COVID-19 led to a surge in telemedicine utilization. At the peak of the first wave in the US and UK, more than 90% of medical consultations were conducted through telemedicine. A digital-first approach was adopted, as it was simply not safe for patients to physically interact with their healthcare providers. Zimbabwe also witnessed a greater use of telemedicine as many practices shut their doors to in person visits and the government instituted police roadblocks that restricted movement.
To tech enthusiasts this was like the fulfillment of a prophecy! What had been ignored as futuristic suddenly became an immediate necessity. It was a dream come true that inversely was a nightmare for the regulatory authorities. Innovation is easier to regulate when its gradual but when it’s rapid, regulators scurry to grapple with the sudden disruption.
The Health Professions Council of South Africa had guidelines on telemedicine published as far back as 2014 but the increased demand and utilization warranted them to issue revised guidelines in 2021. Similarly, the Medical and Dental Practitioners Council of Zimbabwe (MDPCZ) had a policy on telemedicine published in 2014 that required a serious touch-up. It had a myopic view of telemedicine and seemed to focus on protecting local practitioners from foreign poachers that were trespassing onto their business territory. This left a lot unanswered. Faced with many questions from local practitioners seeking guidance on telemedicine usage in the advent of COVID-19, the MDPCZ had to draft a new policy on telemedicine that was recently published in July 2022.
This was a landmark development in Zimbabwe ‘s digital health transformation that warrants much deliberation and discussion. The policy is directed at guiding medical practitioners and their patients, on how to practice telemedicine. A stakeholder who should also pay much attention to this, is the tech entrepreneur who designs and deploys telemedicine software and related business models.
So, here are some key talking points from the MDPCZ policy on Telemedicine
“This policy shall be used by the Council and Disciplinary Committees as a standard by which to consider the conduct of a doctor when providing medical care through telemedicine.”
- Understand that this policy is binding for doctors! Entrepreneurs seeking to partner with registered doctors need to appreciate that the doctor is the one held ultimately responsible if their telemedicine system breeches the guidelines. The partnering doctor runs the risk of losing their practicing license whilst the tech business is relatively safe as the MDPCZ has no jurisdiction to summon or penalize them. This was the case in 2015 when the MDPCZ tried to go after Econet’s Dial a Doc service. If doctors seem hesitant to partner with your business and use your technology, it is probably because they know they carry the greater risk.
“When providing healthcare services through telemedicine a practitioner should pay attention to these ethical and professional principles: protect the patient’s privacy and confidentiality”
- Privacy is of the utmost importance when dealing with sensitive information such as medical records. Patient encounters must be documented and the records securely stored. This has been the challenge with using social media apps. They are readily available and affordable so many people use them but they are not secure for telemedicine. A conversation on WhatsApp can’t certainly be regarded as a proper medical record. It’s also possible for patient information to be shared without their consent on such open platforms. Therefore, telemedicine platforms are mandated to be secure and obtain explicit patient consent.
“A provider of telemedicine should practice from registered health premises where patients might have face to face consultations”
- This sets back the ideas of a fully virtual business model where doctors do not have to set up medical rooms, but just set up shop online and consult patients from anywhere, anytime. There were several of such online platforms that tried to recruit local doctors for provision of telemedicine services without the need of being attached to a health facility. Simply setting up a large call center of doctors to provide telemedicine is another business model not allowed by this policy.
The following are issues that that seem quite impractical but are included in the policy:
“The practitioner should confirm a patient’s identity and medical history with their regular practitioner”
- In the context of telemedicine this is easier said than done. In a country with single digit percentage health coverage, how many people have regular practitioners? How exactly can this confirmation be done when most practitioners still use paper-based records that are not easily recalled? This may limit the right of patients to seek an independent second medical opinion. Sometimes people really prefer to be treated privately and anonymously at a place where they can be forgotten.
“When providing professional services to a patient in a setting without an immediately available health professional the provider shall provide the patient with the details of the nearest public health institution.”
- Yet another precept not so feasible in our context. People in remote areas are the ones most desperate for telemedicine because the nearest facility may be a long distance away. How easy is it for a doctor providing telemedicine from Harare or Bulawayo, to know the details of the nearest clinic or hospital for a patient who is calling from a rural growth point deep in the heart of Zimbabwe? The policy insists on details of the nearest public health facility. We then wonder if the telehealth provider will be held liable for providing details to a provincial hospital when there was a mission hospital close by that they didn’t know. In addition, with such a paper-based health system, how can a telehealth provider easily find the phone number, email or physical address or directions to the nearest public health facility?
“The practitioner should also know the preferred healthcare system for the patient’s insurance to avoid unnecessary financial strain for the patient”
- This statement demands that the telehealth doctor verify with the health insurance company prior to providing teleconsultation. In an era where health insurance companies are morphing into healthcare service providers, this stipulation hands a lot of power to the insurance companies. Doctors already view this as unfair competition that is limiting the right of patients to a service provider of their choice.
“A prescription for medication issued electronically must comply with national electronic prescribing security and authentication standards as well as legal standards and requirements”
- The above sounds quite reasonable except for the fact that Zimbabwe does not yet have a national electronic prescribing security and authentication system! An e-prescription is a key part of the teleconsultation process that unfortunately is not being supported by this policy.
A country’s regulatory and legal framework is a key building block of the enabling environment for digital health implementation and growth. The publishing of this policy by the MDPCZ was a welcome development that was long overdue. However, some of its dictates are baffling as they do not seem to take our local context into consideration. This is probably explained by the fact that the local regulator largely did a copy and paste job of policies in other countries, particularly the New Zealand Medical council policy statement on telehealth. As digital health continues to grow, we should expect and call for more regulation. The hope is that this regulation will guide innovation and not stifle it. Regulation can be an enabler, only if it has been tailored to suit the local context.