Russian law on telemedicine allows to embrace a vaster number of patients to provide healthcare than it used to. However, it has a range of drawbacks. That is a point of view of a medical lawyer Irina Gritsenko who will speak at M-Health. In her interview, Irina dwelled on the pros and cons of a telemedicine law and its prospects for doctors and patients.
Interviewer: M-Health Congress (MHC).
Respondent: Irina Gritsenko (I. G.).
MHC: What do you think are pros and cons of a law on telemedicine?
I. G.: The mere legalization of telemedicine is an advantage because a vast number of healthcare institutions provide real remote services. Besides, any doctor has acquaintances and friends who call even from other countries to ask for recommendations in case of itch or redness. They send photos, and doctors easily give advice.
We have this state of things because foreign people happen to find it pretty difficult to get healthcare service by insurance. That is why telemedicine is a real key bridging a gap between medicine and people.
On the other hand, it helps sort medical cases. Some of them may be emergency, difficult, requiring serious labs and laboratory tests. In other cases, it would be enough to set somebody’s mind at rest and recommend visiting a hospital in case things get worse. That is why a big plus of telemedicine lies in the legalization of actions of doctors who currently practice the new method.
Cons accompany the law realization. For instance, in order to provide medical assistance, a voluntary informed consent needs to be signed by a patient. It means that a patient has to be granted a digital signature, which is not that popular among the Russians. Such technical aspects need to be solved. Another important task is the reconciliation of various institutions.
MHC: What possibilities and rights does a law grant to patients and patients?
I. G.: You should not regard this law as something supernatural. It is Federal Law No. 323-FZ that stipulates the basic duties of doctors and patients. However, diagnosing and recommendation of medical treatment via remote consulting are not allowed. A doctor can only tell a patient about the need for emergency as well as change the ongoing treatment scheme. Thus, this law significantly reduces the scope of doctors’ rights and duties compared to a face-to-face examination.
MHC: What aspects of this law need to be amended and why?
I. G.: It’s important to find out the principle of interaction with general information systems connected to healthcare institutions. The point lies in a type of software to buy for remote healthcare assistance. The reason for that is the importance of a physician–patient privilege that is protected by the law. Thus, program software has to be safe.
MHC: What remote medical services can a doctor provide? What legal implications will a doctor suffer in case of other services provision?
I. G.: First of all, a doctor cannot make a diagnosis by means of telemedical technologies. They are allowed to bring changes to the ongoing treatment, examine a patient’s health state and say whether he or she needs to make a face-to-face appointment at hospital.
Concerning legal implications in case of other services delivery, let’s mention three types of responsibility in Russia: civil, administrative, and criminal. Doctor’s actions are rendered in relation to the requirements of certain legal articles. In case a doctor does harm to a patient’s health state, he or she will be made liable for a poor healthcare service because telemedicine is also a medical service.
MHC: Who to address in case of data leakage? Who would be liable for that?
I. G.: The legal terms remain the same. If it is a criminal case, address a juridical person who has a license i. e. a clinic. If it is an administrative case, articles provide fines for both juridical persons and officials.
MHC: Can doctors write a prescription for psychotropic and drug medication remotely? What are the advantages of this method?
I. G.: There aren’t any direct references concerning this information. However, my answer is as follows – no, they can’t. Prescriptions are filled with ink or ballpoint pens, or printed. For instance, prescriptions written on a 107/u-NP form are signed not only by a doctor but by a head of a healthcare organization. So, live signatures should be given.
If a patient receives a prescription with a signature and a digital signature, this form will automatically become a copy when printed. Drug stores accept only original prescriptions.
Besides, there is the risk of recipe’s unlimited copying, their fabrication using various graphical programs. Including this point in telemedical services would be too risky in terms of possible inconveniences and liability.
MHC: Can patients dissatisfied with telemedical services file a lawsuit? What will be a sufficient reason for a medical malpractice charge during remote consultations?
I. G.: Yes, dissatisfied patients can file a lawsuit. A patient’s common right is applying to a court in case of discontent with a hospital with a justification of the complaint. Among the reasons, there are: negligence during remote consultations, damage to health as a result of an incorrect consultation, etc.
It should be noted that the requirements to a medical service remain the same regardless of the type of medical service: be it face-to-face or telemedical. Any service should be high-qualitative. It should be provided by a certified professional that works at a licensed medical institution.
In order to render actions towards a patient as criminal, they should consist of three components: 1) defect in medical assistance; 2) deterioration in the patient’s condition or his or her death; 3) direct cause-and-effect link between the first and the second points.
MHC: Can doctors provide legal private telemedical services if they do not work at a medical institution?
I. G.: No, they can’t. Currently, services in the sphere of telemedicine are available only at licensed organizations. That is why a doctor as a natural person cannot offer such services. It is doable only if a doctor registers an individual entrepreneur and gets a license for medical services. If he or she is a usual physician, there is no right to provide medical consultations.