TO do more with less, beyond the pandemic, innovative developments in technology can increase access to care (where appropriate) and lower systemic costs, particularly for vulnerable groups and those in underserviced rural areas, where face-to-face care is not a viable or efficient option.
What is telemedicine?
Terms such as telehealth services, digital health and e-health are often used synonymously with telemedicine. Examples include specialists exchanging a patient’s medical history via messaging apps, telephonic or video consultations between patients and healthcare workers and remote monitoring of patients.
The aim of telemedicine is not to eradicate face-to-face consultations with healthcare workers, but to improve accessibility and efficiency of healthcare services.
Regulation of telemedicine in South Africa
COVID-19 necessitated a relaxation of the rules governing telemedicine. As an infection-control solution, telemedicine helps reduce health care workers’ contact with patients, whilst enabling vulnerable groups to receive certain healthcare services during self-isolation. Telemedicine in South Africa is regulated in terms of, amongst others, theGeneral Ethical Guidelines for Good Practices in Telemedicine, issued by the Health Professions Council of South Africa (HPCSA) in 2014 (2014 Guidelines).
When the national lockdown commenced, and only for the limited duration of the COVID-19 pandemic, the HPCSA minimally relaxed its stance by issuing guidance which replaced the reference to “telemedicine” with “telehealth”, which definition now included telepsychology, telepsychiatry, and telerehabilitation, amongst others. The requirement for an already established practitioner-patient relationship remained, except for telepsychology and telepsychiatry. Critics referred to a lack of clarity in respect of the length of time and other requirements needed to “establish a relationship” between the patient and the physician. Despite the hard lockdown having commenced, the HPCSA specifically advised against telephone and/or virtual consultations for new patients (HPCSA Guidance Note 26 March 2020).
Benefits
Telemedicine is frequently judged against the counterfactual of face-to-face care, where it may fall short. In South Africa, however, the lived experience of the counterfactual is often no or less care due to access constraints. Telemedicine can enable healthcare workers, particularly scarce specialists, to reach patients in remote and rural locations which they would not normally be able to access.
An additional important benefit is the role telemedicine can play in upskilling health care workers, by using technology as a training tool; a huge gain in South Africa where we face a healthcare human resources crisis and an inequitable geographic spread of available specialists, amidst a high burden of disease.
Challenges
Most obviously of concern are inaccurate clinical diagnoses in a virtual world, for example, if patients are unable to correctly describe their symptoms, particularly where there are language barriers, and there is no physical examination. These challenges are less prevalent for certain specialities, such as mental health consultations.
Another considerable obstacle is the ownership and transfer of patient data, in the light of the absence of an implemented system for a single electronic interoperable health record. From a pragmatic perspective, South Africa’s electricity load shedding epidemic and the high costs of data may present connectivity challenges. However, this does not mean that telemedicine in and of itself is a dead-end, but rather that eradicating total inequality in healthcare delivery will be unlikely.
