Conference on telemedicine

by Gabriel Avigdor

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On 4 October 2018, I was invited by Planète santé to speak at the assises de la médecine romande on the topic of telemedicine. The title of my conference was:

Telemedicine : legal framework for physicians

The Swiss health forum 2018, including the “assises de la médecine romande”, is global conference and Forum where more thatn 1’000 healthcare professionals and doctors meet and participate during a few days. This forum held a practical conference on the ‘digitalisation of the medical profession‘. I had the pleasure to speak along with Dr Jean-Gabriel Jeannot and other healthcare experts, including lawyers and physicians on digital in the context of healthcare.

Dr Jean-Gabriel Jeannot and I had the pleasure to develop thoughts and highlights challenges with this specialized audience in the context of telemedicine. For those who do not know him, Dr Jeannot is a Swiss physician specialized in internal medicine known for his digital initiatives to medical care, his numerous websites Medicalinfo, Medplus.ch, cabinetmedical.ch and his large amount of articles on his blog hosted by the local newspaper “Le Temps”. He spoke about the practical aspects of telemedicine for physicians, while I tackled the legal part of the topic. I mainly oriented my presentation for global awareness to healthcare professionals and doctors about legal issues which they may not find obvious, while offering practical recommendations.

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ISSUES RAISED BY TELEMEDICINE

Telemedicine is a wide topic.

Physicians and healthcare professionals have issued a few guidelines. Just to name a few, in the US, the American Telemedicine Association (ATA) and, in Europe, the Standing Committee of European Doctors (CPME) have created a useful documents, containing best practices for telemedicine services and remote healthcare.

Those guidelines are a first step to understand what a telemedicine project requires as a minimum. But a telemedicine project or initiative, may remain very simple (such as online or telephone medical consultations) or become extremely complex. Healthcare remains a heavily regulated environment, where laws are different in each country, with different practices and particularities, especially for cross-border projects. Moreover, there are many other aspects to take into consideration, such as from a regulatory perspective. Other issues relates to how securing contracts with third parties and partners in distant healthcare, how to tackle protection of health data and personal data under local laws, including the GDPR, as well as liability issues and how insurer can recognize distance medical services and reimburse them to  patient and pay doctors.

Structure of my conference

The main points of my talk related to three main pillars:

(1) Acts of telemedicine

The first part consisted in presenting the different acts of telemedicine that healthcare professionals my do. For each act, I have explained the typical contract that needs to be in place, highlighting the problem what issues may arise in each different scenario. A physician may provide four types or acts of telemedicine :

  • teleconsultations, which relate to the distant telephone or videoconferencing to provide a medical evaluation, including e-prescribing;
  • teleexpertise, where one physician instruct another physician that is answering remotely as an expert;
  • teleassistance, which applies in the event a doctor is unable to examine a patient on the site (emergency, distance, etc.) and a third person that is not a doctor assists the patient while communicating with the remote doctor based on his instructions; and
  • telesurveillance, which may involves remote biomonitoring of vital functions of the body, where a doctor is not present, or because there is no need for medical examination directly on the patient.

(2) Legal framework for physicians

The second part of my presentation was about the legal issues of telemedicine for doctors. It consisted in answering to a few questions, such as:

  • does telemedicine require a particular legal framework and how law applies to it?
  • who can practice telemedicine?
  • how to manage protection of health data?
  • telemedicine  and liability: how to minimize the risks?
  • how does the social insurance reimbursement work for telemedicine services?

(3) Recommendations

Finally, the last part had a main goal to provide practical guidelines and checklist for doctors and healthcare professionals, including insurance companies and innovators (start-ups and hospitals).

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TELEMEDICINE IS NOT A NEW METHOD, BUT A GROWING MARKET

A bit of history. It is not obvious to realize that the practice of medical services remotely is pretty ancient. The system of emergency medical hotline that associations of doctors have set up is a proof of it, as has been working for decades.

We can already find acts of telemedicine provided at the early 20th century.  Since the telephone invention in the late 19th, and television in early 20th century, doctors have provided medical services through different means, such as telephone (ECG and EEG), videoconferences in the context of psychiatry, virtual reality and with more modern tools after the invention of TCP/IP, etc. Four days before 9/11, the famous remote “Lindberg” surgery was a success, which demonstrated that technology could bring promising solutions remotely even to perform extremely sensitive acts of medicine.

In Switzerland, two main centers of telemedicine are in place since early 21st century, created by, and based on the model of, insurance companies such as Medgate and Medi24. These 2 providers mainly offer acts of teleconsultation (medical telephone calls). Other insurer now propose remote medical services, such the software myguide that the CSS insurance company provides to its clients.

Private initiatives, such as “heal-me” ” (“soignez-moi” in French) offer non-synchronized models (compared to synchronized). This online telemedicine platform allow patient to only pay CHF 39.- per consultation, with a assurance to receive a call from a doctor with a timeframe of 60 minutes. If the response takes longer, the medical consultation becomes free of charge, which becomes an incentive for the platform to ensure performance and availability for patients.

With respect to private clinics, the Aevis Victoria Group has massively invested telemedicine with acquisition of 40% of the share in MedGate, the Swiss leader in telemedicine. The Group also increased its participation in “LifeWatch AG” with an IPO in 2017. THis company is specialized in developing tools and devices for distant medicine. The Aevis Victoria Group continues to invest in other institutions or projects in the area.

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NOW WHAT?

Potential, but a probable slow growth. With such investments, and the potential of telemedicine, this market is likely to grow and complement ordinary medical care. One thing is sure, telemedicine will never replace ordinary physical examinations on patients. But it appears that physicians remain careful with distant medicine, probably for liability matters, or not knowing that most remote medical acts can be reimbursed by social insurances, by not using electronic communications, such as e-mail or text messages, or simply because they do not have the time or the need to change the way the provide healthcare to patient.

There are many ongoing initiatives, but as we saw, regulatory, legal, political barriers and reluctance from doctors. So this market remains full of potential, but is likely to grow slowly before becoming more in the daily practice and complement traditional care.

Some elements to consider. Patients use more electronic communication means. They have few time to go and visit the doctor. Nowadays, it is common that both parents work and struggle to organize to find medical appointments either for themselves or for their kids. They also prefer not to go to the doctor unless it becomes urgent. Sometimes, they even perform medical care on themselves. Now patients change their doctor more easily, or even have not a general physician: therefore telemedicine has all potential to match with a true market.

Now the players arriving with new ideas on the market will have to demonstrate that it is worth it from an economical and quality standpoint, while being able to reduce the costs of healthcare.

But maybe, digital medical office are not so far to come on the market…

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To know more:

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You are launching a project in the context of digital health or distant healthcare? If you have questions or want to meet, go and check out our platform and schedule a meeting with us on datalex.

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