In the absence of readily available vaccine and treatment against COVID-19, the most effective preventive measure appears to be the social distancing. Such measure should be also considered with respect to the medical examinations that doctors perform in relation to their patients. Therefore, in the context of COVID-19 outbreak, telemedicine is increasingly being applied.
Medical examinations at a click of a button. In the light of the above, the Romanian Government has passed the Decision No. 252 of 30 March 2020 on establishing certain measures in the healthcare sector during the state of emergency on the territory of Romania (the Decision). In order to reduce the number of patient visits in healthcare units that can expose both doctors and patients to potential infections with COVID-19, the Decision regulates, inter alia, the patients’ remote access to healthcare services. However, the remote provision of medical services does not mean that patients are no longer entitled to benefit from examinations physically provided in the relevant clinics.
Below are a few highlights from the rules set out by the Decision in relation to the provision of the remote medical examinations in the context of COVID-19 outbreak:
1. WHAT SERVICES CAN BE PROVIDED VIA TELEMEDICINE?
1.1 Regular medical examinations
According to the Decision, telemedicine can be used by family practitioners and specialist doctors within outpatient departments for providing medical examinations included in the minimum and basic package of medical services, as these are set out by the framework agreement governing the conditions for the provision of medical care, medicines and medical devices within the health insurance system.
The medical examinations include, for example, examinations for chronic patients, examinations based on integrated management plans (hypertension, type 2 diabetes, chronic obstructive pulmonary disease, asthma, chronic kidney disease). Such medical services are performed by the above-mentioned doctors and settled by the healthcare insurance houses, similar to the ones included in the packages of medical services that are physically provided in the relevant clinics, with the observance of the concerned legal provisions.
1.2 COVID-19 related medical examinations
As per the Decision, the patients presenting clinical manifestations suggestive for COVID-19 benefit from medical examinations that can be performed remotely by family practitioners and specialist doctors within outpatient departments. Such examinations should be available to any symptomatic patient located on the Romanian territory.
The medical services so provided are assimilated to the examinations included in the basic package of medical services that are physically provided in clinics in relation to acute, subacute diseases and exacerbation of chronic diseases.
2. WHAT ARE THE MEANS BY WHICH MEDICAL EXAMINATIONS CAN BE PROVIDED REMOTELY?
By definition, telemedicine encompasses medical services provided by using telecommunications technology. Although the Decision refers to a broad and vague concept when explaining how the remote medical services can be technically performed (i.e., by any means of communication), it is expected that usual means of information technology are going to be used for this purpose, such as any software application that lets doctors examine their patients remotely via video-chat, telephone calls, email exchanges, etc.
3. HOW ABOUT THE PROCEDURAL DETAILS REGARDING TELEMEDICINE?
The medical services provided remotely will be recorded in the examinations registry and in the patient records, as the case may be, with indication of the (i) means of communication used for the performance of the medical examination, and (ii) time frame in which the examination took place. By the care of the doctor performing the remote examination, all necessary documents following such examination (including medical prescriptions) will be issued and sent to the concerned patient via electronic communication means.
In principle, family practitioner and specialist doctors within outpatient departments can provide maximum 8 examinations per hour.
The provisions of the Decision related to the remote medical services are applicable only during the emergency state in Romania declared through the Presidential Decree No. 195 of 16 March 2020.
Conclusions. The Decision represents a step towards the development of telemedicine in Romania, a sector in which so far there have been registered slight evolutions at national level (e.g., certain projects in the military sector and public health in rural areas, emergency number and hotlines (e.g., Peditel, Toxapel)).
However, the Decision is rather intended to set the principles of the remote provision of medical services during the state of emergency, without taking into consideration all potential practical and legal issues, such as: (i) potential data protection implications concerning the patient’s personal data; (ii) the complexity of the medical examinations that can or cannot be provided remotely; (iii) the precise methodology for settlement of the provided services by the healthcare insurance houses, etc. Therefore, it comes to the practitioners in the healthcare sector to implement the generality of the new piece of legislation.
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