The survey was carried out by the Brazilian Association of Telemedicine and Digital Health Companies, and draws a parallel between the regulation of telemedicine around the world and Brazil
Saúde Digital Brasil (Brazilian Association of Telemedicine and Digital Health Companies), a non-profit organization that brings together entities that operate in the telemedicine service provision chain and represent 90% in this market, conducted a benchmarking study that identified that out of 15 countries, only Uruguay has strong restrictions on the first remote consultation. In almost all of the countries analyzed – including healthcare references such as England, which through the NHS serves as inspiration for the creation of the Unified Health System (SUS) – there is total freedom of care, even if initially via telemedicine, and this occurs in other countries in Europe and the Americas, including the United States, Canada, Mexico, Colombia, Argentina, among others.
Maintaining the first non-face-to-face consultation is one of the central points of the discussion on the definitive regulation of telehealth in Brazil, which is being processed in the National Congress. The Federal Council of Medicine (CFM) requests that this resource be used only for monitoring chronic diseases and follow-ups.
The objective of this benchmarking, carried out by the legal department of Saúde Digital Brasil, was precisely to understand how other countries around the world are dealing with some specific points related to telemedicine: the general context; definition; activities covered; need for a specific license; being in-person or remote; prescription; physician autonomy and patient consent, these two aspects being very important for the future of telemedicine, especially in Brazil.
“The main contribution of this study is to show that, unlike what is observed in Brazil, telemedicine is widely accepted around the world. Debates like the one we are having here, full of obstacles, such as the issue of the first consultation and territoriality, end up delaying regulation and putting the country even further behind in terms of technological advances in the health area. In addition, there is no support in the medical literature that justifies the ban,” highlights Eduardo Cordioli, president of Saúde Digital Brasil.
According to the executive, the regulation of Telemedicine in Brazil is quite peculiar. While in countries like Portugal and Colombia it is the Ministry of Health's responsibility to regulate the practice, here, this responsibility is assigned to the Federal Council of Medicine (CFM), an agency with no comparison in other countries. “It is important to look at other countries and how other economies are dealing with telemedicine and, in this way, bring technological innovations to Brazil. Among the supporters of the first remote consultation are Germany, Spain, Canada, Chile, Colombia, the USA, France, New Zealand and the United Kingdom”, he says.
In parallel with South American countries, Colombia passed a law establishing guidelines for telehealth in 2010. Years later, in 2019, even before the pandemic, the Ministry of Health and Social Protection regulated, through a Resolution (equivalent to an Ordinance in the Brazilian legal system), criteria for the exercise of activities by medical professionals. Colombian regulations define interactive telemedicine as the remote relationship between a doctor and a patient for the provision of health services in any of its phases, which includes the first consultation.
In Europe, it is possible to observe the evolution of the debate in countries such as France. In 2009, the country approved an amendment to its Health Code, imposing restrictive regulations on telemedicine, prohibiting the first consultation from being carried out remotely. Given this restriction, in 2019, a small change was made to the law to broadly authorize the first consultation from being carried out remotely, without the need for the patient to be accompanied by a doctor at the place of care. “The way France changed its Health Code is a sign of the times. Many countries are working to change their regulations and expand this scope, including before the pandemic, such as Colombia, France and New Zealand,” he highlights.
Another important example is the United Kingdom. In recent years, it has been investing heavily in a “Digital First” strategy. Aiming to improve access to care, patients enter the English healthcare system primarily through digital services. This model reduces waste for public healthcare systems and simplifies the patient journey.
In the international benchmarking, countries were identified that do not completely prohibit the first remote consultation, allowing some procedures. This is the case of South Africa. The Health Professions Council (HPCSA) changed its understanding. In 2016, the first remote consultation was largely prohibited. With the advance of the pandemic, an exception was made for telepsychology and telepsychiatry. In other cases, it is preferable that there is a prior relationship between doctor and patient, although, when this is not possible and it is in the patient's preference and interest, this first consultation can be remote.
“It is a fact that Brazil urgently needs regulation. Telemedicine was authorized as a matter of urgency in 2020, and its regulation will only be in effect until the end of the pandemic. We need to prevent the country from returning to the level of 2002, which was a time when technology availability was much lower and, if we look closely, the regulation was already outdated considering the innovations of the time. In this sense, looking at international examples can be a starting point,” he concludes.
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