Luke Boddam-Whetham l Palladium - Sep 30 2020
Telemedicine is on the Rise - Can Regulation Keep Up?

Source: National Cancer Institute 

COVID-19 has changed much of the way people around the world live their lives and from the outset, has challenged and stressed global health systems.

One particularly pressing challenge is the need to provide quality healthcare to people that are hesitant to see an in-person provider due to fears of infection. The consequences have been dire. Recent reports from the UK show an excess number of non-COVID-19 deaths because patients were unable to access treatment due to constraints on the healthcare system, or avoided seeking in-person care due to concerns of infection.

“Pandemics expose the fragility of our systems,” says Alonzo Fulgham, former head of USAID and Palladium Board Member. “Collateral damage in the form of increased (and otherwise preventable) mortality is inevitable.”

But where there is a challenge, there is an opportunity, and the explosion of telemedicine (the delivery of healthcare services using information and communication technology) is a case in point. Some healthcare providers in the United States, for example, are seeing 50 to 175 times the number of patients via telehealth than they did before the pandemic. In the Asia Pacific region, the market is expected to grow by 16.8% by 2026, and in countries like Indonesia, healthcare providers are actively investing in technology to tap into what they see as a growing market.

This is seen in many quarters as a positive development – and an example of a change that was in the offing but that the pandemic has brought forward by several years. An increase in clinician-patient interactions over the internet or phone has potential economic benefits – both for society and clients – and is certainly more convenient for a large portion of the population. With the right connectivity, underserved populations can access health services in areas where expertise exists.

However, not everything about telemedicine is straightforward. While technology introduces new players into the health market, it also brings its own set of unique challenges. Quality assurance, continuity of care, and confidentiality are all issues that need to be addressed by healthcare providers when using telemedicine technology.

Keeping the client front and centre

As with any technology-enabled revolution, governments have an obligation to their citizens to ensure that the change benefits them. Governments in all countries, but especially low- and middle-income countries where telemedicine has the potential to overtake in-person medicine, should be considering how they are going to regulate the industry. With regulations in place, governments can ensure that providers are taking full advantage of the benefits of telemedicine, while at the same time safeguarding the quality of care for their citizens.

In a number of countries, initial responses to the COVID crisis have been to deregulate or ease regulation in an effort to ensure that people can access health services under the restrictions. While this is an understandable approach, it can only be temporary.

Moving forward, ministries of health and their partners should consider the following questions when formulating policy and regulation for the future of telemedicine:

1. How can we ensure patients use quality telemedicine providers?
In order to provide telemedicine services, health care providers (regardless of their physical location) must be registered with the relevant authorities and must meet the relevant standards, with the ability to hold providers accountable if necessary. These standards should not unfairly discriminate against telemedicine providers (compared to providers offering services in person) nor private providers (compared to the public sector).

2. How can we ensure continuity of care?
Telemedicine providers should demonstrate how they are linked into other health services in order to provide patients with the full continuum of care they need. Providers need to enable sharing of essential client data through interactive data systems.

3. How can we maintain data privacy?
With confidential data being shared more widely and often, the need for strong data protection is all the more important. Telemedicine providers should demonstrate how they will protect their clients’ data and ensure confidential communication.

Balancing the need for effective regulation with enabling access to health care through a mixed health system is a constant challenge for governments – especially in times of crisis. Telemedicine has demonstrated great value in maintaining health services during the COVID-19 pandemic and it is important not to stifle this. However, in managing the pandemic and in building for a future where a significant proportion of health services are provided virtually, it is equally important not to compromise on quality of care, in all of its manifestations.