Welcome to the Fear and Greed Daily Interview. I'm Sean Aylmer. The pandemic accelerated a lot of change in the way we do business, think remote and hybrid working, and the cashless economy. Prior to COVID-19, not many of us would've had a telehealth consult with a doctor. That certainly changed now. Australia's leading telehealth service provider is a company called Coviu, which was originally created within the CSIRO. To give you an idea of scale, in 2020 Coviu users in Australia offered more than 3 million healthcare video consultations. Dr. Silvia Pfeiffer is the CEO and founder of Coviu. Dr. Pfeiffer, welcome to Fear and Greed.

Welcome to the Fear and Greed Daily Interview. I'm Sean Aylmer. The pandemic accelerated a lot of change in the way we do business, think remote and hybrid working, and the cashless economy. Prior to COVID-19, not many of us would've had a telehealth consult with a doctor. That certainly changed now. Australia's leading telehealth service provider is a company called Coviu, which was originally created within the CSIRO. To give you an idea of scale, in 2020 Coviu users in Australia offered more than 3 million healthcare video consultations. Dr. Silvia Pfeiffer is the CEO and founder of Coviu. Dr. Pfeiffer, welcome to Fear and Greed.

Great to be here.

Great to be here.

So telehealth certainly predates the pandemic. Just give me the history of telehealth. We've heard a lot more about it since COVID, but why was it, I mean, just what's the background, and why did we come up with it originally?

So telehealth certainly predates the pandemic. Just give me the history of telehealth. We've heard a lot more about it since COVID, but why was it, I mean, just what's the background, and why did we come up with it originally?

Oh my gosh, how far back do you want to go?

Oh my gosh, how far back do you want to go?

Yeah, okay. Not too far.

Yeah, okay. Not too far.

It kind of already started with the beginnings of telecommunications because we had people living in Outback Australia for a very long time, and they would need telehealth, basically medical support at any one point in time. So over the years, we've come up with different ways of delivering telehealth, be that, to begin with even via faxes and things like that, via phone. Telehealth is everything that encapsulates delivering medical care over a distance.

It kind of already started with the beginnings of telecommunications because we had people living in Outback Australia for a very long time, and they would need telehealth, basically medical support at any one point in time. So over the years, we've come up with different ways of delivering telehealth, be that, to begin with even via faxes and things like that, via phone. Telehealth is everything that encapsulates delivering medical care over a distance.

COVID really accelerated the progression of telehealth. Prior to COVID though, where was telehealth at? Was there much use of video conferencing for health consults?

COVID really accelerated the progression of telehealth. Prior to COVID though, where was telehealth at? Was there much use of video conferencing for health consults?

Very good question. So telehealth before the pandemic was something that was mostly known to rural people and mostly happened either in the GP practice or maybe in a hospital. So hospital to hospital communication was often termed telehealth. Let's say it's a smaller rural hospital, which needed help from a specialist in a hospital in the city with a special procedure or something like that. Also, in mental health, we used it prior to COVID, it's a plan called Better Access that Medicare supported, and under Better Access, up to 10 mental health consultations were able to be delivered into rural and remote areas via telehealth. And the whole thing centered around the qualification of the different regions into different areas of remoteness. So all the reimbursements depended on where you lived. The pandemic has completely done away with it, and I'm really glad about that.

Very good question. So telehealth before the pandemic was something that was mostly known to rural people and mostly happened either in the GP practice or maybe in a hospital. So hospital to hospital communication was often termed telehealth. Let's say it's a smaller rural hospital, which needed help from a specialist in a hospital in the city with a special procedure or something like that. Also, in mental health, we used it prior to COVID, it's a plan called Better Access that Medicare supported, and under Better Access, up to 10 mental health consultations were able to be delivered into rural and remote areas via telehealth. And the whole thing centered around the qualification of the different regions into different areas of remoteness. So all the reimbursements depended on where you lived. The pandemic has completely done away with it, and I'm really glad about that.

Okay. So I mean, Coviu would have been an organization, which in a sense, I don't like to say benefited from it if ... Well, the services were needed during the pandemic. So how has it changed telehealth in Australia?

Okay. So I mean, Coviu would have been an organization, which in a sense, I don't like to say benefited from it if ... Well, the services were needed during the pandemic. So how has it changed telehealth in Australia?

Oh, very much, immensely. And it's all down to, well, Medicare reimbursements, but also awareness. Awareness of telehealth has increased thousand folds during the pandemic. Before the pandemic, you would talk to somebody on the street and they'd ask you what you're working on, what you're doing, and you say, " Oh, we build a telehealth platform." And they'd go, " What, you do what?" And now everybody knows what the word means. They've often already had a consultation via video, particularly during the pandemic. And it's just become something that's quite normal these days. About a quarter of all GP consultations are now done via telehealth, and that includes phone consultations. GPs do more phone consultations than video. And similarly, about a quarter of all Medicare- reimbursed mental health consultations are done via video. Now, in mental health, it's actually video because that's a preferred interaction. Clinicians learn more from patients when they're on a video.

Oh, very much, immensely. And it's all down to, well, Medicare reimbursements, but also awareness. Awareness of telehealth has increased thousand folds during the pandemic. Before the pandemic, you would talk to somebody on the street and they'd ask you what you're working on, what you're doing, and you say, " Oh, we build a telehealth platform." And they'd go, " What, you do what?" And now everybody knows what the word means. They've often already had a consultation via video, particularly during the pandemic. And it's just become something that's quite normal these days. About a quarter of all GP consultations are now done via telehealth, and that includes phone consultations. GPs do more phone consultations than video. And similarly, about a quarter of all Medicare- reimbursed mental health consultations are done via video. Now, in mental health, it's actually video because that's a preferred interaction. Clinicians learn more from patients when they're on a video.

Okay. So I kind of understand it, but there must be some limitations to telehealth.

Okay. So I kind of understand it, but there must be some limitations to telehealth.

Sure. And the biggest limitation is, of course, lack of touch. As a GP, when you have to examine a person physically, you can't easily do that via video. In some examinations, they found ways of doing it by guiding the patient to move their hand in certain areas themselves and then report on what they're feeling, you find ways of doing it. But the knowledge of a practitioner, also a specialist, is difficult to convey to somebody else's hands, be that a carer or the patient themselves. So that's obviously the limitation, but many other thing, and in fact, almost everything else can be done via video call.

Sure. And the biggest limitation is, of course, lack of touch. As a GP, when you have to examine a person physically, you can't easily do that via video. In some examinations, they found ways of doing it by guiding the patient to move their hand in certain areas themselves and then report on what they're feeling, you find ways of doing it. But the knowledge of a practitioner, also a specialist, is difficult to convey to somebody else's hands, be that a carer or the patient themselves. So that's obviously the limitation, but many other thing, and in fact, almost everything else can be done via video call.

Stay with me, Silvia. We'll be back in a minute. My guest this morning is Dr. Silvia Pfeiffer, CEO and founder of healthcare technology platform Coviu. So what's next? It's amazing how many people I know who have used telehealth, from my aged mother through to friends, and it's very convenient. And around mental health it's extremely useful in some cases, obviously. What's next?

Stay with me, Silvia. We'll be back in a minute. My guest this morning is Dr. Silvia Pfeiffer, CEO and founder of healthcare technology platform Coviu. So what's next? It's amazing how many people I know who have used telehealth, from my aged mother through to friends, and it's very convenient. And around mental health it's extremely useful in some cases, obviously. What's next?

Very good question. So we in Australia are moving quite slowly. So I'm going to bring in some knowledge that I have from trying to do telehealth in the US market, which is where we are expanding into as a company. I can see over there that there's reimbursement for remote patient monitoring, which means a patient will have a device in their homes and they use their mobile phone to self- monitor progress of diverse medical indicators. And there is a dashboard at the other end for the clinician to oversee all of the patients that are on this remote patient monitoring scheme. And the dashboard, so the technology indicates when a patient should be looked after. They're going well for a couple of days, and then suddenly there's like a red flag and they need a call from the clinician to check in what's going on. That kind of thing is called remote patient monitoring. There's a similar thing called remote therapeutic monitoring. Not really a term yet used in Australia, but very big in the US. Remote therapeutic monitoring is about patient self- measuring. And that's where you don't use a medical device to measure, but it's actually more about how are you feeling. It's more a questionnaire where the patient feels and how they're going, and it's mostly used in allied health areas, mental health, maybe dietetics. And in those areas you really want the patient to self- analyze how they're going. And if they're saying, " Oh, I feel really, really terrible today." And it comes up on a dashboard of a clinician, then a clinician or maybe a nurse can pick up the phone and actually talk to the patient about this as well and help them when they're needed rather than waiting for the patient to feel like they really have to go and see the practitioner.

Very good question. So we in Australia are moving quite slowly. So I'm going to bring in some knowledge that I have from trying to do telehealth in the US market, which is where we are expanding into as a company. I can see over there that there's reimbursement for remote patient monitoring, which means a patient will have a device in their homes and they use their mobile phone to self- monitor progress of diverse medical indicators. And there is a dashboard at the other end for the clinician to oversee all of the patients that are on this remote patient monitoring scheme. And the dashboard, so the technology indicates when a patient should be looked after. They're going well for a couple of days, and then suddenly there's like a red flag and they need a call from the clinician to check in what's going on. That kind of thing is called remote patient monitoring. There's a similar thing called remote therapeutic monitoring. Not really a term yet used in Australia, but very big in the US. Remote therapeutic monitoring is about patient self- measuring. And that's where you don't use a medical device to measure, but it's actually more about how are you feeling. It's more a questionnaire where the patient feels and how they're going, and it's mostly used in allied health areas, mental health, maybe dietetics. And in those areas you really want the patient to self- analyze how they're going. And if they're saying, " Oh, I feel really, really terrible today." And it comes up on a dashboard of a clinician, then a clinician or maybe a nurse can pick up the phone and actually talk to the patient about this as well and help them when they're needed rather than waiting for the patient to feel like they really have to go and see the practitioner.

Okay. Back to Coviu, the company. It's spun out of CSIRO originally. Is that right?

Okay. Back to Coviu, the company. It's spun out of CSIRO originally. Is that right?

Yeah, absolutely. So my background is as a PhD in computer science, and I worked at the CSIRO twice actually after coming to Australia. And the last time I started was in 2012 and we started working on a project around a new technology that would allow video conferencing on web browsers. And so we were looking to apply that in healthcare and to take telehealth to the next level. And not just make video conferencing something like what Zoom does, but really give clinicians an ability to create the best possible telehealth consultation with a patient via video. And so that's where it all started really taking telehealth to the next level by giving clinical tools, diagnostic tools, and therapeutic tools to the clinicians within the consultation to let them operate at the top of their license. And that's where it all originated. That started in 2012, by 2015, we had built a first application that we used with clinicians out of Royal Far West, incidentally, where we started. And in 2015, we incorporated Coviu as a company, still wholly owned by the CSIRO. And in 2018 we spun it out of the CSIRO as a standalone company with some investment from Main Sequence Ventures.

Yeah, absolutely. So my background is as a PhD in computer science, and I worked at the CSIRO twice actually after coming to Australia. And the last time I started was in 2012 and we started working on a project around a new technology that would allow video conferencing on web browsers. And so we were looking to apply that in healthcare and to take telehealth to the next level. And not just make video conferencing something like what Zoom does, but really give clinicians an ability to create the best possible telehealth consultation with a patient via video. And so that's where it all started really taking telehealth to the next level by giving clinical tools, diagnostic tools, and therapeutic tools to the clinicians within the consultation to let them operate at the top of their license. And that's where it all originated. That started in 2012, by 2015, we had built a first application that we used with clinicians out of Royal Far West, incidentally, where we started. And in 2015, we incorporated Coviu as a company, still wholly owned by the CSIRO. And in 2018 we spun it out of the CSIRO as a standalone company with some investment from Main Sequence Ventures.

Okay. Connectivity seems, I mean, I'm sure is at the heart of everything you do, but when we talk about where Coviu can work best and telehealth can work best, often it is in regional and rural and remote areas of Australia. Is that a major problem?

Okay. Connectivity seems, I mean, I'm sure is at the heart of everything you do, but when we talk about where Coviu can work best and telehealth can work best, often it is in regional and rural and remote areas of Australia. Is that a major problem?

Aah, very good question. Connectivity is obviously the basis of everything we do. We need to have an internet connection to be able to deliver video calls and now also phone calls. Incidentally, phone- only telehealth to our patients and to the clinicians to do with their patients. And connectivity in rural and remote areas has improved massively over the last 20 years. We used to basically just get satellite connections into those areas. Satellites are very high up and the delays that they introduce into a video call are often not sustainable, and you can't hold a normal conversation because of the delays. In more recent times, and that's all thanks to Elon Musk. He's actually brought a network to the world and also to remote Australia where you can sign up for a neural orbit satellite or a neural orbit connection, which is the mesh of satellites. And through that, you can actually get almost as good a connection as you can get in urban areas now. So I honestly think within the next five years we have the connectivity problem completely eliminated.

Aah, very good question. Connectivity is obviously the basis of everything we do. We need to have an internet connection to be able to deliver video calls and now also phone calls. Incidentally, phone- only telehealth to our patients and to the clinicians to do with their patients. And connectivity in rural and remote areas has improved massively over the last 20 years. We used to basically just get satellite connections into those areas. Satellites are very high up and the delays that they introduce into a video call are often not sustainable, and you can't hold a normal conversation because of the delays. In more recent times, and that's all thanks to Elon Musk. He's actually brought a network to the world and also to remote Australia where you can sign up for a neural orbit satellite or a neural orbit connection, which is the mesh of satellites. And through that, you can actually get almost as good a connection as you can get in urban areas now. So I honestly think within the next five years we have the connectivity problem completely eliminated.

Okay. And then a final question. Does government understand telehealth? Is it doing enough around telehealth? I would imagine at times there'd be interest groups who would not be fans of telehealth, but is policy right to promote telehealth?

Okay. And then a final question. Does government understand telehealth? Is it doing enough around telehealth? I would imagine at times there'd be interest groups who would not be fans of telehealth, but is policy right to promote telehealth?

That's a very complicated question. I am very grateful that the government has done what they did during the pandemic. And I think every person in Australia should be grateful that they brought in the telehealth and that they allowed us to get he healthcare without having to be in personal contact with people. But since then, some decisions were made that were actually backwards, that were taking us almost back to pre- pandemic stage. I want to point out one particular decision, it's the so- called patient support service. And the patient support service means that a patient can sit with a GP while they're meeting with their specialist in an urban area, it's particularly important for rural and remote areas where patients often don't have direct access to a specialist.

That's a very complicated question. I am very grateful that the government has done what they did during the pandemic. And I think every person in Australia should be grateful that they brought in the telehealth and that they allowed us to get he healthcare without having to be in personal contact with people. But since then, some decisions were made that were actually backwards, that were taking us almost back to pre- pandemic stage. I want to point out one particular decision, it's the so- called patient support service. And the patient support service means that a patient can sit with a GP while they're meeting with their specialist in an urban area, it's particularly important for rural and remote areas where patients often don't have direct access to a specialist.

Yeah.

Yeah.

And what's happening is that we continue to have reimbursement for these sessions, but not with the GP present. So now that the patient has to meet directly with the specialist, and then that means that the GP actually loses out on understanding what's happening to this patient. We're taking away the ability for group care, for having this interaction between the specialist and the GP, and getting a better quality of care for our patients. And I think that was a really poor decision that the government made, probably in an effort to unify things, thinking it wouldn't be necessary anymore because now patients can directly access the GPS and the specialists via telehealth. But we need to think more holistically. We still continue to have this thinking around, it's all about a patient and a clinician talking to each other. Well, it's not every patient has a whole care team that they're talking to, they're talking to a mental health provider, they're talking to a dietetics provider, a physical therapist, a specialist and you know what. There's a lot going into care, particularly people with chronic disease have a really large group of practitioners that they interact with. And if those practitioners don't know what each other is doing, that's where we see it all fall down. And so I think a couple of decisions have been made by the government that they really need to reconsider and maybe bring in different ways of doing it. But group care should be something that we support and not actively discourage.

And what's happening is that we continue to have reimbursement for these sessions, but not with the GP present. So now that the patient has to meet directly with the specialist, and then that means that the GP actually loses out on understanding what's happening to this patient. We're taking away the ability for group care, for having this interaction between the specialist and the GP, and getting a better quality of care for our patients. And I think that was a really poor decision that the government made, probably in an effort to unify things, thinking it wouldn't be necessary anymore because now patients can directly access the GPS and the specialists via telehealth. But we need to think more holistically. We still continue to have this thinking around, it's all about a patient and a clinician talking to each other. Well, it's not every patient has a whole care team that they're talking to, they're talking to a mental health provider, they're talking to a dietetics provider, a physical therapist, a specialist and you know what. There's a lot going into care, particularly people with chronic disease have a really large group of practitioners that they interact with. And if those practitioners don't know what each other is doing, that's where we see it all fall down. And so I think a couple of decisions have been made by the government that they really need to reconsider and maybe bring in different ways of doing it. But group care should be something that we support and not actively discourage.

Silvia, listening to you, I'm all for group care. I've just decided I'm on board. Thank you very much for talking to Fear and Greed.

Silvia, listening to you, I'm all for group care. I've just decided I'm on board. Thank you very much for talking to Fear and Greed.

Pleasure to be here. Thanks for having me.

Pleasure to be here. Thanks for having me.

That was Dr. Silvia Pfeiffer, CEO and founder of Coviu. This is The Fear and Greed Daily Interview. Join us every morning for the full episode of Fear and Greed, Australia's most popular business podcast. I'm Sean Aylmer. Enjoy your day.

That was Dr. Silvia Pfeiffer, CEO and founder of Coviu. This is The Fear and Greed Daily Interview. Join us every morning for the full episode of Fear and Greed, Australia's most popular business podcast. I'm Sean Aylmer. Enjoy your day.