”.

“This loophole needs to be closed through better regulation … because there are significant safety concerns,” she said. “Particularly what happens if a person has a bad reaction to this new medication or product, or perhaps the health practitioner who’s doing the prescribing doesn’t have their full history and understand the other medications they’re taking.”

Deveny said she had heard of telehealth platforms prescribing products such as weight-loss drugs without live consults.

“This model of online, no-consumer-contact prescribing doesn’t meet a lot of the safety features we would normally see,” she said.

“Telehealth is a great model that helps consumers access a health practitioner using a phone or computer, allowing them to have important conversations in a way that better suits them. What we’re seeing [when live consultations do not occur] is not telehealth, and we think it has potential for significant harm.”

‘I do not provide tick-box prescribing’

Guardian Australia has previously reported being able to access a prescription for vapes from an online telehealth platform, despite having never been a patient of that GP and never having previously been prescribed vapes.

The prescription was sent via email almost immediately after a $40 fee was paid and an online questionnaire filled in, with no live phone or video consult required.

The doctor, Dr Carolyn Beaumont, states that her website, medicalnicotine.com.au, “utilises innovative proprietary AI to effectively achieve its aims”.

But Beaumont told Guardian Australia that AI was not used by the platform in prescription generation. She did not clarify how the platform used AI.

“Scripts are individually reviewed and actioned as appropriate,” she said.

She said her online questionnaire “covers all the requirements of taking a medical history and there is plenty of scope for ongoing follow-up as needed”.

Guidelines from Ahpra and the Medical Board of Australia, which came into effect in September 2023, state that “asynchronous, online tick-box prescribing without a real-time patient-doctor consultation is not good medical practice”.

But the guidelines do not explicitly ban the practice. “Real-time doctor-patient consultations remain key to safe prescribing,” the guidelines state.

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“I do not provide tick-box prescribing,” Beaumont said. “There is scope for individualised responses and follow-up is available, including in the form of longer-term telehealth that offers preventive care for smokers.”

Ahpra does not disclose the names of doctors who are the subject of complaints, and there is no suggestion that Beaumont is among them.

Beaumont has also commented about her method of prescribing without a live consult on an article about vaping on the Medical Republic website.

“It is worth addressing why I choose mostly written communication with my patients, rather than conventional phone or video consults,” she wrote.

“Firstly, timezones. I’m in Victoria, and many patients are from WA. There’s a 3 hour gap, so realistically I can’t make calls until midday. Consider also that as a whole, heavy smokers are more likely to work jobs such as construction, mining or hospitality. These jobs don’t lend themselves to taking time out for a phone consult.”

Deveny told Guardian Australia that in her view time zone differences did not justify a lack of a live consult via phone or video call.

“What happens if something goes wrong with the medication?” she said. “Is the timezone going to mean that they can’t be helped by that doctor? Who’s responsible for that person’s aftercare if the timing doesn’t work?” She said a live consultation also allowed for a more comprehensive medical history than a questionnaire.

Beaumont told Guardian Australia that ideally patients would have a regular GP, but that was rarely a reality for remote workers.

“I manage their aftercare in relation to my prescribing,” she said. “To circumvent timezone difficulties, written communication has proven the most effective modality.”

A spokesperson for the Medical Board of Australia said any practitioner who prescribed in a way not consistent with the board’s guidelines “must be able to explain how the prescribing and the management of the patient was appropriate and necessary in the circumstances”.

“Failure to do so may lead to action from the board,” the spokesperson said.

Beaumont said the Medical Board’s guidelines were “designed for optimal healthcare delivery which I fully support”.

The government is investigating the appropriate use of AI in the health system, including possible regulation.

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