- Choi’s View on Healthcare Innovation
While the world was going all out to contain the new coronavirus (COVID-19) pandemic, the Korean medical community was divided by an untimely controversy over the government’s temporary approval for telemedicine.
The Ministry of Health and Welfare recently announced that it would allow physicians to give over-the-phone medical consultation and prescriptions temporarily until the COVID-19 outbreak ends. On Feb. 22, the ministry said, “At the doctor’s discretion, and when the doctor can secure safety, patients can temporarily receive phone consultations and prescriptions without having to visit a medical institution.”
Telemedicine is almost a taboo subject in the local medical community. Mentioning the word alone can create an intense backlash, for a variety of reasons. However, Korea is the only country in the world that the law bans telemedicine “totally and explicitly.” The clause, “totally and explicitly,” was included because some countries allowing telemedicine still require face-to-face consultation in the first appointment with a doctor, and others do not have explicit laws on telemedicine.
It is almost impossible to diagnose an infectious disease if a doctor cannot collect the patient’s specimen for testing. However, the government pushed to give the go-ahead for telemedicine to lower the risk of infection by reducing contact between patients and healthcare workers. When a clinician suspects the infection of a patient, the doctor can talk on the phone to triage the patient and recommend a clinic visit only when necessary. Telemedicine can be useful for patients who need outpatient service due to an underlying disease but cannot visit a clinic due to infection fear.
Other countries, including the U.S. and the U.K., are also expanding telehealth as countermeasures against COVID-19. In late February, the American Telemedicine Association and the Healthcare Information and Management Systems Society (HIMSS) demanded the U.S. Congress expand the scope of Medicare for telemedicine benefits in preparation for the fight against COVID-19. They asked Congress to provide healthcare professionals “as many tools as possible.” Congress immediately approved their request, and President Donald Trump signed the bill swiftly.
The U.K. followed suit. In early March, the National Health Service (NHS), the publicly funded healthcare system, encouraged first-tier medical institutions to use telemedicine to cope with the spread of COVID-19. The U.K. records about 340 million cases of annual medical consultation at primary care clinics, and only 1 percent of them are made through video calls. If the proportion of remote medical care goes up to 5 percent, first-tier hospitals can reduce weekly face-to-face consultations by 300,000 and lower the chance of the virus infection, the NHS said.
Despite the merits of telemedicine, the health and welfare ministry’s temporary lift of the telehealth ban was too hasty and unpolished. The government allowed it without any minimum preparation. Telemedicine requires different methods, compared to vis-à-vis medical consultation, and it has definite limitations. To reduce confusion and negative consequences, the government should have adequately prepared and discussed with various stakeholders to introduce telehealth.
To provide telemedicine, doctors need entirely new processes, including patient identification, billing and receiving medical expenses, sending and receiving prescriptions, and helping patients receive medicines. However, there was no such process, no infrastructure, and no principles at all to practice telehealth in the clinical scenes.
Moreover, the government described the guidelines too vaguely, using phrases like “at the doctor’s discretion,” “by consultation between the medical institution and the patient,” and “by consultation between the pharmacist and the patient.” The guidelines were no different than telling patients and doctors to do what they thought they had to do. The approval of unprepared telemedicine only creates confusion among doctors and patients.
Fortunately, startup companies in the private sector are voluntarily developing telemedicine platforms and distributing them to physicians and patients for free, closing the loopholes. This process had to be coordinated by the government in advance. The NHS in the U.K. is discussing collaboration with healthcare tech firms such as PushDoctor, Babylon, Docly, and Visiba, to widen telemedicine drastically.
The move contrasts with that of the Korean government, which allowed telehealth without any preparation and left the healthcare community in bewilderment.