New Australian research supports telehealth IMEs

  • MedHealth Chief Medical Officer, Professor Peter Steadman, is the lead author on this timely review paper published by the ANZ Journal of Surgery, 2021
  • Telehealth saw ‘ten years of progress in ten weeks’ during height of COVID-19 pandemic in 2020
  • Virtual Independent Medical Examinations (vIME) found to be suitable for permanent impairment examinations, involving the measurement of range of motion, for the majority of cases where examiner is assisted by a trained allied health practitioner

A newly published research paper in the ANZ Journal of Surgery has found that the ‘virtual IME’ (or vIME) setting is appropriate for the majority of permanent impairment assessments when the examiner is assisted by a musculoskeletal trained allied health practitioner at the ‘patient end’.

Struck by the speed of innovation during the onset of the COVID-19 pandemic, MedHealth’s Chief Medical Officer and lead author Professor Peter Steadman pulled together experts across the medical, allied health and legal fields to review the available literature and examine the potential for vIME through an evidence-based lens.

“The speed of adoption and innovation around telehealth as the COVID-19 pandemic hit was extraordinary. Telehealth saw ten years of progress in ten weeks,” he said.

Professor Steadman wanted to explore the evidence around the validity and accuracy of new technology (i.e. apps) versus visual estimation as used by skilled surgeons to measure range of motion in the telehealth setting.

Assessment types that were considered only possible through face-to-face examination quickly evolved to online delivery or a hybrid delivery, with the specialist able to assess a patient or client from anywhere via technology and a trained allied health professional able to support with measurements for range of motion.

“Telehealth has long been effectively used for psychiatric and psychological assessments, so we knew the virtual link between doctor and client was possible. The missing piece of the puzzle was how to deliver telehealth assessments of a physical injury effectively, and whether the surgeon’s expertise around range of motion could be well replicated in a virtual setting,” he said.

Over the course of 2020, MedHealth delivered more than 8,000 vIMEs using this hybrid approach, pioneering the inclusion of allied health professionals in this type of assessment.

“Through both practice – and now this research – MedHealth has established that virtual IMEs are a very effective tool for instances where a face-to-face appointment with the specialist is not possible,” Professor Steadman added.

“We now have this useful delivery method available for any reason that doctor and client cannot be in the same room. It’s particularly useful for people who live in regional and remote areas, who will now not necessarily have to travel for an independent medical examination; and equally appropriate for people who have injuries or illnesses, or any circumstance including risk of infection, that does not allow them easy access to the doctor’s rooms.”

Professor Ian Freckelton QC emphasised the fact that provided vIMEs are conducted rigorously, and suitably documented, there is no reason why their results should not be admitted into evidence by courts and tribunals.

“They have the potential to be a convenient and reliable component of expert opinion evidence,” he said.

CEO of MedHealth Tim Morphy said the company was keen to contribute to the body of knowledge on telehealth by publishing the research in the ANZ Journal of Surgery.

“MedHealth is a family of businesses, bringing together both medical specialists and allied health professionals. We were in the unique position of being able to bring the two sets of professional expertise together to continue to provide high quality services to our customers throughout lockdowns around Australia. Thus, the assisted or hybrid vIME was born.”

“This research allows us to share what we learnt in this time; and explore all the practical applications of this alternative delivery method – pandemic or not. Telehealth makes IMEs for physical impairment more accessible, able to be conducted faster and for more people; thereby providing clarity on the best way forward for a person who is injured,” he said.

MedHealth will continue development work on more detailed guidelines and protocols to maximise the efficiency and consistency of this flexible and innovative method of delivery.

The full name of the paper is ‘Considerations surrounding remote medicolegal assessments: a systematic search and narrative synthesis of the range of motion literature’. Its authors are:

• Peter Steadman FAOrthA, FRACS (Orth)
• Dianne Sheppard PhD, BSc (Hons)
• Janette Henderson RN, MBA
• Brett Halliday FAOrthA, FRACS (Orth)
• Ian Freckelton QC, PhD (Griff), LLD (Melb)

Professor Peter Steadman, Dianne Sheppard, Janette Henderson and Brett Halliday are all MedHealth team members.

[1] Steadman P, Sheppard D, Henderson J, Halliday B & Freckelton I. (2021). Considerations surrounding remote medicolegal assessments: a systematic search and narrative synthesis of the range of motion literature. ANZ Journal of Surgery. Online first from 23rd April 2021.

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