CFM regulates telemedicine. The doctor will be able to decide whether to attend by computer or in person

RIO – Resolution No. 2134/2022 of the Federal Council of Medicine (CFM), which defines and regulates telemedicine in Brazil, enters into force on the fifth of this month. This practice has previously become restricted in the past two years, with the spread of the covid-19 epidemic and isolation measures. Specialists see this procedure as inevitable, but are afraid of insulting and marketing advice.

Under the new decision, health plans may decide whether or not to offer teleconsultation. The doctor will be able to choose the type of consultation he wants to have. It will refer to the service face to face if necessary. This procedure does not place restrictions on remote consultations. Nor does it prioritize vis-à-vis service.

“In principle, a trained physician knows very well what care he should receive with the patient, and if he finds it wise, he must provide mixed or face-to-face care, ensuring that the services provided are not inferior,” explained specialist Zhao El Wen, head of the telemedicine department. at the University of the South Pacific School of Medicine. “This avoids, for example, the physician having to provide remote care, regardless of the patient’s clinical status.”

The debate on the regulation of telemedicine began in 2018 with the participation of representatives from regional councils and medical associations. Specialists believe that the organization of practice will be very beneficial to the Unified Health System (SUS), which provides 75% of care in the country. It will be important for the most isolated municipalities and will make life easier for patients. “For example, 50% of SUS tests are wasted because, all too often, the patient has no one to show them to, or when they can make a new appointment, they are already expired,” says Wang.

He remembers that this can be easily resolved through teleconsultation. “Another example: for some complex tests, the patient needs the doctor’s instructions beforehand; I’ve seen cancer patients travel more than 600 kilometers just to receive these instructions, and the next week, they have to come back for the test.”

Telemedicine is not just a teleconsultation. It is just one of the seven avenues outlined by the new resolution. The others are: teleconsultation (when doctors consult other doctors), telediagnosis (sending test reports to doctors), telesurgery (by robots), telemonitoring (monitoring a patient’s clinical development), and remote correlates (modifying the patient to enter hospital) and remote consultations.

Donizetti Giampardino, Rapporteur of the resolution, emphasized that “face-to-face medical advice remains the gold standard, that is, a reference in care.” “But the pandemic has shown that telemedicine can be an important complement to medical care, allowing access to thousands of patients.”

For CFM President, José Herran Gallo, the practice has shown, during the pandemic, its great capacity to provide assistance to cities at home as well as to benefit large centres. He assesses that it has reduced the bottleneck caused by the system due to the exodus of patients seeking treatment.

“The lack of regulation makes it difficult to make the subject mandatory in professional training; in training and accommodation the physician develops investigative thinking and empathy for the patient,” Zhao Wang recalls. “But we need to raise the flag, we want responsible telemedicine, not mercantilism; and in that sense, accountability of the professional helps a lot.”

questions and answers

What is telemedicine and how does it work?

The method is used for preclinical care, care support, counselling, monitoring and diagnosis in the Unified Health System (SUS) or in a private network. Telemedicine care can be provided directly between doctors and patients, through information and communication technology that ensures the safety, security and confidentiality of information. The entire consultation must be recorded in a medical record indicating the date, time, technology used, the doctor’s regional professional board number and its union unit.

Physicians are entitled to issue medical certificates or prescriptions as long as they are signed online and accompanied by information about the specialist. They must also follow the requirements set by the Health Monitoring Agency (Anvisa). In the United States and European countries, remote assistance is already widely used.

How can telemedicine help during the novel coronavirus pandemic?

The idea is to use telemedicine as a tool to tackle the novel coronavirus pandemic in Brazil. In this way, it will be possible to reduce the demand for other services, allowing hospitals to take care of patients with covid-19, urgent and emergency cases. Other types of assistance can be clarified through remote assistance without the need for a face-to-face consultation. In addition, the tool can be used to monitor confirmed patients who are in home isolation.

Can a positive case of the novel coronavirus be diagnosed by remote service?

It is important to stress that a confirmed diagnosis of the new coronavirus must be made in person, as it is based on testing. With remote care, it is only possible to direct isolation in some cases, and to monitor and control the clinical picture of milder cases, as described above. In the event of a fever accompanied by symptoms such as a dry cough or shortness of breath, seek medical attention in person. From the diagnosis, a person will know if they need to be hospitalized or if they can monitor remotely from their home.

What care does a patient need when they don’t know who is going to take care of them remotely?

The service can be conducted by phone, messaging platform or video conference. Specialists recommend that the patient choose the third option, in the event that he does not know which doctor he will meet. Prior consultation with medical boards to verify the profile of the person responsible for care. If the doctor is the same or a reliable indicator, then the patient can calmly carry out the consultation through the other two options as well.

How much does a remote service cost, on average?

Within the scope of the Unified Health System (SUS) and health plans, no additional payments should be made (in SUS for free care and in health plans because the value of the consultation is included in the monthly fee paid by the user). The remuneration shall occur in private consultations and the mode of payment shall be modified by mutual agreement of the parties. The price should vary from 75% to 100% of the value of a face-to-face consultation.

How does remote care work for children?

Children often require medical care, and parents are often unsure whether to go to the emergency room. Since going to the hospital is always a risk, since it is an environment in which people with infectious respiratory diseases are prevalent, the goal of telemedicine is to help families avoid unnecessary trips to the emergency room in this period of the COVID-19 pandemic.

In what cases is telemedicine recommended for children?

Problems such as colds, sore throat, cough, headache, allergies, allergic rhinitis, nosebleeds or red eyes. Skin irritation and allergies, minor infections, itching, skin infections or warts, insect bites, diaper rash and pollen reaction. Questions about the general health of children, breastfeeding, or your child’s vaccination.

Is remote service an ally of face-to-face service?

The telecare physician will ask questions of the patient, being of the same type of triage as in in-person care. By monitoring the patient, you can refer the patient, when necessary, to hospital care. These are supplementary services. In some cases it is not enough to talk and observe, the doctor needs to put his hand on the patient to examine him.

What are the pros and cons discussed about telemedicine?

The positive side of telemedicine is that health care is made available to the largest number of people at any time and place, which significantly reduces the time and costs of patient travel, as well as providing connectivity to professionals from several other specialties. Telemedicine is revealing a new way of working in the entire health sector and can represent a new field of work for many professionals.

The most immediate and visible downside is the lack of personal contact with the doctor and the potential lack of protection, custodianship and security of confidential information, including patient medical records, which could mean an increase in lawsuits and lawsuits. Repair.

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