Mon | Aug 3, 2020

Garth Rattray | Fast-track support systems for telemedicine – Pt 1

Published:Monday | July 6, 2020 | 12:12 AM

Until vaccines (hopefully) offer safe, effective and long-term immunity to the SARS-CoV2 virus, we will be forced to avoid congregating, intimate greetings, unprotected outings, and we must reduce our exposure time to public spaces. We need to maintain social distancing, along with high personal and environmental hygiene, if we are to beat this thing.

Now that Internet meetings have become commonplace and far less expensive than congregating variable distances away and renting meeting rooms, I’m certain that telemeetings, telecommuting and telecommunication will continue long after COVID-19 no longer poses a health threat. There has been a noticeable emergence and uptick in telebusinesses of all kinds. Several brick-and-mortar-based enterprises now offer and encourage online and telephone purchasing. There is kerb-side pickup and delivery available. Banking in Jamaica is catching up to what banking was in places like Japan 20 years ago.

The practice of medicine is also undergoing metamorphosis. Several maladies can be dealt with from a distance. Patients are consulting doctors by telephone conversations, emails, text messages, WhatsApp and video links. Telemedicine is gaining traction here in Jamaica because patients are attempting to minimise their exposure. This is especially applicable to the vulnerable and/or elderly age group. Sometimes the medical consultation only requires refilling of expired or lost prescriptions. Sometimes it’s about a minor problem for which a history will suffice. More technical, difficult or tactile matters still necessitate visiting a doctor’s office.

EMERGED AND EVOLVING

Even before this plague arrived, many of us were practising some form of basic telemedicine. However, nowadays it has become mandatory in several instances. Consequently, several telemedicine platforms have either made themselves known, recently emerged or are evolving. Individual physicians and medical centres chose the platform most suited to their particular need. Some platforms are straightforward and require only fundamental Internet capabilities and no digitalisation of medical records. In spite of their simplicity, such platforms can be very functional and satisfactory to both patient and physician. Platforms either require that the physician pays a fee to the provider or factor in the cost and include it in the consultation fee.

The most rudimentary version of telemedicine is when the patient calls in and speaks with the physician about a problem and is advised what to do or is prescribed something. Sometimes, ailing patients are not able to send for or pick up the original prescription immediately and the physician uses technology to send the script to a pharmacy of choice. Sometimes the matter is so urgent and, perhaps, the physician is so far from the patient or it’s after office hours, that in order to alleviate suffering or even save a life, the physician calls in the prescription.

Currently, the Pharmacy Act mandates hard-copy scripts for pharmacy record-keeping. Furthermore, other supporting systems – health insurance claims, and perhaps indemnification, do not support telemedicine. This has become a huge stumbling block for the practice of medicine, especially in today’s COVID-19 world.

Calling in or sending in a prescription by fax, email or WhatsApp can be problematic because the Pharmacy Act (Regulations) (August 4, 1975, Section 20 (2) and (4)) states that, “… a prescription for a drug may be in writing; be communicated verbally by a registered medical practitioner, which verbal communication shall be validated pursuant to be transmitted by facsimile, or other electronic means to a pharmacist by a registered medical practitioner. A person to whom a prescription for a drug has been communicated verbally by a practitioner shall forthwith reduce the prescription to writing (which shall be validated by the practitioner within thirty-six hours) … .”

Given modern technology and, more recently, the urgent need for the ability to prescribe telemedically, changes to the 1975 Pharmacy Act is way overdue but extremely slow in coming. Next week – Part 2, systemic inertia.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.