“Telemedicine is a blessing in a pandemic.” The government is preparing big changes for patients

“For many reasons, the patient cannot appear at a stationary visit, telemedicine solutions support the patient’s treatment process”, “The inability to decide in what form the visit is to take place is a way back to the Middle Ages medicine” – said the participants of the conference on new standards telemedicine care. The government is preparing big changes in visits. The problem is that they are criticized by both doctors and patient organizations.

1. The Ministry of Health has developed a draft regulation on the provision of telemedicine services in Poland
2. Many environments are concerned about the planned changes that may hinder access to telemedicine services in Poland
3. More than 20 organizations, societies and foundations are working on developing standards for such services
4. “The patient should be able to decide whether he wants to use teleportation or real advice” – they emphasize
5. More information can be found on the TvoiLokony home page

Changes in telemedicine from October

On Monday, at the seat of Employers of the Republic of Poland, a press conference was held, co-organized by the Telemedicine Foundation, on the commencement of work on a new standard of telemedicine care.

According to the organizers, “a dozen or so organizations, including patient associations and medical societies, declared their will to take action to develop a systemic proposal of solutions to improve the quality of telemedicine services”. It is a response to the draft ordinance of the Ministry of Health, which in some cases limits the possibility of using telemedicine.

The new rules for teleporting are to enter into force on October 1. In a few cases, the regulations limit or even exclude the possibility of remote consultation with a doctor, only direct contact during a visit to the facility will be allowed. This will happen, for example, in the event of a new disease, a change in symptoms in a chronic disease or a visit by a child up to 6 years of age.

Both the medical and patient communities are protesting against the changes, Employers’ unions have a negative opinion, and online consultation companies also raise objections.

Many organizations emphasize that the new regulations will make it difficult to access specialists, limit the possibility 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. We cannot forget about the prevailing pandemic, so the necessity to make a stationary visit may still pose an epidemiological threat.

Telemedicine is a specialized use of IT in many areas of patient care

At the beginning, Jan Pachocki, who hosted the meeting, emphasized that telemedicine is not only a solution reduced to teleportation over the phone, it is also a specialized use of IT in many areas of patient care. This solution is constantly moving forward, new technological solutions are added.

– This requires joint work to prepare standards, refresh them so that all participants of the health care system can use these solutions at the best possible level and, above all, that the patient is satisfied and aware of this process – he stressed.

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– We have prepared many documents to improve the quality of telemedicine services. We have prepared guides for patients and doctors on how to use it. The draft regulation, which is currently being processed, has a lot of good, but it introduces a few limitations that may set us back in the development of modern technologies in the health care system by a few years. The legislative change is a good opportunity to integrate the environment and develop appropriate solutions that will ensure quality improvement. We have prepared a declaration signed by 21 leading organizations and we want to start working as soon as possible and prepare a standard that will meet the needs of the XNUMXst century Pachocki said.

Telemedicine plays a very important role in diabetology

Prof. Agnieszka Szadkowska, the secretary of the Polish Society of Diabetologists said that telemedicine in diabetology has been present for 20 years and plays a very important role in controlling the course of the disease, also with the use of devices that remotely monitor the patient’s condition.

– We have glucose meters with applications, continuous glucose monitoring systems. Thanks to this, we can connect with patients remotely and download data on their glycemic results, which are the basis for assessing the treatment of a patient with diabetes. During the pandemic, we gave a lot of telemedicine visits, we found ourselves very well in telemedicine. We have legally sanctioned possibilities of using teleportation and what we could not report in the past, now we have the possibility – she added.

Szadkowska said that when it comes to first-time visits, during the pandemic this number in diabetology decreased, also in the case of children. If telemedicine allowed for more, this decrease would be smaller. – It is good if we can see the patient in the office during the first visit, but in many cases, also in other specialties, we could have the first visit telemedically. It would save time. If the patient is well prepared by the GP, examined, and the results are sent to us, and we are to determine the treatment path, we can really do it in the form of teleportation. The next one may be stationary, when specialist examinations are needed. We can obtain glycemic data remotely – emphasized prof. Szadkowska.

Telemedicine has been present in cardiology for years

Telemedicine has also been present in cardiology for several years.

– Cardiology is a medicine where telecare standards were introduced early, such as broadcasting ECG from ambulances, we have telerehabilitation, teleporting was conducted back in the days of the minister, prof. Zembali. We were partially prepared, the pandemic accelerated the progress, showed that it is necessary to start and extend remote medical care. The pandemic has also shown that a golden mean must be found. Patients may not have enough care or contact. Telemedicine should not be implemented everywhere. But we wrote down the rules according to which telepaths can be used, but also situations when they should not be used – said Prof. Marcin Grabowski, spokesman for the Polish Society of Cardiology.

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According to Grabowski, even a third of the advice could be done remotely. 60 percent patients require personal contact, but it does not have to be the first visit. A spokesman for PTK stated that the provisions on the inability to make the first visit remotely close certain solutions in cardiology. – I know from personal experience that many patients came to the cardiologist only because there was a possibility of teleportation. Putting the matter in a restrictive manner will result in the fact that some of our activities will be limited – added Grabowski.

Finally, a spokesman for PTK pointed out that the burden of responsibility for whether teleportation is enough or a personal visit is needed rests with the doctor.

ECG sent in the form of telemedicine

Another interviewee, cardiologist Dr. Łukasz Kołtowski He noted that the last six years have been a continuous development of legislation, unlocking the possibility of providing telemedicine services and looking at telemedicine by the medical community as a real alternative to traditional medical, sometimes as an even more effective way of providing healthcare. – The pandemic accelerated this process, we have many examples, not only in cardiology, but also in pulmonology, that telemedicine solutions worked well in a situation where a personal visit was not possible – added Dr. Kołtowski.

– I am observing with great concern all barriers on the path of development, a return to the model when a doctor cannot perform telemedicine services would be a big blow. As a practicing cardiologist, I can say that I take several or a dozen ECGs daily in the telemedical form. I cannot imagine a situation where we could not provide specialist teleconsultation, but only send the patient to the hospital – Kołtowski emphasized.

Pandemic remote solutions are a blessing

They made a similar statement Agnieszka Wołczenko, president of the National Association of Patients with Heart and Vascular Diseases “EcoSerce”. Her medical care will be very quickly focused on remote solutions.

– It is inevitable. Such solutions have been functioning in the world for years. In our country, remote ECG transmission from ambulances made a revolution – she reminded.

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– Pandemic remote solutions are a blessing. I am talking about diagnosed patients who continue their treatment. At the time when we were dealing with limited access to real visits, if we had the majority of remote consultations, we would have fewer deaths, not so much from COVID-19, but due to the inability to react or diagnose quickly – she noted.

Volchenko emphasized what many specialists commenting on the Ministry of Health’s telemedicine project said – the patient should be able to decide whether he wants to use teleportation or real advice.

– The development of telemedicine in patients with heart failure is very important. For example because of the place of residence. The issue of inequality in access to benefits has been discussed for a long time. The decision should lie with the attending physician and the patient. This cannot be ruled out systematically. Even for the first visit. If at POZ we are prepared for specialist consultations, we have test results, then a television visit with a specialist is already effective – emphasized Agnieszka Wołczenko.

The President of the National Association of Patients with Heart and Vascular Diseases noted that our neighbors’ remote solutions are part of the standard of cardiological care. There, patients feel safe and feel cared for.

– Telemedicine is not only teleportation, there are many technological solutions, we can perfectly take care of patients in terms of rehabilitation. Good care in this area reduces the need for hospitalization. The costs of caring for cardiac patients can drop significantly – she said.

Telemedicine was treated as a necessary evil, and the exact opposite is true

Prof. Ryszard Piotrowicz, chairman of the IT and Telemedicine Committee, noted that telemedicine was promoted by the pandemic, it was introduced suddenly and unexpectedly. This resulted in side effects, hence, in some bodies, telemedicine was treated as a necessary evil. – This is a view that we must combat. It is exactly the opposite. Telemedicine is a remedy for deficiencies in the functioning of the health service – he stressed.

In his opinion, it is good for the Ministry of Health to create a document to organize this, but the current project is “too administrative” and destroys the whole idea.

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– This is binary order. And medicine does not work like that – he emphasized.

The paragraph that defines situations where telemedicine cannot be used is the most controversial. Then, as he pointed out, telemedicine is reduced only to a control role. – And the opposite is true. Telemedicine will play the greatest role precisely in those situations where something new is happening. The patient waits for an appointment for several weeks, and thanks to telemedicine it can be within 24 hours or even earlier, he said.

– Telemedicine releases the importance of intelligence. Let’s go back to the tradition of the interview. Thanks to the conversation with the patient, the doctor will decide whether the patient requires emergency assistance, an emergency visit, whether it is enough to change the treatment or call an ambulance.. This is not taken into account by the proposals of the Ministry of Health document. It should be a document of a kind of “telemedicine functioning strategy in Poland” and it should be decided by doctors for the benefit of patients and in consultation with the patient. The inability to decide about it is the way medicine goes back to the Middle Ages – emphasized prof. Piotrowicz.

Telemedicine solutions support the patient’s treatment process

According to Magdalena Kołodziej, president of the My Patients Foundation, the patients felt that telemedicine solutions found their place in the system. – They believe that this ordinance from March is respected, there are no more abuses, which were mentioned earlier, they appreciate the possibility of remote contact. Four-fifths of respondents admitted that this contact was sufficient. During the teleportation it is possible to make another traditional visit, the doctor in many cases proposes such a solution – emphasized Kołodziej.

She noted that when the patient, for many reasons, is not able to come to a stationary visit, telemedicine solutions support the patient’s treatment process.

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– It can be seen from the experience of patients and doctors that the first visit is not always required in the office. We are seeing a decline in first-time visits. If we ban them in the form of teleportation, the decline could be even greater. Prohibitions do not work, it is important that the patient can make such a decision, or it is better to use teleportation quickly, and a stationary visit would be a supplement – said the president of the My Patients Foundation.

Telemedicine complements and strengthens traditional medicine

What to do to maximize the possibilities and benefits of telemedicine? He tried to answer this question Andrzej Osuch, an expert of Employers of the Republic of Poland.

– First of all, in order to go the right way, we should realize the scale of using telemedicine. The problem is that the current attempts to limit the negative phenomena are very general, non-selective. We need a point of reference. Such a point could be the standard that we propose during this meeting. Organizations that have joined the project to create this standard do not want it to be of an administrative nature. The standard we propose is a more selective, more specific, specialized and flexible tool, said Osuch.

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The representative of Employers of the Republic of Poland said that a test sample appears where telemedicine is introduced instead of classical medical care. – And telemedicine works best, not trying to replace traditional medicine, but complementing and strengthening it – He said, adding that the doctor, using medical indications, is able to plan the patient’s path in the best way, in a situation where the forms of traditional and remote medicine complement each other.

The conference was attended by prof. Marcin Grabowski, spokesman of the Polish Society of Cardiology; Magdalena Kołodziej, president of the My Patients Foundation; Andrzej Osuch, vice-president of the Telemedicine Working Group Foundation; Jan Pachocki, president of the Telemedicine Working Group Foundation; prof. Ryszard Piotrowicz, chairman of the IT and Telemedicine Committee of the Polish Cardiac Society; prof. Agnieszka Szadkowska, secretary of the Polish Diabetes Society; Agnieszka Wołczenko, president of the National Association of Patients with Heart and Vascular Diseases “EcoSerce” and a cardiologist, Dr. Łukasz Kołtowski.

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