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During a pandemic, telemedicine has become an alternative to a stationary visit. It was used mainly for remote consultations with a doctor. Telepainting is only a part of telemedicine services. – Telemedicine is based on an effectively conducted interview, i.e. a conversation between a doctor and a patient, on data that the doctor knows in advance, i.e. medical documentation, on data from other service providers and on medical information collected from certified medical devices – says Jan Pachocki from the Telemedyczna Grupa Robocza Foundation .
- In the first months of the coronavirus pandemic, 80 percent. medical consultations took place in the form of teleportation
- “Remote solutions in a pandemic are a blessing,” say people with heart disease
- However, changes in the rules of teleporting are in the pipeline. In several situations, they can make access to specialist doctors difficult and cause queues to appear in clinics again
- – All these premises are equally bad and should be removed – says Jan Pachocki from the Telemedicine Working Group Foundation.
- More information can be found on the TvoiLokony home page
Changes in telemedicine will make it difficult to access specialists
From October, a new ordinance of the Ministry of Health on the provision of tele-advice is to enter into force. In a few cases, the regulations limit or exclude the possibility of remote consultation with a doctor, only direct contact during a visit to the facility will be allowed.
According to many specialists, the new regulations will make it difficult to access specialists, limit the possibilities of contacting a doctor for people from small towns, cause queues at clinics to be longer, and the waiting time for an appointment will increase significantly. And all this in times of the new wave of coronavirus.
Both the medical and patient communities are protesting against the changes, employers’ unions have expressed negative opinions, and online consultation companies have also raised objections.
- “We recognize the key right of the patient to choose the type of service”
Some of these organizations, 21 to be exact, a few days ago signed a declaration on the development of standards for the provision of telemedicine services in Poland. The list of signatories includes, among others: the Federation of Polish Patients, the Supreme Medical Council, the National Cancer Federation, the Polish Federation of Hospitals, the Polish Diabetes Association and the Employers of the Republic of Poland.
What is telemedicine, what benefits does it give us and what are the risks of the changes proposed by the Ministry of Health? These questions are answered by Jan Pachocki from the Telemedicine Working Group Foundation.
Telemedicine is changing the model of care
Adrian Dąbek, Medonet: What are the benefits of telemedicine?
Jan Pachocki, Telemedicine Foundation Working Group: First of all, it is a change in the model of care. We do not limit ourselves to caring for the patient only when he is in the office, but we extend to additional contact, e.g. if the patient forgot something during a stationary visit, he does not have to come back for information. Such simple things already extend the contact. And vice versa. If he has a new problem and needs advice, he or she does not always have to go to the clinic. Telemedicine, and within its framework, triage may be the first form of contact during which one learns what to do next. Whether he should take the drug, how much should he take, after which time he should consult again. This is precisely the extension of contact with the doctor, the doctor is more available. Plus, of course, overcoming distance or communication barriers and everything related to it. We can’t do everything, so sometimes we have to give up some things. From the patient’s perspective, it is easier to opt out of a stationary visit than online, i.e. a quick form of contact, because with the latter we can perform any life activity and when it is our turn to visit, it practically does not cost us time.
- “A project by the Ministry of Health will put telemedicine back a few years back”. Experts on the future of telemedicine and planned changes
Increasing availability is one thing, and the other area is the entire med-tech, medical internet, internet of things, measuring patient parameters, long-term monitoring, remote diagnostics. This is the digital revolution in medicine.
Many people still think of telemedicine as being in touch with a doctor by phone. And the concept is really wide.
Telemedicine is based on several components, on an effectively conducted interview, i.e. a conversation between the doctor and the patient, on data that the doctor knows in advance, i.e. medical records, on data from other service providers and on medical information collected from certified medical devices, etc. what has been collected in the health care system. This is a high-level solution based on several pillars.
Telemedicine is no longer just an ad hoc solution that worked well during a pandemic. This is the future of medicine.
With the benefits I have mentioned, I have deliberately left out of the covid themes. It is just an additional component of care. In addition to the outpatient clinic, which implies the necessity to come to the clinic, telemedicine adds a component that makes it possible to use this service at the patient’s home.
Are regulations keeping pace with medical advances?
This is a perverse question. Regulations will never keep up. This progress is so rapid that there will always be a distance between the two. The point is that this distance should be as short as possible and that the regulations should set a general framework for what goals we want to achieve and what rules we should remember. Standards such as regulations introduced more detailed organizational rules, and the soft guidelines that we, as a foundation, are preparing, already explained to doctors and patients how to properly provide and use such services. This standardization should be an integrated quality and education system that includes a framework both at the statutory level, specified at the level of implementing acts and soft educational guidelines. These are very important elements, not only in telemedicine, but above all in telemedicine.
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Changes in telemedicine – telecare will not be legal
It seems that this new ordinance of the Ministry of Health goes against and limits accessibility.
If it comes out as it is currently being processed, then yes. It tells you when telemedicine a priori cannot be used. It will be right in some situations, but not right in others. What is it causing? For example, the Polish Society of Cardiology will say that there are recommendations for the use of telemedicine and introduce, for example, telecare, which is financed as a research program. In this situation, this telecare also involves examining new health problems or assessing changes in symptoms. In the light of this regulation, telecare will not be legal. We have a medical benefit, but administrative regulations prevent it from being used. For me it is obvious that such a provision is subject to change. Of course, you can try to describe the situation in such a way that these administrative prohibitions correspond to the current medical guidelines. However, e-medicine is changing so fast, with new research programs emerging, that this is the wrong direction.
- Telemedicine – what is it? What technologies does telemedicine use? [WE EXPLAIN]
The law is clear: telemedicine is part of medicine. The doctor is obliged to exercise due diligence, act in accordance with the current medical knowledge, care for the patient’s welfare in accordance with the guidelines. If he does not, he is responsible. For this, it is not necessary to say from above that teleportation cannot be given, only the correct procedure of a doctor is needed, already under the applicable law. Instead of being administratively limiting, we should consider how these general rules should be better enforced. We have a very good IT system, quality monitoring, we are talking all the time about the law on quality in health care and patient safety, which is to improve controlling. It is enough to monitor the applicable regulations.
The order for the first in-patient visit to a specialist doctor is probably the most controversial.
In my opinion, everything is equally controversial. And the first visit, and a new health problem, and a change in symptoms, and the need for a personal visit in the case of a child. We must remember that even if the patient requests this visit, in the light of the regulation, he will not be able to use it, but will have to come in person. So we have the following situation: a medical recommendation, the patient’s will, and an administrative prohibition. All the premises are just as bad and should be removed. We can multiply medical examples, guidelines of one, another, third scientific society that will fit into these limitations, and eminent experts said that it is worth at least considering this form of contact.
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Is there still a chance to amend this regulation?
There is always a chance. There is a dialogue, presenting arguments, and I think that the ministry also thoroughly analyzes before sending it to the final announcement of the act. For now, we have this first act, before the consultation, a report that responds to comments, we do not have a new draft yet.
Where does this idea of limitations arise from? The ministry is concerned that a remote visit is of lower quality than a stationary visit?
And that’s not a question for me anymore, it’s a question for designers.
Recently, there was also a statement by Minister Niedzielski, in which it is said that those clinics in which the share of telepaths will be less will be rewarded.
This is a different mechanism. He does not fall under the medical competences, but tries to limit the excess of tele-advice by means of a top-down quantitative mechanism. Personally, I would see better solutions in the long run, which means that I would be more interested in monitoring whether these services were provided correctly or if they brought quality, and assess them in this respect and possibly reward doctors. And when a visit was badly granted, it sanctioned. So let’s fight more for quality than quantity. Because the quantity should be the product of quality.
- Do you want to have your heart under control? The right research package will help
I am not a health policy creator, but I can see that this is an idea of limiting the situation when there are too many teleports. I understand the intentions a bit, but in the long term, better solutions related to quality monitoring could be proposed. But I assume that if there is 90 percent. teleporad, something has to be done about it. No extreme is good. But I prefer it to limiting and entering into medical competences in the kind that something is impossible. Finally, it should be pointed out that the mechanism introduced by the ministry concerns primary health care, and the draft regulation concerns other areas, i.e. specialist and services financed from resources other than the National Health Fund (i.e. by insurers, employers and patients).
This may interest you:
- Tomasz Grzelewski, MD, PhD on the advantages of telemedicine: I can help an ocean of patients
- According to GPs, teleporces revealed that we are technologically handicapped, irresponsible and that we often lie
- How to prepare for teleportation?
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