Second, one of the province-regulators in Canada noted that — in order not to discourage doctors and specialists from other Canadian provinces from providing telemedicine services in this province — the licence cost is linked to the number of patients treated remotely. Specifically, no licence fee would apply if a doctor treats fewer than 12 patients, a discounted fee would apply to doctors treating between 12 and 52 patients, and a full fee would be charged for those treating more than 52 patients. Table 4.2: Licensing requirements — summary Jurisdiction Telemedicine only licence Local licence Australia Denmark France New Zealand encouraged Portugal Singapore Alberta British Columbia Newfoundland and Labrador Ontario Saskatchewan California Maine North Carolina Oklahoma Oregon Washington 1 9 Note: Here, and elsewhere in this report, by ‘local’ we mean in the jurisdiction of the patient. Cells with no mark mean the telemedicine regulation does not explicitly mention this issue. Source: Europe Economics. Requirements and standards for the provision of telemedicine We distinguish between three main categories of requirements: general requirements — applicable to telemedicine services as a whole; procedural requirements — relevant for the interaction between patient and doctor itself; and specific requirements — relate to particular applications of telemedicine. we present our key findings for each of these categories in turn. General requirements General requirements predominantly focus on establishing when telemedicine may be used. The key general requirements or standards we identified in our research are listed below. In general these requirements seek to ensure that telemedicine replicates as far as possible traditional face-to-face care. Ensuring the same standard of care is provided via telemedicine as via face-to-face care. This requirement is consistent with the understanding of telemedicine as just another way of providing medical service rather than as a distinct service. Out of the 17 jurisdictions in our core sample, 13 explicitly included this requirement in their policies or standards. Having access to sufficient information — be it medical records, medical history or other information provided by the patient or the referring doctor. Since in telemedicine the patient cannot be physically examined by the doctor, the latter will be more reliant on medical records or other information from the patient’s history. This requirement — while more specific and thus limited to a particular aspect of
Surveying Surveyor using ICT to assess condition of a building/plot of land Client sends photos of the house interior – surveyor advises on house value or repair; Video-drone to examine a high building/plot of land Save time/cost; Reach otherwise inaccessible parts of the building or area Critical dependence on quality of images Yes, remote service involves ICT, examination of a specific building and individual advice; substitutes for human presence No special regulation or guidance services services using ICT and algorithms Preparing a standardised document, e.g. will; Online legal advice for an undisputed divorce Save time on standard solutions; Reduce cost; Increase accessibility of legal services Client’s identity verification; Transparency and accountability when automated are based on algorithms too complex for a solicitor to fully understand To some extent: client’s identity verification is a similar issue; Problem description is similar to making the diagnosis; Could be viewed as similar to online pharmacies Law Society’s practice note on online services Source: Europe Economics.
Summaries of Key Findings In this section we replicate the summary tables from the main body of the report but provide direct to the relevant sections of Appendix 2 — core countries where more details can be found. We also note that some of the findings come from interviews which are not transcribed here. As such, not all information included in the summary tables could be directly referenced here. Definition of telemedicine Table 11.1: Definition of telemedicine — summary Jurisdiction ICT Distance For diagnostics For treatment Appendix 2 section reference Australia 1.2.1 1.7.1 Denmark 3.2.1 France 4.2.1 4.3.1 New Zealand 5.1.1 Portugal 6.2.1 6.3.1 Singapore 7.2.1 Alberta 2.3.1 British Columbia 2.4.1 Newfoundland and Labrador 2.5.1 Ontario 2.6.1 Saskatchewan 2.7.1 California 9.10.1 Maine 9.4.1 North Carolina 9.5.1 Oklahoma 9.11.1 Oregon 9.6.1 Washington 9.7.1 Total 17 15 16 10 15 10 Source: Europe Economics Licensing requirements Table 11.2: Licensing requirements — summary Jurisdiction Telemedicine only license Local license Appendix 2 section reference Australia 1.2.3 Denmark 3.2.3 France 4.2.3 New Zealand encouraged 5.1.4 Portugal 6.2.3 6.3.3 Singapore Alberta 2.3.4 British Columbia 2.4.4
Newfoundland and Labrador 2.5.4 Ontario 2.6.4 Saskatchewan 2.7.4 California 9.10.4 Maine 9.4.3 North Carolina 9.5.4 Oklahoma 9.11.4 Oregon 9.6.3 Washington 9.7.4 Total 1 9 Source: Europe Economics. Requirements for healthcare professionals General requirements Table 11.3: Telemedicine general requirements — summary Jurisdiction Same standard of care Having access to sufficient information Appropriateness of telemedicine Established relationship with patient Appendix 2 section reference Australia encouraged* 1.2.2 1.7.3 Denmark 3.2.2 France 4.2.2 New Zealand 5.1.3 Portugal 6.3.2 Singapore 7.2.2 Alberta 2.3.3 British Columbia 2.4.3 Newfoundland and Labrador 2.5.3 Ontario 2.6.3 Saskatchewan 2.7.3 California 9.10.3 Maine 9.4.3 North Carolina 9.5.3 Oklahoma 9.11.3 Oregon 9.6.3 Washington 9.7.3 13 9 7 1 Note: * Encouraged by a medical association, not the regulator. Source: Europe Economics. Procedural requirements Table 11.4: Telemedicine procedural requirements — summary Confidentiality, safety, security consent Patient’s identity medical records Technical and equipment requirements Appendix 2 section reference Australia 1.2.2 1.7.3 Denmark 3.2.2 France 4.2.2
standards of work; discipline and/or fitness to practise. The policy are to be reviewed with the 12 professional boards. Regulation of individual doctors who provide telemedicine services The Council has stated that all telemedicine services should involve a healthcare provider where there is an actual face-to-face consultation and physical examination of the patient in a clinical setting. The consulting practitioner will communicate the information to the servicing practitioner, who will then provide the necessary assistance. The ethical guidance includes: Competence, registration and authorisation: practitioner must be licenced in South Africa. Healthcare practitioner-patient relationship: formally, the location of telemedicine service is the patient’s location. Assumption of primary responsibility: the consulting practitioner is ultimately responsible for treatment. The servicing practitioner must keep the medical record. Evaluation and treatment of patient: prescription based only an on online questionnaire is not allowed. Professional duties: obtain informed consent of the patient specifically for use of telemedicine; verify the locations of the consulting and servicing practitioners; verify patient’s identity. Cross-jurisdiction issues in telemedicine In the case of telemedicine across country borders, practitioners serving South African patients should be registered with the regulating bodies in their original states as well as with the HPCSA.