The rise in the use of telemedicine: advantages and pitfalls

Joanna Krakowiak

Wardynski & Partners, Warsaw

joanna.krakowiak@wardynski.com.pl

Telemedicine is viewed as a means of improving patients’ access to healthcare, allowing doctors both to work more effectively and reduce costs. This is achieved by cutting the number of unnecessary hospital admissions and facilitating doctor contact from as patient’s home in urgent cases. Such a way of working is possible, but requires a well-designed and predictable regulatory framework of standards for providing telehealth services.

Opportunities and challenges

Despite technology’s advances, before the Covid-19 pandemic, telemedicine was not as common as might have been thought. Some countries even only permitted medical consultations if the patient was physically present. The pandemic forced a change in this approach, making teleconsultations a widely promoted solution. As a result, the global telehealth market is forecast to grow from US$94.44bn in 2023 to US$286.22bn by 2030, representing a growth of just over 17 per cent.[1] However, the rise of telemedicine is not free from concerns, as it has often been introduced rashly, without building on solid foundations. Only 17 OECD countries have reported well-established and clear rules and regulations governing the provision of telemedicine.[2] A global Survey of Telemedicine prepared by the IBA’s Healthcare and Life Science Law Committee shows the most pressing issues concerning telemedicine, such as the registration and surveillance of healthcare providers, health data systems, and the training of healthcare professionals.

Different regulatory approaches

Telemedicine’s current mode of operation has been necessitated by the realities of the pandemic. Different approaches to regulating exist. Some countries have decided to extend the existing regulatory framework governing all healthcare providers to include telehealth providers, whereas others have adopted specifically dedicated telehealth regulations.

As an example, in 2022 Brazil enacted specific regulations governing robotic tele-surgery to ‘encompass regulated health professions as a whole, delegating competence to their respective professional councils in relation to the ethical standards that should be observed for the provision of this type of services’. They are aimed at ‘expanding access to health in Brazil, especially within the public system’. They cover the most important aspects of explicitly listed telehealth services which are permitted, and also impose extensive registration requirements for entities rendering such services. Providers are supervised by competent authorities, with communications platforms and data filing services also identified as entities subject to scrutiny. The personal aspect of telehealth provision is also strictly regulated: nurses, psychologists nutritionists, pharmacists, physiotherapists and occupational therapists may also provide teleconsultations apart from doctors, but need to be authorised beforehand, under the regulations issued by their professional bodies.[3]

In France, telemedicine is regulated by the French Public Health Code, as well as by numerous guidelines and recommendations issued by health authorities. They set standards and rules to be followed in a wide range of matters, such as criteria of eligibility to practise telemedicine, rules to be followed during consultations, technical protocols, and how to inform (or train) patients to access telemedicine services. It also specifically establishes that the delivery of telemedicine must include the health professional’s authentication, the identification of the patient, access to the patient’s health data required for the consultation and, if required, training or preparing the patient to benefit from telemedicine.[4]

On the other hand, in Poland, telehealth is understood as one of the channels for providing healthcare and, therefore, falls under the standard rules. Providers of telehealth services must be listed in the universal register of healthcare providers. Telemedicine services are publicly funded on the same basis as in-person services and are included in mandatory insurance cover which has not been specifically adapted to telemedicine. There are no specific requirements for registering or monitoring health professionals or telemedicine platforms. This situation may change in future with respect to ‘on demand prescription services’. While the service itself is responding perfectly to the demands of society (in recent survey, 84 per cent of respondents expressed a need for a way to obtain repeat prescriptions for ongoing conditions without having to visit the doctor), it has been operating without sufficient control and led to two deaths from overdoses of psychiatric medicines. An attempt has been made to curb this by placing limits on the number of prescriptions which may be issued per day day, with special requirements applying to psychiatric medicines, and a digital prescription may be issued no later than three months after an in-person consultation. While the new regulations could help resolve the issue of over-medication, they may also lead an over-restriction of access to medication.[5]

Health data protection

One of the biggest challenges facing telemedicine is ensuring adequate patient data protection. France is the country to look up to in terms of data protection. It has introduced very strict regulations regarding the technical aspects of delivering telemedicine. The requirements for telemedicine platforms ensure that health data is sufficiently protected and regulations are thoroughly enforced. Providers whose platforms fail to comply with regulations cannot apply for reimbursement of medical services rendered by their doctors.

This strict legal approach contrasts sharply with its absence in Poland. Current requirements on the protection of data shared during consultations are set out in the Supreme Medical Council Guidelines. They call for the use of systems owned by providers and discourage the use of communicators which have not been optimised to provide medical services. This is very different from the French requirements, but a step has recently been taken towards improving standards. While awaiting the European Union’s ‘European Health Data Space’ to be implemented, Poland is piloting its own programme which features an advanced healthcare platform. While the main goal of the e-consultation (e-Konsylium) programme is to serve as a ‘virtual doctor’s surgery’, improving patients’ access to specialists and facilitating consultations between doctors, it also includes an advanced designated platform. All medical documentation is to be stored on the platform, with access granted to all involved in treatment, while ensuring data is adequately protected. The system is currently being tested in oncology and cardiology, with plans for its wider implementation.

Training of healthcare professionals

Currently, teleconsultations predominantly do not require high levels of technological skill. But telemedicine has already gone beyond medical advice provided over the phone, and it is certain that it will further develop. This calls for changes to the training of health professionals. Apart from countries such as Israel, which entails designated training in telemedicine; and Brazil, requiring a Specialist Qualification Record and legally required specific training before admission to robotic tele-surgery; it is difficult to find any educational requirements for doctors performing telemedicine. If matters are left unchanged, while this may not affect medical consultations provided over the phone, it could mean that doctors and nurses become seriously undertrained for working efficiently in technology intense environments. The solution proposed by Polish (or more exactly Silesian) academics, is to establish a curriculum that would ensure students obtain an engineering degree before proceeding to medical school. This would lengthen their education, but produce health professionals with training to treat patients using modern technology.

Outlook for the future

The pace at which technology is developing makes it difficult to keep up with and be used to its full potential. The double-digit growth of telemedicine may only continue if it is within an environment of regulatory clarity. There is no turning back from the changes which started in 2020, and all participants should strive to use their full potential and provide the healthcare of the best possible quality to patients. Countries are introducing new systems may meet the needs of citizens, but are not mutually compatible. This is creating a hurdle to telemedicine becoming a safe and useful tool in an increasingly advanced and international environment. There is, therefore, a pressing need for the sector to adapt and promote standards for reliable telehealth services and build greater trust among patients to use these services, irrespectively of their age or origin. Current solutions were arrived at by having been tested in under pandemic conditions 19. Despite their functionality, they remain riddled with limitations.

This article is based on a global survey of telemedicine produced by the IBA Healthcare and Life Sciences Law Committee which covers 54 jurisdictions. The author, who completed the survey as it relates to Poland, would like to thank Renata Oliviera, Committee Co-Chair for the invitation to participate in this project and at the roundtable discussion during the 9th IBA Annual World Life Sciences event in Washington, DC, 1–2 June 2023.