- On November 18, 2019
- November / December 2019
Digital Recall and Remote Clinical Appraisals
AMA (NSW) is looking for feedback from VMOs to find the best approach to addressing the non-payment for Digital Recall and Remote Clinical Appraisals.
To best inform AMA (NSW)’s approach to addressing the non-payment for Digital Recall and Remote Clinical Appraisals for VMOs, we welcome feedback from VMOs.
In a modern technology-driven environment, doctors must embrace and adapt to changes in service delivery in the same manner as other professionals. The replacement of pagers with mobile phones in the 1990s allowed for significant time improvements for on-call clinician responses. Not long after, broadband internet connectivity and remote logins allowed doctors to review images and scans from the comfort of their own home. At first this was restricted to personal computers and laptops, but now this is possible on tablets, mobile phones and even smart televisions. You may be surprised to hear that the smartphone in your reach has a million times more computing power than all of NASA when the Apollo 11 landed on the moon exactly 50 years ago.
When the provisions of the current VMO Determinations were drafted, it was not envisaged that such technology would be available to allow for what we may now call Digital Recall, ie. the remote review of medical images and scans while on call (or even when not rostered on call). However, we believe the definition of Services under the Determinations is broad enough to encompass digital recall.
Up until 1985, VMOs were not paid for the time spent attending to public patients in public hospitals. Looking back now, it does seem quite unfathomable that doctors would agree to such arrangements. Will we look back in another 35 years’ time and say the same thing about payment for Digital Recall?
This year, AMA Queensland and ASMOFQ negotiated a Digital Recall clause for Junior and Senior Medical Officers, which sees consultants paid at a minimum of 30 minutes work for each time they provide a service using digital resources. Digital Recall is defined in the Award as follows:
“… digital recall includes, but is not limited to, work that requires access, review and/or creation of a record containing a patient’s medical information, care or treatments received, test results, diagnoses, and/or medications taken and includes clinical decision documentation.”
The clause does, however, note that review of information that would reasonably be conveyed effectively verbally by phone is not considered to be Digital Recall. In contrast, the NSW JMO award does allow for payment to junior doctors for remote clinical appraisals. Unfortunately, the claiming process is burdensome, with doctors required to jump through nine different hoops before being paid (PD2014_002). AMA (NSW) was not involved in the negotiations, but is looking to improve the payment process.
We welcome feedback from VMOs working in a variety of specialties and geographic areas as to the remote duties that they currently undertake. What we are particularly interested in hearing from you is:
- What is the nature of the calls (and emails, texts etc.) you receive while on call?
- How often would the call necessitate you to return to the hospital as opposed to providing an appraisal remotely?
- What are the specific advances in technology that would have previously required you to attend the hospital?
Please contact me via email at Andrew.firstname.lastname@example.org or 02 9439 8822,
should you wish to provide input. It’s important that we hear from as many VMOs as possible.
Professional Indemnity Insurance for VMOs
With the advent of new quinquenniums for several Local Health Districts in 2019 we have received questions from VMOs regarding Contracts for Liability Coverage, otherwise known as Treasury Managed Fund (TMF) cover. While we cannot provide insurance advice, we can provide general information regarding TMF coverage.
VMOs have two or more options for TMF coverage depending on where they are based:
- Coverage for public patients only
- Coverage for public patients and private paediatric patients
- Coverage for public and private patients
Options 1 and 2 are available to all VMOs, but option 3 is generally only available to VMOs working outside of metropolitan areas.
Should you wish to utilise TMF cover for private paediatric or private adult patients, it is a requirement that the patient not be charged an out-of-pocket fee. Should you wish to charge an out-of-pocket fee, you will need to rely upon professional indemnity insurance cover from your MDO. All VMOs must have professional indemnity insurance as a condition of engagement with their LHD.
It is not correct to say that by accepting option 2 or 3 you are waiving your right to charge a gap to your private patients.
VMOs engaging through a practice company must also note that their contract requires the company to have public liability insurance*.
Please contact your Medical Defence Organisation or AMA (NSW) with any further questions.
Such insurance may also be useful for sole traders. You may wish to contact our preferred partners Specialist Wealth Group to discuss your public liability insurance needs.
Vale Justice James Macken AM
The Hon. James Macken AM was a Justice of the Industrial Court of NSW. He presided over proceedings between AMA (NSW) and NSW Health which ultimately led to the modern VMO Determinations.
Before his appointment to the NSW Industrial Commission, he had a successful career as a barrister and was a forceful advocate for the organisations whose brief he accepted. He was well known to the maritime industry through numerous industrial proceedings in NSW.
Justice Macken presided over a number of VMO arbitrations with his determinations often referenced in the NSW Court of Appeal and by the full bench of the Industrial Commission.
AMA’s former Medico-Legal and Strategic Policy Division Director, Mr Allen Thomas had a long history with Justice Macken and recalls attending his lectures on industrial and employment law for the Law Society of NSW.
“He was a fearless advocate before he went to the bench,” Mr Thomas says.
“One of the best there was.”
Justice Macken is remembered for a lifetime of achievements across a broad range of areas, including the formation of the Bush University in the Kimberley region. In addition, he became a volunteer ranger of the Ku-ring-gai Chase National Park and founded the Coasters Retreat Fire Service after the 1994 bushfires.
He passed on September 19 surrounded by family. He is survived by 11 children.