Telemedicine in Covid-19 times

The pandemic highlights the advantages of remote service for doctors and patients

By Sérgio Siscaro

The “new normal” that shall arise after the end of the current pandemic of Covid-19 shall intensify the use of communication tools via the internet in several industries. As well as the goods and services business, other activities shall also be digitally intermediated, with an incentive of working from home and distance education. Similarly, telemedicine must take on a role much more prominent in people’s daily life from now on.

Telemedicine has already been practiced for years in Canada, the United States, and Europe, including these modalities:  teleconsultation (medical consultations to the patients), teleconsultancy (clarifications and guidance), telediagnosis (support for supplementary exams’ reports), teleinterconsultation (interaction between doctors), and telemonitoring (follow-up of body parameters at a distance). These tools use many technologies, both of remote communication as of artificial intelligence.

The practice of online medicine has gained space in Brazil due to the spread of the novel coronavirus. In March, the Government authorized the teleconsultation practice during the sanitary crisis by law 13.989/2020, of the Ministry of Health Ordinance 467/2020; and the official letter 1756/2020 of the Federal Board of Medicine (CFM).

In order to discuss the matter, and bringing to the table the experiences done in the last months in telemedicine and the perspective of more wide permission of this practice in the Brazilian legislation, the Health Innovation Commission of the Chamber of Commerce Brazil-Canada (CCBC) has promoted on May 28th the webinar Telemedicine in the Era of Covid-19 (Telemedicina na Era da Covid-19). At that moment, the theme’s current status and its trends were debated by the coordinator of the Program of Telemedicine Education for Doctors of the Associação Paulista de Medicina (São Paulo’s Medical Association – APM), Jefferson Fernandes; the medical director of Teladoc Health, Caio Seixas Soares; and the director of health claims of SulAmérica, Erika Fuga.

New Regulatory Horizon

Fernandes has pointed out that the arrival of the novel coronavirus accelerated the process of familiarization of the population with the benefits of telemedicine – and it has also been leading to advances in the regulatory perspective. “The resolution that was in effect for years dated from 2002.” With Covid-19, a new guideline emerged, authorizing the use of telemedicine to orient patients, exchange information between doctors and for monitoring. The teleconsultation, in which the doctor directly sees the patient, was left out of it. But that was promptly corrected by the Ministry of Health that ended up authorizing this modality as well, which is extremely important in a pandemic context. And, in April, these dispositions have become law”, he says.

According to Fernandes, such regulatory dispositions shall remain, even after the crisis created by the novel coronavirus. “We have conducted research among doctors at the APM and verified that the most part is favorable to telemedicine. And the experience happening now will also break the resistance of doctors in using these tools. It is not possible to go backward.”

Fernandes highlights the need to train healthcare professionals to work with telemedicine. “It is not a chat in front of a screen. There is an entire path to go on in order to establish a good doctor-patient relationship through online platforms. In this sense, a training course is set up at APM, with over 500 doctors. This course explains the characteristics of telemedicine and the way of relating to patients – the posture, the way of making patients confident, and a series of questions that must be considered responsibly.”

Agility and safety

When talking about the characteristics of telemedicine in Canada, where it has been practiced for years now, Soares reflects that the Canadians are already more familiar with telemedicine, even considering their proximity to the culture of the United States. “That helps in the development of technologies, tools, and access to these services,” he states.

Soares considers that Covid-19 has led to a swift need to rely on the distance medical service modalities for – and this trend should continue. He says that the raise noticed by Teladoc Health after March 15 – when it went from an average of 500 daily calls to something around 5 thousand calls – is proof of such behavioral change both by doctors and patients. “The pandemic has accelerated the regulations of the activity since it was made possible to use the telemedicine tools during the crisis. Besides, the method is ideal to continue offering medical services to the population as social distancing is currently the rule”.

He estimates that some factors shall incentive telemedicine expansion, such as the increase in the use of digital technologies, the greater willingness of people in sharing their personal data, and the dissemination of digital ways of access to medication or medical care services. “The stimulus to the use of tools ensuring security and privacy, both for doctors and patients, is one of the points that has propelled the use of telemedicine in Canada – and it shall be here in Brazil,” he states.

Positive Experience

Even though there is not a regulation yet for the practice of telemedicine, at the end of 2018, SulAmérica has begun its first activities in that area – with distinction for the service of medical orientation by video. “We were pioneers among the health insurance operators to put this service in our app – starting with the pediatrics service and then expanding to the general practitioner. Despite the fact that we do not make a consultation at this stage, we were already initiating these remote services,” declares Fuga.

According to her, these experiences placed the health insurance operator in a favorable position considering having the necessary knowledge to use this service modality. “When the legislation clearing teleconsultation during the pandemic was approved, we had the opportunity of moving forward very quickly. Our beneficiary can access today, through a specific button for Covid-19, a complete journey starting at initial triage and up to a remote consultation with a doctor. In parallel, we also could swiftly enable doctors in our accredited network to use the teleconsultation platform.”

SulAmérica currently offers a telemedicine activity range that starts with suspected Covid-19 patients’ triage, done by specific apps, going through phone or web services and up to elective teleconsultations. “More recently, we started to also offer services of non-medical specialties such as psychologists, speech therapists, and physiotherapists, for example.”

The director assesses that the current scenario inhibiting the circulation of people due to the prevention of contamination by the novel coronavirus has changed the behavior of SulAmérica’s beneficiaries, making them more open to telemedicine solutions. “They start to see it as a safe, agile, and available alternative. Proof of that is the increase in the use of these solutions by our users; with the pandemic, the number of access has increased by 10 to 15 times, and the satisfaction levels of the beneficiaries are pretty high”, she comments.

Performance of the Health Innovation Commission

Composed by doctors, pharmacists, researchers, lawyers, regulatory specialists, and industry companies, the CCBC’s Health Innovation Commission (CIS) promotes periodic meetings to discuss the industry’s scenario and surveying the opportunities of the Canadian and Brazilian markets. The stimulus to the increase of bilateral relations in the industry also happens through the participation in fairs and congresses, besides the organization of seminars and diverse events. In parallel, special contents concerning relevant topics are produced by exclusive publications.