In our previous article we discussed business opportunities arisen from the emergence of telemedicine for the insurance industry (link).

We will explore further in this article, against key developments and milestones, some shortfalls which are critical in enhancing our telemedicine landscape.

1. An MOU between the National Broadcasting and Telecommunications Commission (NBTC) and the Ministry of Public Health (MOPH) was signed in March 2020 with the objective of facilitating medical services using digital platforms, AI and technology. It appears that there will be good development in infrastructure and platform building. While no major progress has been reported, the government has allocated around Baht 7 billion for the MOPH to develop relevant digital platforms further.

2. During the COVID-19 lockdown and requirement to live in the new normal situation - staying home and maintaining social distancing in public places, the MOPH and Department of Medical Services launched a pilot project with 27 hospitals where patients are allowed to virtually visit doctors and medicine may be delivered to them at home. It has been around five months now and the pilot program of virtual doctor visits and medicine delivery seems to be going quite well as we understand it. It looks like these practices will continue beyond the COVID-19 pandemic and become the “new normal” for years to come. Of course there will be a need to improve and adjust these practices for the better and hopefully cheaper (given the economy of scale).

3. The Medical Council of Thailand approved the Telemedicine Guideline which was published in the Royal Gazette on 21 July and will become effective on 20 October 2020. Under this guideline, the provision of healthcare via the telemedicine healthcare system must be in accordance with the professional standards, competency criteria and guidelines of the Medical Council. Healthcare providers and healthcare recipients should be aware of, and must acknowledge, the technological and electronic restrictions. These include, among other things, the medical facts and the fact that only certain diseases or conditions are suitable for the use of telemedicine. The use of tools, programs, or artificial intelligence (AI) jointly with telemedicine must be in accordance with specific laws, such as the law on medical devices and drug laws. Telemedicine must be conducted under an information system that meets the international information standards and security and maintained in a condition ready for use and for audit. The verification of identity of a healthcare provider and a healthcare recipient must be provided by the system. Online clinics must comply with relevant regulations also to be issued under the Medical Facilities Act.

As pointed out in our past article, one obstacle of telemedicine is the exposure that physicians have to carry. Routine follow-ups and telepharmacy (see item 5, below) should for certain be carried on after the COVID-19 pandemic but the "full scale" telemedicine where doctors treat serious diseases and sicknesses might require more time and other legislative supports that could reduce the physicians’ concerns and exposure. We could be wrong but the Medical Council’s guideline for patients which lists all the undesirable patient’s behaviors somewhat suggests that “telemedicine” and its digital content are feared to be inappropriately used and could expose the physicians more if patients deliberately record the online sessions with their doctors and post the recording online or edited parts of it for their benefit in court cases or claims etc. in the future.

4. In June 2020, the Department of Health Service Support (the “DHSS”) issued a draft guideline for telemedicine facilities for public hearing. The draft outlines specifications and requirements for hospitals and clinics whose doctors will be allowed to practice telemedicine. A medical facility wishing to provide the telemedicine service must ensure there is a sufficient number of professionals to provide the telemedicine service without disrupting the medical facility's main services. The medical facility must have telecommunication plans and devices for the telemedicine service that allows for clear communication, with information security standards implemented. Medical facilities must implement a process to inform patients of the telemedicine service details before providing the telemedicine service, including service procedures, all aspects of the possible effects of the service, and risks associated with the service. The medical facility will be required to submit a supplemental service application form in respect of the telemedicine service for operating telemedicine services to the DHSS. The draft is being developed by the DHSS and the content is yet to be finalized. There is no specific timeline when the draft will come into effect. To a certain extent, relevant physical facilities require improvements and thus more time. Hopefully during this period of time, relevant government agencies will be able to somehow develop qualified personnel who will be working in these fast growing areas.

5. The Pharmacy Council has announced telepharmacy guidelines on 2 June 2020 under which pharmacists will be allowed to provide pharmaceutical care without a face-to-face meeting with patients, including the delivery of drugs. The key requirements are that the service provider must be a licensed pharmacist and must have a system for enrollment and a record of the patient's profile and telepharmacy received, as well as a system to record video or voice data when providing the service. The patient's consent must also be obtained. The guideline states three scenarios for providing telepharmacy services: a) the provision of telepharmacy at a medical facility; b) the provision of telepharmacy via a pharmacy with a drug prescription; and c) the provision of telepharmacy via a pharmacy without a drug prescription. The main telepharmacy processes include verification of the patient's information (or enrollment); contacting the patient and making a schedule for delivery of the drug; identification of the patient upon providing the telepharmacy service; providing consultation on the use of the drug; keeping a medical record; and following up on the result of the drug use.

As mentioned in our previous article, the Food and Drug Administration's review of drug category should be supportive to the telepharmacy system. Generally as discussed above, the draft telepharmacy guideline requires more administrative efforts and cost. Allowing patients to access drugs more conveniently is to add more drugs into the "general household drugs", known in many countries as "OTC" drugs. In order to do that, various studies and past records of adverse effects for example could take time and budget as well.

6. The National Health Security Office (NHSO) has started to allow reimbursement of doctors' fees and costs for consultation at a distance and relevant medicine delivery. It seems that the public and private sectors are equally keen to support “telemedicine”, virtual sickness consultation and drug delivery, allowing reimbursement from the Gold Card scheme and private medical policy. Most of the insurance companies have started to allow reimbursement for telemedicine, including Krugthai AXA, Muang Thai Life Assurance, Bangkok Life Assurance, Tokio Marine, Dhipaya Insurance and FWD. Given the fact that the legal framework for telemedicine is developing, we are optimistic about seeing medical insurance products in the future being developed in response to other new functions and enabling functions of what will be deemed to be a “full scale” telemedicine and not just the reimbursement of simple doctor consultations at a distance and medicine delivery.

Seeing the developments and efforts of various stakeholders, a few critical ones are listed above. Thailand will soon be second to none in the telemedicine healthcare scheme. The big question mark, however, is still how comfortable the physicians are with the Telemedicine Guidelines vis a vis their exposures. It does not matter how far the relevant guidelines and legal requirements, along with digital platforms and insurance schemes and medical reimbursements, have developed if the physicians are not completely comfortable with all of these. We might find ourselves back to square one, pre-COVID 19 pandemic time, as far as treatment at a distance is concerned.