The current situation surrounding the COVID-19 coronavirus has created a number of challenges, many of which relate to self-isolation and social distancing, in order to reduce the spread of the pandemic and prevent infections. For healthcare practitioners, this has raised the question of whether interactions with patients should extend to include remote consultations. A National State of Disaster in South Africa was declared on March 15, 2020, and the use of remote consultations has been advocated, including by the South African president, as one of the ways of delivering healthcare during the crisis.
Medical Protection has received numerous enquiries from members regarding the security and suitability of remote consulting by telephone or virtual platforms – also known as Telehealth – and this article outlines our current advice and guidance.
We recognise this is an extremely challenging time for all healthcare professionals and Medical Protection is here to support you. The treatment of patients is of paramount importance and we are working to ensure practitioners are able to deliver this in a safe and effective way.
HPCSA guidance on Telehealth
The HPCSA’s Covid-19 HPCSA Guidelines for Healthcare Practitioners published on 26 March 2020 defined “Telehealth” as follows:
““Telemedicine” is hereby replaced with “Telehealth” which includes amongst others, Telemedicine, Telepsychology, Telepsychiatry, Telerehabilitation, etc., and involves remote consultation with patients using telephonic or virtual platforms of consultation.”
The HPCSA’s Notice to amend Telehealth Guidelines during COVID-19 published on 3 April 2020 states that:
“Telehealth should preferably be practised in circumstances where there is an already established practitioner-patient relationship. Where such a relationship does not exist, practitioners may still consult using Telehealth provided that such consultations are done in the best clinical interest of patients.”
The amendment aligns with the advice and support we have been providing members and we welcomed the new guidance as a positive step in South Africa’s efforts to contain Covid-19. This news was equally welcomed by many healthcare professionals working on the front line.
The HPCSA reminded practitioners that the Ethical Rules of Conduct for Health Practitioners are still applicable during the practice of Telehealth, and that this amendment to their guidance is only applicable during the COVID-19 pandemic. The HPCSA intends, soon after the end of the pandemic, to inform practitioners of when this amendment to their guidance will cease to apply.
If you are undertaking a remote consultation
Where face-to-face consultations are preferred, but not possible, and you are considering the use of Telehealth, you need to be satisfied that proceeding with a remote consultation is in the patient’s best interests and that you can adequately assess the patient in this way. In addition, during any remote consultation, be aware that both practitioner and patient should be able to reliably identify each other. You should inform the patient of your conclusions, and explain why you have, on this occasion, pursued Telehealth as a means of delivering patient care.
You should document that you have undertaken this consideration, and discussion with the patient, in their clinical records. Unless there are exceptional circumstances, it is preferable that remote consultations will relate to patients already known to you or where you have access to their full medical records.
If you have doubts then you should recommend the most appropriate route for the patient to seek medical assistance, in accordance with local public health/government guidance; and refer the patient to an appropriate service where they can be adequately assessed face-to-face.
In an emergency, patients should be encouraged to seek assistance via the recommended route, in accordance with the most recent government and/or public health guidance.
Remote consultation with an existing patient in another country
If you are contacted by an existing patient and you hold their medical records, but they are out of the country and unable to return due to restricted travel reasons, you should recommend to the patient that they follow the most appropriate alternative route for assistance, which may involve seeking local medical care.
If the patient is calling about a pre-existing condition, you should make a reasoned decision on the safest course of action for the patient. This may include consulting remotely or advising the patient to seek medical assistance locally. If the patient is presenting with a new condition, ideally you should recommend the patient seeks medical assistance locally where this is practically possible.
Remote consultation with a new patient in the same country as you
If you are asked to undertake a remote consultation with a new patient, you should request the medical records from the patient’s previous practitioner. If you cannot access their records, you would need to consider whether you are able to adequately assess the patient clinically and document that consideration. If you cannot adequately assess the patient, then you should recommend the most appropriate route for the patient to seek medical assistance, in accordance with local public health/government guidance.
Choice of virtual platform for Telehealth
Medical Protection does not make recommendations regarding the use of a particular, preferred, platform for the purpose of Telehealth. Advocating for any one platform for this purpose lies out with our remit; and it is our view that it is a matter for the practitioner to decide on for themselves. A practitioner should take reasonable steps to ensure that the platform they use adheres to the HPCSA guidelines and the relevant data protection legislation. It may therefore be advisable for practitioners to consult with their professional society, and/or an I.T. specialist, concerning the appropriate virtual platform to use for the particular services that they offer; to ensure their compliance in this regard.
Practising safely and your indemnity position
With regard to all remote consultation, it is your responsibility to ensure that you practise in accordance with any applicable laws and regulations in relation to the diagnosis, treatment, prescription and provision of medication to patients – both within the country in which you practice and, if applicable, within the country in which the patient is based at the time of the consultation. Where members depart from their usual practice they will remain accountable for their actions. Communicating clearly with patients, and documenting your considerations will assist both you, and Medical Protection, in dealing with any medico-legal matters that may subsequently arise.
If the patient is not able to access local, face-to-face medical advice due to quarantine protocols, and you are satisfied that this is the case and documented this rationale – then you will be able to request assistance from Medical Protection for incidents that arise from the consultation, where the complaints or claims are brought in South Africa (the jurisdiction in which you hold your membership).
However, you should be aware that you will not be able to seek assistance from Medical Protection for remote consultations undertaken on a new patient in another country. If you are contacted either directly by a new patient outside of your normal jurisdiction, or by a practitioner in another country seeking treatment for a patient, you should advise that the patient would need to seek medical advice in the country in which they are based at that time.