Requirements for application of telemedicine in medical practice

Telemedicine in Ukraine

Today, we have the opportunity to apply the latest means of communication in various spheres of life. Keeping pace with the times, the society introduces innovative ideas and mechanisms in the most important fields of activity, in particular in medicine.

Nowadays, one of the newest achievements and developments in the field of medicine is telemedicine.

Today we will elaborate on what telemedicine is, the implementation process, the requirements for medical staff and for the process of providing such consultations.

What is telemedicine?

Telemedicine refers to a set of activities, technologies and measures carried out by physicians and other participants of the telemedicine process aimed at providing medical care to a patient.

Unlike traditional in-hospital consulting, teleconsultation is provided via electronic communication.

It’s very easy to understand why telemedicine is convenient. There are no queues, you don’t need to wait long for the doctor and spend time on the road. It allows doctors to hold joint consultations without leaving the office. Today, teleconsultation can have a significant positive impact on the doctors’ work in rural outpatient clinics.

How it works

Telemedicine involves establishing telemedicine network that consists of:

• Legal entities: healthcare facilities;
• Individual entrepreneurs engaged in medical practice.

In this regard, there was created a specialized online platform, Telemedicine Portal, for joint work. The portal ensures electronic communication between the participants of the process and registration of all stages of remote consultation.

The Portal involves the use of electronic communications to connect participants.

To set up the Telemedicine Portal within your healthcare facility, the future Telemedicine Network Participant shall conclude an agreement with other Participants.

Telemedicine Tools

The telemedicine tools and technologies include:

• Teleconsultation
• involves assistance to patients in terms of treatment and refinement of the diagnosis by electronic communication via the Telemedicine Portal. In this process, the physician may provide recommendations regarding the patient’s health status directly to the patient, or explain the case to other physicians on the basis of images or images recorded on digital media (ECG data, X-ray films, etc.).
• Case teleconference is a teleconsultation conducted by several doctors at the same time.
• Telemetry is a technology that enables remote collection and transmission of information on a patient’s health status. It can be used when it is necessary to constantly monitor the patient’s physiological parameters, as well as the treatment process. For example, patients undergoing treatment after the coronary intervention, can remotely transmit their data with the help of sensors and a mobile ECG system.
• Home teleconsultation.
• is the direct communication between the patient and the doctor via video, telephone or the Internet. Home teleconsultation also allows a doctor to monitor the patient’s health during treatment.

Who is entitled to provide teleconsultations?

Teleconsultations can be provided by:

• Medical specialists, employees of the higher medical educational institutions (in this case, the agreement shall be concluded with a legal entity, a hospital/higher educational institution);
• Individual entrepreneurs who are entitled to practice medicine.

It is necessary to distinguish between them, since individual entrepreneurs do not need to design a telemedicine room in this case.

Thus, the following information is prepared for legal entities wishing to join the Telemedicine Portal.

The room is a structural subdivision of the healthcare facility that shall be be equipped according to the List of equipment of the telemedicine room.

A telemedicine room is a room provided by the head of the institution to carry out telemedicine activities. It shall be equipped with:

• Multimedia-enabled PC;
• Webcam and digital camera;
• Scanner;
• Uninterruptible power supply (UPS);
• Telemetry system;
• Appropriate software, high-speed Internet connection and other equipment according to the List of available equipment.

It’s worth mentioning that in addition to physicians who have undergone appropriate training (methodology of work with the Portal, instructions, etc.), the staff of the telemedicine room includes also nurses responsible for maintaining appropriate records and technicians responsible for appropriate functioning of technical and software equipment of the Room.

Consultation process

So, let’s elaborate on the teleconsultation process and its peculiarities.

Teleconsultations may be required, for example, when a patient and his/her physician need additional professional advice from another specialist, a consulting physician.

The first stage of the process involves submission of the Request by a regular physician where the physician believes it is appropriate.

Such a Request shall be created in accordance with Form No. 001 / tm in the Telemedicine Portal. It is actually an e-mail with the physician’s electronic digital signature.

Note! The Request shall contain all additional materials related to the medical case, including the results of previous examinations X-ray, MRT CT, ultrasound results, etc.).

If, for any reason, the physician does not have a digital signature, he/she shall sign the original paper copy of the Request and send it by post or courier service to the office of the consulting physician. Such a Request shall be personally signed and stamped by the physician.

The Request, the time of the consultation, all the data on the Request and the name of the consulting physician shall be registered in the Register of Teleconsultation according to Form No. 003 / tm created in the Portal.

After registration, the Request is sent to the consulting physician via e-mail or in electronic format.

The next stage involves processing of the data by the consulting physician and delivery of his/her Conclusion in accordance with Form No. 002 / tm. The Conclusion shall be digitally signed by the consulting physician and sent via the Telemedicine Portal to the physician who submitted the Request.

In some cases, such a Request may have the status of "Urgent" that means that the consulting physician should provide his/her Conclusion as soon as possible on a first priority basis. The Request may be handled by means of online video and audio communication.

Based on the results of the teleconsultation, a corresponding entry is made in the Register according to Form No. 003 / tm. It shall specify the date of the Conclusion receipt or the consultation refusing date.

A consulting physician may refuse to provide consultations if the Request is not made in accordance with Form No. 001 / tm.

The Case Teleconference follows the same procedure, but the Request shall be sent simultaneously to several physicians acting as consultants.

Conclusion

Thus, if you are a private physician and want to provide telemedicine services, you shall first of all follow the steps below:

• Design a separate telemedicine room (for legal entities), or get special equipment (without the need to design a room), if you work as an individual entrepreneur;
• Employ the necessary staff as specified above;
• Obtain an appropriate license at the Ministry of Health of Ukraine;
• Connect your facility to the Telemedicine Portal and comply with the terms and conditions of its use;
• Maintain records on the provision of medical care using telemedicine as required by the law.