Telemedicine in the time of coronavirus
With hundreds of millions of people staying at home over the next few weeks, attempting to minimize the spread of the coronavirus, it may be a good time to avoid seeing a doctor or visiting a medical clinic for run-of-the-mill illnesses. The medical services in our respective countries need to be focused on those people suffering with symptoms of the virus. While we are homebound, we will need to reconsider many of the services that we traditionally have done in professional settings and that we can do in the comfort of our own homes. Welcome to the next level of telemedicine.
Telemedicine provides convenience and cost-effective medical care. Recently, it has become more comprehensive, expanding to acute and chronic conditions, and migrating from hospital to home and mobile devices. In its simplest and low-tech form, visits to the doctors are not necessary and a simple telephone call or video conference can be facilitated instead. At the other end of the spectrum are surgical procedures that can be undertaken by a doctor in one country and a patient in another through robot-assisted technology.
Telemedicine is fast becoming integrated into the daily operations of hospitals, specialty departments, home health agencies, private physician offices and the homes and workplaces of health care consumers around the world. The industry is growing. In 2015, more than 15 million Americans received some kind of medical care remotely. Last year, one in 10 Americans received medical care through telemedicine.
In Japan, telemedicine is not as pervasive. It began to be covered by public insurance in April 2018, but unfortunately, has not been widely adopted. Only 1 percent of medical institutions have been registered in the public insurance program, and 60 percent of them have no practical record. The reimbursement systems are too strict. Moreover, the rules for the physician-patient relationship are too arduous: More than six months must have passed since the first consultation and the same doctor must have been providing face-to-face treatment every month for six months since the first consultation (this was eased to three months, from April 2020). Further, the covered illnesses are limited to chronic diseases such as diabetes and hypertension. The coronavirus outbreak has forced the Japanese government’s hand in opening up these restrictions.
At this difficult time, patients can use telemedicine as a supplement to the already overburdened health care system. As it transforms the practice of medicine and our relationships with doctors and other health care providers, telemedicine promises to transform the traditionally nationalistic (or in the U.S., state-centric) practice of medicine.
Transnationally, telemedicine can bridge the gap among developed and less developed states, reduce overall costs for this important public good, and save lives in general. There is power in leveraging specialities. In this unprecedented global outbreak of coronavirus, it is important to isolate the patient at home to prevent the spread of further infection, and it is ideal to perform monitoring, examination and follow-up at home. Big issues remain about how best to conduct examinations such as palpation, blood tests, virus tests and image tests. However, consolidation at testing centers and the advent of digital devices are quickly making these examinations available at lower costs. In other words, high-level treatment in telemedicine with global experts is possible. As the global medical community facilitates the access to physician sub-specialty expertise there will be more efficient use of “in field” equipment.
We see how the selflessness of the health care profession is valiantly fighting coronavirus. Telemedicine can still ensure that medical practitioners from elite medical schools and leading hospital groups maintain a public health approach. That this is a pandemic provides the test case for the transnationalization of medical practice. Telemedicine can help match medical care practitioners in the developed world with patients in the developing world, far from hospitals, let alone medical specialists.
There are, however, major challenges from a medical practitioner’s point of view that come with the practice of telemedicine. The advent of telemedicine alters the manner in which physicians undertake diagnoses, recommend and conduct treatment, and develop medical strategies for patients. First, there is the thorny issue of licensure. In many countries, occupational licenses, bestowed by a specific government-approved professional association or by a government agency itself, are required for the practice of medicine. Only those persons with a valid medical license can legally practice medicine. Telemedicine presents a myriad of cross-jurisdictional challenges when it comes to licensure.
We need to harmonize rules about licensing, prescriptive authority, and informed consent for medical services across jurisdictions. This is a regulatory nightmare in the United States alone: Patient privacy regulations are federally mandated, bolstered by some individual states. The European Union has its own onerous data protection laws and each member state has its own laws concerning patient information. Japan, too, has its own rules. Enter the lawyers and auditors as we contend with increased administrative costs from compliance.
The second challenge of telemedical practice involves transnational pricing, coding, billing and collection. The global medical profession — under the aegis of the World Health Organization — needs to codify rules that each country will implement into its respective domestic laws. We also need to figure out a more global standard of care and refashion our tort law when it comes to the provision of medical services across national boundaries.
There are indeed a number of regulatory and legal challenges for telemedicine and the sooner we sort them out, the better. The good news is that we can work them out over the next few weeks or months while many of us are at home.
James Cooper is a lawyer and professor of law at California Western School of Law in San Diego. Tokio Matsuzaki is an orthopedic surgeon in Japan and a visiting scholar at the University of Tokyo. They research, write and consult on disruptive technology and regulatory matters.