TELEMEDICINE; VIDEO CONSULTING AND THE LAW
Telemedicine and Video consulting, seems to be suddenly running ahead of itself in the absence of concise purpose built and detailed guidelines. The HPCSA Booklet 10 is clear for the purpose for which it was written, namely to bring healthcare to distant underserviced communities , but innovation seems to have rapidly outstripped the bounds of regulation, as well as the regulator.
CMS , BHF and the HPCSA seem to have been left on the back foot.
Technology exists to fulfil the dream of the National Department of Health and the principles which the HPCSA have embraced and which pervade the carefully written booklet 10, namely to use Telemedicine to bring healthcare to underservice communities at a distance, far from conventional medical services and specialists availability.
Telemedicine, and the ideals which the HPCSA have espoused, link healthcare facilities to underdeveloped rural areas.
The American Medical Association as well as the HPCSA, say affirm “no” to first consultations on new patients being done along the lines of Telemedicine. They see Telemedicine as a supplementary service to an existing an already existing doctor patient relationship.
CPC/Qualicare firmly agrees with this position, which is congruent with that of the Council.
Booklet 10 guides the profession that all Telemedicine should involve a Healthcare Providers who performs a face to face consultation and physical examinations of the patient in a clinical setting, on one side, and either the specialists or specialised family practitioners on the other side.
The current regulations written by the HPCSA however need more focus on refining a number of critical points, the most important of which is:
“ what constitutes a primary consultation and how long after such a consultation can a Healthcare Practitioner decide that it is medically safe and legally defensible to conduct a Telemedicine service?”
Quoting from the Council: Telemedicine must be restricted to where a previous Dr Pt relationship exists and enables the dr to gather sufficient knowledge of the clinical condition which is the subject of the request, to render clinically justifiable diagnosis, treatment or recommendation.
Certain Funders are however looking at products which lower costs paid to providers and at the same time introduce a convenience factor to their prospective members, instead of concentrating on using it for the purposes described in the HPCSA booklet.
The stage is thus set for a number of new entrants who will, and have already entered, the market place offering large potential underservices patient bases to cohorts of willing, eager but ill- informed doctors, who themselves are keen to provide Telemedicine services in scenarios where Telemedicine was never envisaged by the Healthcare Regulators. Their offerings are however the “chicken and the egg “ story… they have no patients, as they have no providers to offer the service. Sign up with them, and YOU provide the missing link, with which they can approach Funders with a willing cohort of doctors to service their products offering.
YOU however have to answer to the HPCSA, and not to them!
Innovation should ideally follow regulation and not vice versa, least the professionals find themselves in a situation which can land the willing individual and often ill-informed Private Practitioner in hot water with the regulator.
The reverse is however usually the case around the world. Regulation, by its very nature, has to go through numerous iterations and is a slow and often cumbersome process, whereas innovation needs a white board, agile minds and free-thinking individuals unimpeded by regulatory constraints, thus becoming an implementable idea in a relatively short space of time.
Telemedicine in the correct settings and used to improve the Health Care accessibility of the poorest of the poor is to be applauded. It is currently however the topic of a number of get rich groupings importing technology and ideas from the USA, and taking advantage of the relatively under regulated South Africa medical environment… And you all know what happened to those American companies who rushed in with Yankee Managed care before the playing fields were levelled by the CMS. Many of these newer schemes are operating in the grey zone of uncertainty and backed by legal opinions which have not been tested either in court or in the court of the Health Professions Council of South Africa.
Locally, Discovery Health’s Teleconsulting offering seems to be the most “on track” of the current offerings and it is sensitive to our inputs to further refine certain rough edges within a positive working environment with us.
CPC/Qualicare embraces change and moves with the times. As such we are committed to provide you with the latest information as it emerges from the HPCSA in response to the new demands offered by Telemedicine services.
Continue to Watch this Space!!
Tony Behrman and the Q/Care team