Jeffrey A. Blount, Jing Wang, Lynn Yang, Partners, Norton Rose Fulbright Hong Kong
With the explosion of the internet and mobile technology in recent years, the use of telecommunication and information technology to provide remote healthcare services has become increasingly prevalent. China recently issued for the first time comprehensive guidelines on telemedicine services, the Opinions of the National Health and Family Planning Commission Regarding Promoting Medical Institutions’ Telemedicine Services (the “Telemedicine Opinions”) and interpretations of the Telemedicine Opinions.
What is Telemedicine?
According to the Telemedicine Opinions, telemedicine services are defined as medical activities whereby the medical institutions of one party (the “host medical institution”) invite other medical institutions (the “invited medical institutions”) to use communications, computer and network technologies to provide technical support in the diagnosis and treatment of patients in their own institutions. Telemedicine services as so defined do not seem to include all aspects of healthcare related-services on a remote basis.
Telemedicine service items include: remote pathological diagnosis, remote medical imaging diagnosis (including imaging, ultrasound, nuclear medicine, electrocardiograms, electromyography and electroencephalograms), remote monitoring, remote consolidations, remote outpatient services and remote case discussions and other items provided by administrative authorities above the provincial levels in charge of health and family planning.
The Telemedicine Opinions do not apply to (1) internet-based consultation and education, or (2) remote surgery.
Who Can Provide Telemedicine?
Currently telemedicine services can only be provided by licensed medical institutions, including hospitals, infirmaries, sanatoriums, outpatient departments, clinics, health centres and first-aid stations which exercise diagnosis and treatment activities. Non-medical institutions or personnel working for medical institutions are not permitted to perform telemedicine services.
Telemedicine services between Chinese medical institutions and foreign medical institutions are also covered by the Telemedicine Opinions.
What is Required?
According to the Telemedicine Opinions, if a medical institution is to provide telemedicine services, it must have appropriate equipment and qualified personnel to facilitate its operation. This includes designating dedicated departments or personnel to run regular tests to ensure the maintenance of the equipment, and where relevant, to arrange for suitable modifications and updates. It must ensure that telemedicine service systems (hardware and software) are in standard operation, as well as meet the relevant health information standards and information security provisions related to telemedicine services.
How to Provide Telemedicine?
According to the Telemedicine Opinions, it requires at least two medical institutions to provide telemedicine services: the host medical institution, which is primarily responsible for the diagnosis and treatment of the patient, and the invited medical institution, which upon request assists the host medical institution in the diagnosis and treatment. Both institutions need to enter into a telemedicine services agreement and agree on such items as purpose of a cooperation, conditions of cooperation, processes of telemedicine services, rights and obligations of each party and the sharing of the risks of medical harm and responsibilities.
Open Issues or Gaps
The Telemedicine Opinions provide a relatively clear guideline on conducting telemedicine services in China and have received positive feedback from medical institutions, in particular the well-equipped class 3 public hospitals. However, in light of the rapidly changing landscape of this sector, there are shortfalls in the Telemedicine Opinions which leave certain issues unanswered.
For example, under the Telemedicine Opinions, medical personnel cannot provide telemedicine services to patients without consent of their employer and must use the platform provided by the employer. This is not entirely consistent with the national policy of encouraging medical personnel to practise at multiple sites, which admittedly already encounters resistance from the employers.
It also remains to be seen how to draw a fine line between telemedicine and other internet based healthcare services or m-Health, which already has attracted a lot of investment in China. Whether the Telemedicine Opinions will constitute a real challenge to them will be a focal point for many investors.