What are Telemedicine and its Regulations and Future Challenges?

What is telemedicine?

所谓的远程医疗是informati的使用on and telecommunications technology to exchange medical and clinical data and expert opinions of patients in two places to overcome obstacles in space and even time. It combines the professional knowledge of computers, communication technology, and medical staff so that doctors can conduct video conferences and see doctors in the air thousands of miles away, provide comprehensive medical care for people in remote and outlying areas, and also provide teaching and training for doctors and nursing staff. Chance. The definition and content of telemedicine have also changed with the progress of the times. In a narrower sense, telemedicine refers to specialized subjects such as teleradiology, telepsychiatry, and telepathology. In a slightly broader interpretation, telemedicine refers to the act of taking medical care in two places separated by a certain distance. Telemedicine refers to the behavior of long-distance health care, including various clinical medical applications and medical and health education.

COVID-19 affects the development of telemedicine in various countries

U.S. Telemedicine Development

About 60% of consumers in the United States express their willingness to use telemedicine, but only 8% of them have used it. Age is an important factor that affects the willingness to use telemedicine. In addition, nearly half of the patients who have used telemedicine are concentrated in the south.

U.S. telemedicine regulations loosened

In response to the amendment of the Bipartisan Budget Act of 2018 (Bipartisan Budget Act of 2018), the Centers for Medicare and Medicaid Services (CMS) for patients with end-stage renal disease, acute stroke treatment, etc., relax the designated areas and facilities of Medicare Restrictions; and starting from January 2019, payment will be made for part of the service fees that use communication technologies (non-telemedical services), such as short communication, Virtual Check-Ins, and remote evaluation of pre-recorded patient information.

The United States Medicare (Medicare) only pays for the following conditions:

• Patients receiving telemedicine are located in designated rural areas.
• Receive telemedicine services in clinics, hospitals, rural health centers, health centers with federal data, nursing facilities, community mental health centers, dialysis centers, etc.

Advantages of telemedicine development:

Telemedicine can continue to provide services, whether during the COVID-19 period or after the epidemic is over, it will become one of the important ways to provide medical services.

• Increase the patient's chances of getting care
• Reduce patient demand for medical facilities and equipment
• Reduce the chance of contact between medical staff and patients
• Patients with chronic diseases can seek medical treatment through telemedicine
• Telemedicine-related data can be used to improve public health surveillance systems

During the epidemic, the service methods provided by telemedicine in the United States

• Improve telemedicine services to make them easier to use
• Screen patients suspected of COVID-19 through telemedicine, or guide confirmed cases
• Treatment of mild patients

Recommendations for infection prevention and control during an epidemic

• CDC formulates COVID-19 infection prevention and control recommendations for medical institutions, as well as precautions for providing nursing care

Provide non-COVID-19 clinical care during the epidemic

• CDC develops a framework for providing non-COVID-19 clinical care during the epidemic

Recommendations for other healthcare facilities

• For pharmacies, clinics, and other places, it is recommended to post notices on the doors, provide masks before entering specific areas, provide separate entrances for patients, etc., and formulate guidelines for pharmacies

U.S. telemedicine policies and regulations

• Relaxing Medicare's restrictions on telemedicine
• Penalties are temporarily not applicable to telemedicine activities

U.S. Telemedicine Commercial Insurance

• Insurance companies expand the scope of insurance coverage and exempt deductibles

Medical scene

• CDC develops guidelines for the operation and management of medical institutions and provides services through telemedicine
• AMA developed a telemedicine manual to assist in the introduction of telemedicine at the medical site

Japan Telemedicine Development

According to the data of the Japan Medical Innovation Association, 1,250 medical institutions can implement online diagnosis and treatment before April 2020, and it has grown to 1,596 in May. In addition, according to the annual report of the Central Social Insurance Medical Council, about 10.7% of the people who have received online diagnosis and treatment, and the patients who have never had online diagnosis and treatment experience, the main reasons are in order: they want to receive face-to-face diagnosis and treatment, and the doctor did not propose to go online. Diagnosis and treatment, and did not feel the necessity of online diagnosis and treatment.

The evolution of telemedicine in Japan

• 1997: Based on the principle of face-to-face diagnosis and treatment, telemedicine is only limited to specific situations such as outlying islands and remote areas. No clear standards have been established and the cost of diagnosis and treatment for telemedicine has not yet been reviewed.
• 2008: A conference on telemedicine promotion measures was held, and a report was submitted in July 2008, suggesting that telemedicine can be selected for chronic diseases, health management, etc., and the cost of telemedicine diagnosis and treatment should be reviewed.
• 2015~2017: With the development of ICT and other technologies, it is pointed out that telemedicine can be used in outlying islands and remote areas, and it is proposed to adjust the cost of diagnosis and treatment.
• 2018: Formulate the "Guidelines for the Appropriate Implementation of Online Diagnosis and Treatment", clearly point out that the principle of face-to-face diagnosis and treatment is the principle of initial diagnosis, revised diagnosis and treatment fees, and added online diagnosis and treatment fees.
• 2020: To solve the problems after the publication of the guidelines and in response to the impact of the Covid-19 epidemic, review and revise the guidelines, and relax the restrictions on face-to-face consultations at first visits in a time-limited and exceptional manner.

Guidelines for proper implementation of online diagnosis and treatment

• Change the diagnosis and treatment behavior of using communication equipment from telemedicine to online diagnosis and treatment
• It stipulates the matters to be followed and the matters recommended for the online diagnosis and treatment
• Online diagnosis and treatment activities that comply with the matters to be observed in this guideline will not violate the provisions of Article 20 of the Japanese Medical Doctor Act "No diagnosis and treatment prohibition".

Japan's telemedicine development after the epidemic

• Based on safety and trust, lift the restriction on face-to-face treatment at the first visit
• Telemedicine is based on the principle of imaging
• Safety and reliability need to be comprehensively judged

Japanese telemedicine policies and regulations

• Review and revise online diagnosis and treatment guidelines
• Relax the principle of face-to-face diagnosis and treatment for the first visit in a limited time and exceptional manner

Japan Telemedicine Insurance Applicable

• In principle, only patients who meet the requirements of the online diagnosis and treatment guidelines are eligible for medical insurance
• Affected by the epidemic, relax restrictions on face-to-face diagnosis and treatment, and expand insurance coverage
• However, the cost of online diagnosis and treatment is relatively low, which may affect the willingness of medical institutions to introduce

Medical scene

• In response to the government’s goal of fully opening up online diagnosis and treatment, the Japanese Medical Association expressed its opposition to the reason that online diagnosis and treatment would be less paid and resources would be concentrated in large hospitals.

China Telemedicine Development

Before the outbreak of the epidemic, about 24% of people had used telemedicine. Between December 2019 and January 2020, the number of users of China's medical service platform increased significantly, indicating that Covid-19 will accelerate the development of China's telemedicine industry.

The evolution of China's telemedicine development

• 2018: In response to the "Opinions of the General Office of the State Council on Promoting the Development of Internet + Medical Health", the National Health Commission formulated the "Internet Diagnosis and Treatment Management Measures", the "Internet Hospital Management Measures" and the "Management Regulations for Telemedicine Services".
• 2019: The National Medical Insurance Bureau announced the "Guiding Opinions on Improving Internet + Medical Service Prices and Medical Insurance Payment Policies", confirming for the first time that telemedicine can be included in the scope of medical insurance payment.
• February 2020: The National Health Commission announced the "Notice of the General Office of the National Health Commission on Strengthening Informa ionization to Support the Prevention and Control of Pneumonia Epidemic Caused by COVID-19 Virus Infection."
• July 2020: The State Council announced the "Implementation Opinions on Further Optimizing the Business Environment and Better Serving Market Entities", and proposed 6 measures, including further relaxing the scope of telemedicine and including eligible telemedicine into medical insurance.

China's medical-related policies

February 3, 2020: The General Office of the National Health Commission Announcement to support the prevention and control of the pneumonia epidemic caused by COVID-19 virus infection

• Strengthen data analysis applications:Use the Internet to transmit disease data, analyze and predict through big data, as a basis for governance
• Actively develop telemedicine services:Encourage remote diagnosis and treatment services in major hospitals to alleviate the pressure of the epidemic; provide training through remote education to improve grassroots
• Deepen Internet + Government Services:Strengthen the single-window service on the Internet to avoid virus infection through long-distance and non-contact
• SStandardize online diagnosis and treatment consulting services:Centralize online diagnosis and treatment platforms and hospital websites to promote online consultation, guidance, and other services in hospitals at all levels
• 加强基础设施和安全:Strengthen network infrastructure and information security protection

China Telemedicine Policies and Regulations

• The "Administrative Measures for Internet Diagnosis and Treatment" only applies to some common diseases and chronic disease follow-up visits, not to newly diagnosed patients; except for specific drugs, doctors can prescribe online
• "Telemedicine Management Specification" defines telemedicine services and requirements
• Inviting medical personnel to provide medical services through the platform must apply for the establishment of an Internet hospital, which shall be managed by the "Internet Hospital Management Measures"

China Telemedicine Insurance Applicable

• Announcing that telemedicine will be included in medical insurance

Medical scene

• Compared with the speed of policies and regulations, telemedicine services are developing vigorously

Taiwan Telemedicine Development

The evolution of telemedicine in Taiwan

• 2018: The Ministry of Health and Welfare announced the "Communication Diagnosis and Treatment Measures" to relax telemedicine targets:
  1. Mountainous remote islands
  2. Follow-up treatment of acute inpatients after discharge
  3. Long-term care service users
  4. Family physician diagnosis and treatment
  5. Perform follow-up treatment of remote care or home care
  6. International patients
• February 2020:
  The method of medical treatment for the home quarantine or home quarantine of the Ministry of Health and Welfare for quarantine or anti-epidemic measures can be handled by the "Communications, Inspection, and Treatment Measures":
  1. Immediate medical treatment is required: Physician Act §11+ "Communications, Inspection, and Treatment Methods"
  2. Patients with chronic diseases: §7 of the National Health Insurance Medical Treatment Method or "Communications, Inspection and Treatment Method"

  The Ministry of Health and Welfare added:

  1. Evaluate that patient who have medical needs during the quarantine period can be used for telemedicine, and are not limited to non-newly diagnosed patients
  2. When medical institutions implement communication diagnosis and treatment, they should still comply with the items listed in §7
• April 2020: The Ministry of Health and Welfare announced the "National Health Insurance Specialized Medical Service Institutions Provide Instructions for Insured Subjects Subject to Home Quarantine or Quarantine due to the COVID19 Epidemic". The cost of video diagnosis and treatment is covered by the total health insurance budget, and the subject is restricted to cooperating with the quarantine. , Those who have been referred by the Health Bureau without fever or respiratory symptoms and have urgent medical needs.

Current status of the legal system of telemedicine in Taiwan>

国家健康保险机构宣布"National Health Insurance Telemedicine Benefit Plan", which aims to improve the accessibility of specialist outpatient clinics for people in remote mountainous islands and remote areas and to implement localized medical care.

Taiwan Telemedicine Policies and Regulations

• Releasing restrictions on the applicable objects of the "Communications, Diagnosis, and Treatment Measures" through administrative letters
• However, when medical institutions implement communication diagnosis and treatment, they should still abide by §7 of the Measures

Health Insurance Applicable

• Open up mountainous areas, outlying islands, remote areas, and remote medical service providers to be included in health insurance payments

Medical scene

• Local governments, medical institutions, and enterprises cooperate to promote telemedicine projects
• Telemedicine platform: Divided into telediagnosis/consultation, monitoring, health management, etc., mainly large-scale medical centers and regional hospitals; there is also a psychological consultation platform

Future Challenges of Telemedicine in Taiwan

• Health insurance payment package:
  美国扩大insuranc的报道e benefits; Japan adjusts the cost of diagnosis and treatment; China reviews comprehensively including telemedicine into medical insurance. Taiwan will include telemedicine in its health insurance payment in 2021, which is expected to promote the development of related industries. Only the remote platform involves the use of special personal information.
• Post-epidemic era:
  Before Covid-19, telemedicine in various countries was based on the principle of face-to-face, and the applicable objects were restricted. When the epidemic is over, will telemedicine be restored to its original state, or will be opened up? How to avoid the problem of centralized medical resources caused by telemedicine in large hospitals?
• Diagnosis and treatment methods and restrictions:
  
  • Assess the patient's need for medical treatment, and implement communication diagnosis and treatment methods
  • A way to evaluate patients who are not suitable for communication diagnosis and treatment or have in-person diagnosis and treatment needs
  • Are there restrictions on the number of specific drugs that cannot be prescribed?
• Drug collection and delivery
• There is no sign when the patient prints it by himself; a way to avoid forging prescriptions
• 药品应交付的pharmacist in person and must not be cross-regional, and the medicines should not be mailed or delivered at home. In the future, it is necessary to review and revise the regulations of the Doctor Law and Pharmacist Law

The COVID-19 epidemic has hit the world and has caused major changes in people's lifestyles or economic and industrial development. The zero-contact and remote medical care model may become the new normal in the future.