The term telemedicine refers to the use of telecommunication and information technology to provide medical services remotely. This can encompass a vast array of facilities and so this article will focus on one common demonstration of the use of telemedicine: remote GP consultations. These may be conducted via video link or telephone, and includes NHS but also private online GP services.
Even before the Covid-19 pandemic hit, use of telemedicine was growing and expanding rapidly. This was also being actively encouraged by the government, demonstrated by the Department of Health and Social Care publishing ‘The Future of Healthcare: Our vision for digital, data and technology in health care’ in 2018. Increasing the use of ‘digital first’ primary care is also part of the NHS Long Term Plan, aiming to give all patients the option by 2023/24. Unsurprisingly, the onset of the pandemic and restrictions to face-to-face contact has furthered this trajectory of growth. Before the pandemic about 80% of GP appointments took place in person. In June 2020, this had fallen to just under half in person and equal amount over the telephone.
Telemedicine engages several vital areas of law including privacy, data protection and duty of care just to name a few. With the current pace of progress unlikely to slow in the coming years, it is imperative that the risks involved and the impacts on clinical care are thoroughly evaluated and researched. It is also undeniable that this important and dynamic sector requires a coherent and comprehensive regulatory framework and there is a question as to whether the current state is sufficient to accommodate for such growth.
There are of course many striking advantages of the use of telemedicine, and specifically remote consultations. At the forefront is that it creates greater accessibility and provides a convenient way to get help from medical professionals without the hassle of going into a physical clinic. This became particularly pertinent during the pandemic where telemedicine provided a way to minimise contact and transmission and freed up space in hospitals. Often it means being seen sooner which can in some situation mean offering treatment earlier. It can be an efficient and effective option particularly for those who require GP intervention irregularly.
However, these advantages are balanced with some significant risks. One of the primary issues is safeguarding patient privacy, it is vital that the platforms used for remote consultations are secure and that all information is stored safely. While NHS digital may do its best to keep data protected, data breaches are not an uncommon occurrence in the modern world. It is near impossible to protect against all possibilities, demonstrated by the breaches experienced in multinational technology companies like Facebook. The conversation itself must also be private, which is often easier to guarantee when both patient and doctor are sat in the same room. This also links in with the substantial area of data protection, under the UK General Data Protection Regulation (GDPR) patient data is classified as special category data and as such is subject to more rigorous rules. As digital technology becomes further embedded in the healthcare system it is important that the scrutiny of data protection also continues to develop, in part to also ensure patient confidence.
Some have raised concerns about whether the clinical quality of remote consultations is equivalent to in-person appointments, particularly regarding diagnosis. It may be easier for symptoms or information to be missed and of course physical examinations cannot take place. Cambridge University recently conducted a survey between April 2021 and July 2021 where they asked 1,340 patients who suffered with rheumatological conditions, such as lupus, and 111 Rheumatology clinicians their views on telemedicine. Regarding accuracy of assessment of patients by remote consultation 86% of patients and 93% of clinicians felt that telemedicine was worse than face-to-face consultation, and some even reported misdiagnosis. It is also worth highlighting that not all remote GP services are conducted by your usual GP or practice, therefore may be operating without access to NHS medical records and this makes it harder to get an accurate picture of medical history, particularly for those with complicated long-term chronic illness. This contributes to a broader risk of lack of continuity, which can have a serious impact on treatment but also patient confidence.
The most important way to combat these risks is sufficient regulation and guidance for healthcare providers.
In the UK there are no laws that specifically govern telemedicine, however, there are several regulatory bodies that have published guidance. The Medicines and Healthcare Products Regulatory Agency regulates the technology used in healthcare services including apps; the Care Quality Commission (CQC) regulates healthcare providers in England and ensure all, including those services provided remotely, meet the requisite standards. Individual medical practitioners are also regulated by the General Medical Council (GMC) who have issued specific regulatory guidelines for providing care remotely.
However, the scope of regulation required is vast and as telemedicine continues to grow and evolve in the UK it seems apparent that tailored legislation may be the next necessary and logical step. This would require going beyond adding digital provision of care to the existing regulation, but specifically addressing telemedicine and imposing attuned standards to remote services. This would help to further ensure a coherent framework of regulation tackling the specific issues that arise with digital health.