On March 21, 2022, through Resolution 581/2022 the National Ministry of Health approved the Document of Good Practices for Teleconsultation – Teleconsultation with the patient, incorporating it into the National Program of Quality Assurance in Health Care (the “Program”).
Among the main benefits of the Program’s implementation, we can mention the avoidance of unnecessary travel, waiting time, and/or transfers, since most consultations are mainly aimed at addressing issues of low complexity, speeding up diagnosis and treatment alternatives; it favors accessibility and makes it possible to evaluate requirements to optimize the subsequent face-to-face visit. The use of this modality promotes the improvement of health care since specialties that are not available in all provinces are approached, avoiding sometimes unnecessary migrations.
It also improves information transmission, communication between different services and contributes as well to greater efficiency of the healthcare teams, as well as optimizing administrative processes due to the simplification of request circuits, reduction of errors, and standardization of the care process.
The “Good Practices for Teleconsultation” are intended as an instrument for the normalization and standardization of practices and the improvement of teleconsultation’s quality, within the framework of telemedicine. It is conceived as a dynamic document, which can be revised and improved according to the feedback arising from its development. It is directed to any person who requires and provides health care through information and communication technologies in the public, private, and social security spheres throughout the Nation.
It includes different definitions of what is meant by Telehealth, Telemedicine and Teleconsultation, meaning:
Telehealth: the “set of activities related to health, services, training, management or benefits carried out through information and communication technologies.”
Telemedicine: the “modality of providing health services through information and communication technologies. It is a form of telehealth.”
Teleconsultation: the “health care process that involves the interpretation of medical information and decision making, provided through information and communication technologies that takes place between two or more health professionals, as well as between the health team and the person receiving health care.”
Teleconsultation can be synchronous, meaning that it takes place in real-time; or asynchronous, meaning that it takes place in deferred time, the information of the consultation is received and then the feedback is delivered later; and it can be carried out in two ways, depending on the needs in each case, being these:
Teleconsultation with the patient (TCP): A teleconsultation between the patient and the professional or a member of the health team. Also called First Opinion.
Second opinion teleconsultation (TCSO): refers to teleconsultation between two or more health professionals, without the presence of the patient.
Regarding the implementation of the Program, three basic aspects should be addressed:
Define the model of the telemedicine care process.
It should include a description of the program, target population, services to be provided, description of processes, process flows, activities, responsible parties, structure requirements, technology, business processes and quality and safety protocols, evaluation and training plan, among other aspects.
Define specific care protocols.
They should be developed according to standardized programs, by pathology, level of complexity, etc., based on evidence and validated by the treating team. The protocols should establish the description of how teleconsultation will be implemented in the process flow. Articulation with face-to-face care, referral, and emergency devices.
Validation of internal and external regulatory frameworks for the adequacy of the process and protocols.
Protocols and tools related to the development of telemedicine and teleconsultation should be supported and validated according to regulatory requirements and national and international evidence.
About the consultation, the same quality, and respect should be considered as in a face-to-face consultation. In addition, access to the Internet and a mobile device with its accessories (headphones, microphone, and camera) must be available to carry out the consultation, and the application must be downloaded to the device, when necessary.
The Program is divided into two main sections. First Good practices concerning the process of care by teleconsultation:
Before the teleconsultation
Patients should:
Be in a warm, illuminated, and quiet environment to develop the consultation. Know the reason for the consultation, a list of pre-existing diseases and medications consumed, if necessary and if so, also have the results of previous medical studies.
It should also be ensured that the professional has their contact information (phone and email) to receive written instructions by text message or email.
At the beginning of the teleconsultation
The interaction between the patient and the health team begins, so the health teams should consider, in addition to the patient’s identity, these aspects of the modality of care.
If there is no previous contact with the patient, the health team must determine at the beginning of it, if the case is suitable for teleconsultation, assessing, among others, the available resources, technology and modality for health care.
The decision to use teleconsultation should consider the following initial factors:
Clinical: evaluate the best model of care for the person according to the clinical aspects reported.
Technological: evaluate the technological availability to carry out the consultation between both points (patient/professional).
Personal: consider the person’s ability to participate or the necessary support (cultural situation; language; autonomy, capacity, etc.).
During the development of the teleconsultation
The health team must comply with confidentiality safeguards and promote continuity of medical care. In their interaction with the patient. It is also essential that the health team respects the timing of the dialogue, uses an appropriate tone of voice, and always promotes effective communication.
A complete record of the care should be made, through the same electronic record of the health center where the patient is usually seen. The patient should be asked for all the information that he/she has and that the health team does not have and that is useful according to the subject matter of the consultation.
In addition to the clinical record, copies of all reports and documents generated from the teleconsultation should be made and stored.
After the teleconsultation
According to the needs of the case, the articulation with the face-to-face care, referral, and emergency devices will be carried out. Once the teleconsultation is finished, feedback on the patient’s experience and the health team on the use of the teleconsultation will be collected. Evaluations should be carried out by objective and reliable quality management systems.
Second Best Practices concerning the Structure.
With respect to the physical space, it is established that the professional should carry out his activity in a private, and well-lit space. If third parties are present (undergraduate students, residents, for example), they should be introduced to the patient, clarifying their roles in the process and having the patient’s prior consent. Regarding the technologies, it is indicated that in case of connection problems, the consultation, if possible, should be carried out by phone call. In addition, technology must comply with the standards for health information systems and security and cybersecurity protocols for the inviolability of information, safeguarding confidentiality, integrity and its availability, as well as having risk assessment and audit processes. In case of technologies with simultaneous audio and video transmission, these should use current and updated systems allowing recording and encryption and ensuring the highest possible quality and security standards.
This report should not be considered as legal or any other type of advice by Allende & Brea.
