What gets funded gets counted, what gets counted gets improved
It’s nearing the end of your shift in a regional emergency department. You get your third call of the day from a telehealth provider, letting you know they’re sending in a patient. You pause and reflect: before COVID, giving advice on a patient you couldn’t physically examine was considered inappropriate. Now, telehealth consults are routine. The models are multiplying: some services talk directly to patients at home, others support clinicians in small rural hospitals, and they are staffed by everyone from rural generalists to urban emergency physicians. Public and private providers run side by side. It is a huge change. But what types of telehealth best support rural emergency care, and how do we measure their impact?
Telehealth is transforming rural care, especially at small nurse-led hospitals, but we still lack the data to show how it is working. Rural clinicians value the support, yet we need to know more: which conditions benefit most from telehealth involvement, when is it best activated, and how do we demonstrate quality and safety? These are not questions about whether telehealth is useful — we know it is. They are about making sure we are using it in the best possible way. And before we can answer them, we need to be clear on what we are actually measuring.
That is where the data problem looms large. Larger hospitals routinely submit detailed episode-level emergency data to the Australian Institute of Health and Welfare, but many smaller hospitals submit very little or nothing at all. A few states have added telehealth fields to their emergency datasets, but these are early steps. Telehealth providers themselves collect information, but each does so differently, without shared definitions or standards.
Some important work is already underway. Schultz and colleagues have proposed a set of key performance indicators for virtual emergency departments — an excellent starting framework for thinking about quality. But without an agreed underlying dataset, those KPIs can’t be compared across sites. The Independent Health and Aged Care Pricing Authority has also made it clear that episode-level data will be required for future pricing models, even in small rural hospitals. What gets funded gets counted, and what gets counted gets improved.
This is why timing matters. Right now, data collection is piecemeal — but that gives us a chance to shape it before rules are written elsewhere. If rural clinicians and telehealth services do not help define what counts as telehealth activity, those definitions will inevitably be set by institutions that may not reflect clinical or rural realities. Both IHACPA and the Australasian College for Emergency Medicine’s Emergency Telehealth Network are starting this work. If you are interested, reach out to these organisations, and we will continue to share updates through the RRECN newsletter.
Telehealth is here to stay in rural emergency care. The question is not whether we collect the data, but how — and whose voices will shape it.
First published in the RRECN Newsletter (October 2025).
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