Authors: Václav Audes, Jan Diblík, Kateřina Slavíková
The coronavirus pandemic has stirred up debates about the need for healthcare in the Czech Republic to be modernised so that it can operate remotely without direct contact with the patient. Telemedicine, as the remote provision of healthcare is called, would reduce unnecessary travel to healthcare appointments or prolonged periods spent in waiting rooms. The concept of telemedicine is neither known to nor defined by Czech legislation yet. The first step for enshrining it in Czech law will be, to a certain extent, the amendment of the Health Services Act as well as the pending Healthcare Electronization Act.
Telemedicine could make healthcare in the Czech Republic much more affordable for patients (not just during a pandemic).
Telemedicine is based on modern technology that makes it possible to provide comprehensive care to patients from an initial consultation and diagnosis through monitoring and treatment to prescription and delivery of medicinal products or electronic issuance of a sick certificate. All by means of remote communication and data transmission. This can easily make quality and cost-effective healthcare services available to patients, regardless of where they are physically located. Thanks to the availability of such services, patients will not neglect their problems, thus avoiding hospitalisation and unnecessary visits to the emergency room. This could also result in significant savings.
Moreover, healthcare electronization will enable the collection of vast amounts of data that experts can analyse and use for research. Case modelling and the use of artificial intelligence can help detect diseases early, increasing the chances of patients’ recovery.
Last but not least, telemedicine can make an important contribution to reducing the risk of coronavirus or other infections. Indeed, it would reduce the prolonged stays in waiting rooms, or unnecessary multiple healthcare appointments, before the patient can reach a specialist who could actually solve their problems.
But the Czech legal system does not yet know and define the concept of telemedicine. The sector is thus covered by legislation from many sectors, which was developed long before telemedicine, and is therefore not very up-to-date. Under the legislation, a healthcare service provider is responsible for providing healthcare services to the patient lege artis, i.e. in line with current medical science. This is true even in the case of healthcare provided remotely by physicians. But discussions are held on whether they will meet this standard if they do not see the patient at all and do not physically check the patient.
In the meantime, services are being developed on the market that get ahead of such discussions and implement telemedicine practices outright. The most immediate chance to enshrine telemedicine in Czech law is the Ministry of Health's amendment to the Healthcare Services Act, now being drafted by the Ministry of Health, which should allow the provision of consulting services or clinical pharmaceutical care at a distance.
Some component concepts of telemedicine are already regulated by Czech law, and some are used in practice, including e-certificates and e-prescriptions. But other attempts in the field of healthcare Electronization continue to hit their limits. For example, under the Health Services Act and the Medical Documentation Order, it is now already possible for a health service provider to keep records exclusively electronically.
However, electronic systems often fail to meet the requisite criteria, and practitioners still keep patient records in paper files. A patient's remote access to their medical records is not covered in detail under the current legislation either, therefore in practice doctors still issue paper extracts from electronically kept documents to patients. But the amendment to the Healthcare Services Act should also enable remote access to medical documentation; it will then be up to individual physicians to cope with the technology.
The European Union also plans that its citizens should have electronic access to medical documentation. But questions regarding patient identity verification and documentation security as well as communication with patients will need to be answered before its launch.
In addition to the Healthcare Services Act, the Healthcare Electronization Act could also solve some of the above-mentioned problems in the future. It provides for a new patient identifier, which should replace birth numbers entirely. It also introduces a new integrated data interface to enable secure data sharing among all participants. The new system should also interlink the existing ones such as e-Certificates and drug records.
According to initial plans, the new interface was scheduled to be put into operation from 2022. But it is now already clear that the project will be delayed. In fact, the drafting of the law gets constantly protracted. According to former Health Minister Adam Vojtech, the Parliament was to decide on the bill by the end of this parliamentary term in autumn 2021. But given the recent developments regarding the position of the minister of health, the bill can be expected to undergo significant changes, which is why it is unclear when the law might actually come into force.
Furthermore, an important issue to keep in mind when modernizing the healthcare sector is trust. Doctors or patients will not feel safe if they do not trust the new healthcare system. It is therefore crucial that the new legal regulation convinces all parties that telemedicine is trustworthy. This is by far the most important factor for the remote provision of healthcare.
There is probably nothing that can stop the development of telemedicine now. If properly conceived and professionally executed, it poses another natural progression stage in the provision of services in general, specifically healthcare services in this case. As we have already indicated, its potential is enormous. Combined with the processing of so-called big data or artificial intelligence, or machine processing of selected input data, it is a powerful tool that has the potential to substantially increase the standard of living not only in developed countries, but perhaps even more so in developing countries.
We believe that the evolution of telemedicine is in its infancy, with its true potential to be still discovered. Let us hope that Czech users – patients as well as the developers and providers of telemedicine services – will not fall behind in seizing this potential.
