EHS-COVID (288) Webinar: Telemedicine during the COVID-19 Pandemic: lessons learned one year later (2) Notes from the meeting

13 May, 2021

[Our thanks to HIFA member Richard Fitton who took notes on behalf of HIFA. I am also passing these notes to our colleagues on HIFA-Spanish. Comments and observations on the use of telemedicine during COVID-19, in the PAHO region and worldwide, are welcome. Neil PW, moderator]

There were over 300 participants and over 40 questions – education and training being the most frequent question.

'The webinar focused on what had been learned during the year – to define specifics for going forward. The event was planned to show the experiences of four countries in the region that were successful in expanding the use of telemedicine to share challenges, successes, and opportunities for improvement for other countries in the region. During the pandemic caused by COVID-19, many countries opted for telemedicine solutions to protect the population, health professionals, and to maintain the provision of services not related to COVID-19 to the population, one of the most relevant examples is related to chronic diseases. These countries have many lessons and experiences that are worth rescuing to be used by other countries in the region.'

The delegates of the webinar wanted specifics embedded in public policy...

An immediate problem for all countries had been how to stay at home whilst not preventing access to healthcare. During covid, a number of countries had seen a 10 fold increase in the use of telemedicine. Regulations and public policies had needed to be enacted to enable implementation of telemedicine.

COSTA RICA - Social Health integration with IT had started in 1998 and some videoconferencing and telehealth visits already took place. Only partial guidelines on telehealth visits existed at the start of the pandemic and Costa Rica had had to work on guidelines to make telehealth work legally for different professional and trade organizations. This was leading to a much broader regulation of telehealth, telemonitoring and referral guidelines.

Key challenges - needs the designing of a regulatory framework that is compiled from experience and that not only steers the design of telehealth law on privacy but aids the development of protocols that provide quality healthcare to patients. Resources must be used well for teleconsulting and teleconferencing. All must be advanced in order to enable personnel to become more involved to complement the full use of telemedicine.

Human resources need to engage with professional healthcare groups to ensure full engagement of sharing information with patients and telemedicine and to increase professional health literacy. Telemedicine must integrate with face to face medicine.

Began training personnel in telemedicine, telehealth with educating, teaching for students after covid in 2020. Many personnel did not have experience with platforms. Providers and patients need to have education from centres. Patients do not yet understand the telemedicine models of care.

COLOMBIA - Social Protection has had telehealth from 1997 onwards. More laws were required for telehealth and telemedicine to improve telemedicine and telehealth quality and regulations for the country. More needed to be done for the use of telemedicine in the fields of equity of access and finance. In 2020, it had been easier to implement and advance services for homebound citizens and those treated by hospitals. An action plan to mitigate the effects and spread of covid 19, to support distancing, and to meet all the requirements of digital platforms had required the loosening of some health regulations. Other areas of required change are to meet professionals, measure results of new care pathways and to produce new guidelines for telehealth.

Key challenges - There are gaps in equity of digital access. There is a lack of interconnectivity of medical devices and mobile tools. Information and data security and protection are necessary. Many jurisdictions lack connectivity. There is a question of how Colombia provides digital healthcare that is specifically tailored to health care in Columbia. Appropriate telemedicine training will be required within the framework of health care funding. Measurements of results, incentives, sustainability and guidelines are needed.

URUGUAY - had laws on medical ethics before covid. Telemedicine had been seen as supplementary care but needed to be connected with traditional physical care (face to face). The service offering of telemedicine had to be improved to enhance services and to make use of funds more efficiently. Privacy needed to be assured. New regulations had been implemented just before the rise of Covid cases in April 2021 to receive enabling, comprehensive, forward looking, equitable and enhanced services.

Key challenges - The regions have strong leadership. Providers of care already have a tradition and foundation of telemedicine. Prior to covid there were many initiatives including telesonagrams, mobile emergency telemedicine etc. From April 60% of outpatients have been addressed through digital technologies. It is uncertain whether this will continue after the pandemic. There will be a review summary made in the community. Improvement of regulatory standards of processes needed to improve flow of telemedicine and legislation to support the improvement. Improvement and change in training of professional and health personnel is necessary. Standardisation of protocols and procedures to deliver information to patients are necessary. Metrics of patients’ and professionals’ use of the telemedicine are necessary. There is an uncertainty about the level of continuation of telemedicine after covid. And work is needed with professionals to make changes of patient processing.

Has done surveys in telemedicine. There are major gaps in training of health and IT professionals. These in turn could become trainers and communicators. Primary care has a broad base of relationships with patients in which education of patients could take place. Patients need to know “Can I go on line to deal with these health matters or not?” There is a pressing need to build trust bridging human needs with the services provided. The public has a mature experience of online financial services and the same should occur with on line health services. Six million people under “assistance to elderly people” are using teleprescriptions. Work is taking place with insurance companies as well as with service providers. Young people can become frustrated with teleservices.

ARGENTINA - had increased the scope and scale of ICT which has become more main frame to health service provision. Primary health services are particularly integrated with digital processes. In 2014 regulations to build governance to support digital care sponsored by the ministry had worked. Bringing IT integration to physical health in 24 jurisdictions is in progress. Professional training had taken parts in schools and there had been a blanket agreement to register health professionals. A Bill had been passed to enable electronic prescriptions and telemedicine in 16 of 24 jurisdictions. The most recent telemedicine meeting has been on teleprescriptions. Various jurisdictions will need to come together to present together to the ministry. 9 provinces are well placed having provided connectivity throughout their boundaries

Argentina telemedicine is in a fledgling stage. The pandemic has improved standards and implementation. Telemedicine and teleprescribing seems ready to mushroom. Private services have to move to government frameworks of working for quality gains.

Argentina - needs regulations for professionals and reassurance and education of the public. Advocacy to the public of some form will be necessary. Argentina must make sure people know that the best of what telemedicine Argentina has is being used. Some jurisdictions have had more public engagement than others. It has been important to engage with all agencies as telemedicine is deployed. Management needs to know the numbers of teleconsultations and ideally would like to know from health professionals which processes of care could utilise telemedicine. The culture of healthcare needs to change as a whole with a more unified front to bring these service providers to be consistent. Nationally all health personnel need to be trained n telemedicine and training needs to be in the undergraduate curriculum.

BRAZIL- Major regulations have been passed to allow doctors and hospitals to use telemedicine. There has been experience of telemedicine in all 27 regions. Private organizations have taken telemedicine forward as well as public organizations. There is still no national policy. There are 42,000 family health communities around the country. The government is working on connectivity. There is a joint telemedicine and telehealth committee in Congress to address this.

Key challenges - has challenges similar to the other countries. They are putting together 14 trade professional resolutions and informing members of parliament of policies. There is a major gap in training of healthcare professionals- tens of thousands of domiciliary professionals and students whose educational bodies are not adopting their educational needs. There is a governance and regulation requirement at government level for the 27 states and 5000 municipalities. Ongoing assessment of new technologies would be beneficial and sometimes there is a lack of regulation to support telemedicine. Studies in Brazil have showed an improvement in referral to the right professionals through telemedicine. It is necessary to think about patients and how interagency care is provided – a broader array of services and sharring of information. Privacy training is required for professionals and training is required for the public community as a whole.

Students have better training guided by professors working with faculties. It is a problem to provide telemedicine to slum impoverished areas. There is a need to have interagency working of administrators, IT professionals to improve the doctor patient consultations with telemedicine. Clearly defined standards are necessary, legislation, raising awareness and IT literacy in the community.

Training is necessary for professionals, standardization of digital consultations and privacy protection are necessary.

--

PAHO is measuring data and information gaps and there is concern for the elderly who may not have digital penetration.

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT gmail.com