Newsletter
Ministry of Health and Welfare (MOHW) has promulgated the amendments to the Rules on Medical Diagnosis and Treatment through Telecommunications
During the COVID-19 epidemic, the practice of medical diagnosis and treatment through telecommunications (i.e., via online clinics) became prevalent. In response, the Ministry of Health and Welfare (MOHW) and the National Health Insurance Administration (NHIA) have collaborated with the Department of Public Health (DPH) of local governments to establish a comprehensive review and gate-keeping mechanism. As a result of this collaboration, the amendments to the Rules on Medical Diagnosis and Treatment through Telecommunications (''Amended Rules'') were announced on January 22, 2024.
According to Article 11 (1) of the Physicians Act, online clinics are permitted where there are difficulties in accessing medical resources such as mountainous areas, outlying islands, remote areas and special and urgent circumstances. The Amended Rules expand the scope of special circumstances and the patients by whom access to online clinics is permitted, increase the number of medical items that online clinics may provide, and the circumstances under which physicians may write prescriptions through online clinics.
The MOHW estimates that approximately 2.47 million people will benefit from the Amended Rules. The Amended Rules are scheduled to come into force on July 1, 2024. A summary of the key points of the Amended Rules is as follows:
1. The special circumstances prescribed under Article 11 (1) of the Physicians Act have been increased from five to ten under Article 3 of the Amended Rules. These include post-acute care, patients enrolled in chronic care programs, long-term care services, admission to care by a family doctor, home health care, hospice palliative care, correctional institution admissions, mobility-impaired care, disaster, infectious disease or other major accident care, and international medical care. For details of these ten circumstances, please refer to Articles 4 to 13 of the Amended Rules.
2. The number of medical items that online clinics may provide has been increased from the initial six items to a total of ten items, with some items being consolidated. In addition to the original items, which include inquiring about medical conditions, diagnosing and prescribing, adjusting or instructing original prescriptions, and providing health education, the items added include offering medical consultation, issuing examination orders or test orders, providing consultation, psychiatric-psychological treatment, and other items specified by the competent authorities. Furthermore, considering the practicality, the restriction on prescribing prescriptions under two special circumstances, namely inquiring about medical conditions and medical diagnosing, has been removed.
3. Under Article 16 of the Amended Rules, a new provision has been added to permit physicians to write prescriptions through online clinics under the following conditions:
(A)Follow-up on patients in stabilized condition under post-acute care, chronic care program, long-term care, care from a family doctor, home health care, hospice palliative care or mobility-impaired care (Article 3 (1) to (6) and (8) of the Amended Rules); and
(B)Initial consultation with and follow-up on patients in mountainous, outlying islands, or remote areas, correctional institutions, disasters, with infectious diseases, in other major accidents, or require international medical care (Articles 2, 3, 7, 9, 10 and 14 of the Amended Rules).
4. Article 18 of the Amended Rules provides a streamlined administrative procedure for medical institutions seeking to establish online clinics for special circumstances. The third paragraph of this article states that if a medical institution plans to conduct online clinics and has obtained approval from the competent authority or its subordinate institutions, as per other regulations, such written approval can substitute the implementation plan required under the first paragraph. It is important to note that the competent authority or its subordinate institutions referred to under the said Article are not limited to the NHIA.
5. Article 19 of the Amended Rules provides the security standards for the data privacy of communications and diagnosis. Given that medical data is deemed sensitive personal data as defined under Article 6 of the Personal Data Protection Act (''PDPA''), it requires special protection. According to Article 72 of the Medical Care Act, medical institutions and their personnel must not disclose patients' conditions or health information that they have acquired or possess as a result of their medical care duties. Hence, the Amended Rules specifically emphasize the need for an encryption mechanism for electronic files in commonly used telecommunications and electronic devices in terms of medical communications and diagnosis. This encryption mechanism must adhere to specific international standards for data transmission.
6. Article 20 of the Amended Rules not only expands the locations where physicians may conduct online consultations and treatments but also grants them the authority to evaluate the appropriateness of patients being examined via communications. This provision acknowledges that online consultation may not be suitable to all patients and that under certain circumstances, it would be more suitable for a patient to receive diagnosis from a physician in person.
According to its press release, the MOHW will collaborate with various authorities to establish a comprehensive support mechanism for online clinics before the Amended Rules come into effect on July 1, 2024. The normalization of online clinics aims to benefit patients and improve access to healthcare. Nonetheless, it is important to consider the requirements under the Electronic Signatures Act and the PDPA when seeking patients' consent to ensure that their rights are not compromised during online consultations. It is advisable to closely monitor the development of online clinics for potential legal issues that may arise as this practice becomes more prevalent.