Yes, telehealth is permitted in Argentina.
Yes, telehealth is permitted in Australia.
Prior to the COVID-19 pandemic, there were limited situations where telehealth could be used for the delivery of healthcare services in Australia. This was largely due to Medicare (Australia’s publicly funded universal healthcare system) restricting registered healthcare providers to delivering their services from a registered location (i.e., their medical practice), and limiting the availability of government subsidies for telehealth consultations to patients in rural and remote communities where pre existing provider-patient relationships existed.
On 30 March 2020, in response to the COVID-19 pandemic, the Health Insurance (Section 3C General Medical Services – COVID-19 Telehealth and Telephone Attendances) Determination 2020 (Cth) ("Telehealth Determination") came into force. As a result of the Telehealth Determination, a range of healthcare services delivered via telehealth that previously could not be subsidised under Medicare (including e.g., standard general practitioner consultations) became eligible for subsidy. That is, a variety of telehealth services became available at no cost to the patient under Medicare.
When the Telehealth Determination was first introduced, it permitted the delivery of healthcare services via telephone or video-conferencing to patients where there was no pre existing provider-patient relationship (although an existing relationship was preferred).
The Telehealth Determination was subsequently amended so that from 20 July 2020, telehealth general practice providers are required to have an existing and continuous relationship with a patient in order to provide telehealth services. Therefore, at present, unless an exception applies (e.g., the patient resides in an area where their movement is restricted by a public health requirement or the patient is less than 12 months old), a medical practitioner can only provide telehealth services to patients who have seen the practitioner for a face-to-face service in the last 12 months, or have seen another medical practitioner at the same practice for a face-to-face service during the same period.
Although the Telehealth Determination was scheduled to be revoked on 30 September 2020, the Australian Government announced a series of extensions of the Telehealth Determination, meaning the Telehealth Determination will now be in force until 31 December 2021.
Please also see Anticipated reforms regarding future plans for the permanent adoption of subsidised telehealth services in Australia.
Telehealth in Austria is, in principle, permitted.
The applicable professional rules requiring doctors to exercise their profession "personally and directly" could imply a general prohibition of distance or remote treatments without definite prohibition. Whenever medical science requires physical contact (e.g. physical assessment) between a doctor the patient, any treatment without such contact is a violation of the principle of directness. Consequently, without clear legal guidance any introduction of telehealth measures / devices requires careful assessment under the principle of directness and personal exercise in that specific context.
There is a lot of movement in the area of telehealth and we expect a development of the legal framework in the future.
Yes, the use of telehealth is permitted in Bahrain.
In Belgium, no legal framework exists in relation to telehealth. Healthcare professionals ("HCPs") contemplating the use of remote care technology are faced with two restraints:
- there is a prohibition by the Belgian National Council of the Order of Physicians ("NCOP") for a physician to make a remote diagnosis without any physical contact (see NCOP’s advice of 21 May 2016, "Deontologische en medischethische reflectie gemaakt over het gebruik van e-health en m-health binnen het gezondheidsgebeuren"; NCOP’s advice of 7 February 2015, "Artsen en digitale media"; NCOP’s advice of 26 November 2005, "BeHealthproject"; and NCOP’s advice of 25 September 1999, "Telegeneeskunde"); and
- no reimbursement framework exists in Belgium for telehealth (see report published by Belgian National Institute for Sickness and Invalidity Insurance ("INAMI") on the legal framework of telehealth and INAMI’s dedicated website).
On 16 March 2020, in response to the COVID-19 pandemic, Maggie De Block (the Belgian Minister of Social Affairs and Health) announced that reimbursement will be made possible for telephone consultations for medical services such as triage and advice regarding possible COVID-19 infection, and for continuous medical care (e.g., for elderly and chronic patients that are unable to physically go to a physician). A list of social security codes (used notably for reimbursement) was created for this purpose.
Subsequently, in a more global approach towards medical services provided ‘at distance and without any physical contact’, INAMI extended the scope of the list to also cover services provided by psychiatrists, neuro-pediatricians, dentists, physiotherapists, speech therapists, midwives, psychologists, occupational therapists, and diabetes educators.
Given the new nature of such remote services, additional guidelines have been published regarding basic principles to be observed when providing distance medical services. By way of example, this includes requirements such as patient consent, secure means of communication (specific guidelines are available on the eHealth website), and the necessity to assert if the patient is physically and mentally able to use a computer.
At this stage, it remains unclear how long this COVID-19 specific framework will remain applicable. In any event, the COVID-19 pandemic has increased the focus on telehealth and might speed up the process of ongoing initiatives, which we discuss further in Anticipated reforms.
Yes, the use of telehealth is permitted in Canada.
Even when telehealth is not expressly regulated by law in Chile, it is permitted as part of the means through which healthcare can be provided to patients. Notably, Chile has been developing telemedicine services since 1993, with a particular focus on the provision of healthcare services in remote zones and in regions (i.e., islands and Chilean Antarctic territory), and the Government has fostered a digitalisation agenda that includes telemedicine as part of the main elements of it.
Yes, the use of telehealth is permitted in China. It is commonly referred to as "internet plus healthcare" in China.
Yes. However, it is important to note that Colombian regulation differentiates between telehealth ("telesalud"), being any activity related to health, services and methods, delivered using ICT, and telemedicine ("telemedicina"), which is the delivery of health services including prevention, diagnostic, treatment and rehabilitation of diseases and injuries, by health services providers using ICT. The definition of "telesalud" provided by the Colombian law compresses the concepts of telemedicine and health tele-education in health matters.
Yes. Telehealth (or "Telemedicine"), defined as the provision of healthcare services at a distance (when a healthcare worker and a patient or two healthcare workers are not in the same location) by using information and communication technologies, pursuant to Article 38(1) of Healthcare Act (Official Gazette no. 100/18, 125/19 and hereinafter the "Healthcare Act") and Article 2(1)(I) of Ordinance on conditions, organisation and manner of performing telemedicine in conjunction with Article 257(1)(XXII) of the Healthcare Act (Official Gazette no. 138/2011, and hereinafter the "Ordinance"), is explicitly recognised and permitted in various Articles of Healthcare Act as well as various Articles of Ordinance.
At the moment, there is no such a law that would completely permit telehealth in the Czech Republic. However, a new Act on Electronic Healthcare (In Czech: "Zákon o elektronizaci zdravotnictví") is being prepared. It is currently in the comments stage.
Certain aspects of telehealth are in the Act on Health Services and Conditions for their Provision with respect to maintaining electronic healthcare documentation.
Yes, telehealth is permitted in Denmark.
Yes, telehealth (or "telemedicine") is permitted in Finland. The Finnish National Supervisory Authority for Welfare and Health ("Valvira") uses the term telemedicine for clinical consultations, diagnostics, observations, monitoring, treatment and clinical decisions and recommendations which are provided on the basis of information and documentation accessed by medical practitioners electronically, for example via video link or smartphone.
The Ministry of Social Affairs and Health has confirmed that, in terms of content, telehealth (or "telemedicine", which is a term more often used) services can be considered as a rule equivalent to traditional face-to-face consultations. Valvira approved in late 2015 the provision of healthcare services online, e.g. by means of a video call or a smartphone.
For example, the need for treatment may be evaluated by telephone or another telehealth service. Naturally, due to medical reasons, physical examinations may be required. In this case, where the condition of the patient or the situation requires it, the patient must schedule an appointment at a health centre. In addition, patients have the right to self-determination. Telehealth is not appropriate for consultations that leads to the patient’s right to self-determination being curtailed.
The use of telehealth is authorised in France.
Yes, telehealth is permitted as part of the regular healthcare services in Germany, within certain restrictions.
In Germany, the term ‘telehealth’ is used, often interchangeably, with the term ‘telemedicine’. However, there exists no uniform definition of ‘telehealth’ or ‘telemedicine’ under German law. The German Medical Association ("BÄK") describes ‘telemedicine’ as a collective term for various medical care concepts which have in common that healthcare services for patients including diagnostics, therapy and rehabilitation, as well as medical decision support are provided over spatial distances (or temporal offset) using information and communication technologies ("ICT"). Telemedicine may generally comprise, inter alia, eCare, ePrevention, eAdministration, eResearch, and eLearning.
Telehealth is subject to certain restrictions under German law. As a general rule, physicians, dentists, psychotherapists as well as other healthcare professionals may advise and treat patients in in-person visits exclusively. However, ICT, e.g. authorised e-mail or audio-video chat platforms, may be used to assist in-person treatment of and communication with patients. By contrast, exclusively remote visits, diagnostics and / or treatments, i.e. without any prior real life interaction between healthcare professionals and patients, are only permitted within very strict limitations requiring a case-by-case evaluation of the medical appropriateness.
Yes, telehealth is permitted in Greece.
Yes. Telehealth is referred to as ‘telemedicine’ in Hong Kong SAR, which is defined as "… the practice of medicine over a distance, in which interventions, diagnoses, therapeutic decisions, and subsequent treatment recommendations are based on patient data, documents and other information transmitted through telecommunication systems" in the Ethical Guidelines on Practice of Telemedicine issued by The Medical Council of Hong Kong in December 2019 (the "Guidelines"). This follows the definition of telemedicine in the World Medical Association ("WMA") Statement on the Ethics of Telemedicine, last amended in October 2018 (page 2, para. 8).
Telehealth services are permitted as part of the healthcare services in Hungary. The terminology in Hungary for telehealth services is "telemedicine". We use the terms ‘telehealth’ and ‘telemedicine’ interchangeably hereinafter.
"Telemedicine" is defined by Health Minister Decree no. 28/2010 as special type of healthcare services, where the patient and the healthcare professional do not meet face to face, and the connection between them is established via some sort of distance data transfer device.
Telehealth services, from a regulatory perspective, are considered as part of healthcare services, where the "communication form" of the provision of such services is different than the default face-to-face set-up.
Yes, telehealth is permitted in Ireland.
Yes, telehealth is permitted in Italy. Italian authorities refer to telehealth as "telemedicine" (telemedicina).
The Italian Ministry of Health ("MoH") issued specific guidelines which, although not binding, provide useful indications on how telehealth services should be performed in Italy ("MoH Guidelines"). The MoH Guidelines substantially reflect the definition of telemedicine provided by the WHO, i.e., the delivery of healthcare services using ICT for the exchange of information, in situations where patients and providers (or two or more providers) are separated by distance.
Ministerial Decree of 2 March 2016 established the National Centre for Telemedicine (Centro nazionale per la telemedicina e le nuove tecnologie assistenziali) within the Italian National Health Institute (Istituto Superiore di Sanità) ("ISS"), to promote and coordinate research on telehealth.
Yes. Telehealth is defined under Article 1 of the Regulation of Minister of Health of the Republic Indonesia Number 20 of 2019 regarding the Organisation of Telemedicine Services through Health Service Facilities, as the provision of long-distance health services by health professionals by utilising information and communication technology, consisting of information exchange on diagnosis, medication, disease and injury prevention, research and evaluation, and sustainable education of health service providers in order to improve individual and public health.
Yes, ‘telehealth’ is permitted in Japan. Medical institutions are allowed to decide whether to adopt telehealth systems.
Yes, in Kenya telehealth is known as e-Health and is permitted under section 103 of the Health Act 2017 (‘the Health Act’), which recognises e-health as a mode of health service.
The term “e-Health” is defined in the Health Act as “the combined use of electronic communication and information technology in the health sector including telemedicine.” The term “telemedicine” is, in turn, defined as “the provision of health care services and sharing of medical knowledge over distance using telecommunications and it includes consultative, diagnostic, and treatment services.”
Yes, telehealth is permitted in Kuwait.
Yes, telehealth is permitted in Luxembourg.
At present, to limit the transmission of the virus during the COVID-19 pandemic, health professionals are being encouraged to use teleconsultation methods (e.g. telephone, and video call applications). Furthermore, the Luxembourg government has launched the "eConsult" teleconsultation platform as an emergency measure in order to limit physical contact. The eConsult platform provides a secure environment for carrying out teleconsultations, allowing for remote consultations.
Yes, telehealth is permitted in Mexico, though it is not expressly provided for under relevant local laws.
Yes, telehealth is authorized in Morocco. Due to the COVID-19 pandemic, interest in telehealth has grown significantly which led to an adjustment of the regulations. We are also witnessing a growth in terms of telehealth services in the country, as these services are a quick and easy alternative to address the flaws of the current health care system which is currently under review.
Yes, the use of telehealth is permitted in Namibia, as there is nothing prohibiting the use of telehealth in Namibia.
Yes, telehealth is permitted in the Netherlands and use thereof has increased considerably as a result of the COVID-19 pandemic. Even more so, telehealth (also called E-health in the Netherlands) is part of a stimulus package (Stimuleringsregeling E-Health Thuis) by the Dutch Government in order to stimulate innovations in healthcare, particularly as it is believed that E-health can make healthcare more efficient and cost effective.
Yes, telehealth is permitted as a means of delivery of health care services in Nigeria.
Yes, the use of telehealth is permitted in New Zealand.
Yes, it is expressly stated in the Act of 5 December 1996 on the Professions of Physician and Dentist that professional activities of a physician / dentist may be performed using ICT.
Yes, telehealth is permitted and is currently being practiced in the public and private healthcare sectors in Qatar.
Yes, telehealth is permitted in Romania.
Yes. In Russia, rules on telehealth were adopted in 2017. On 29 July 2017, Article 36.2., governing telemedicine, was added to the Federal Law "On Basics of Health Protection of Citizens in Russia" No. 323-FZ dated 21 November 2011 (the "Health Protection Law"). On 30 November 2017, the Russian Health Authority also adopted Order No. 965n "On Endorsement of the Order of Providing Medical Assistance with the Aid of Telemedicine Technologies" (the "Order") which sets out the requirements relating to the provision of medical services through telehealth technologies.
Yes, the use of telehealth is permitted in the Kingdom of Saudi Arabia ("KSA").
Yes, telehealth is permitted in South Africa but subject to certain limitations as found in the General Ethical Guidelines for Good Practice in Telemedicine ("Guidelines") published by the Health Professions Council of South Africa ("HPCSA") on their website in 2014.
Yes, subject to certain restrictions as set out below.
Telehealth has been allowed by Slovak legislation only for the duration of the crisis situation regarding COVID-19.
Slovenian law explicitly recognises and allows two types of telehealth services, namely:
- "Telemedicine", defined as the provision of healthcare services through the use of information and communications technology in situations where the health professional and the patient (or two health professionals) are not in the same location, which shall subject to the rules of medical doctrine, pursuant to Article 3(3) of Slovenian Health Services Act (hereinafter referred to as "telemedicine"); and
- "Telepharmacy", defined as a means of remote counseling through modern telecommunication technologies involved in pharmaceutical activity, according to Article 4(1)(XVIII) of Slovenian Pharmacy Practice Act (hereinafter referred to as "telepharmacy").
Telehealth (or ‘telemedicine’) is generally permitted in Spain as there are no specific limitations or prohibitions regarding telehealth under Spanish law.
However, it should be noted that in Spain, health competences are transferred to the 17 different self-governing regions. Hence, each regional healthcare authority has the autonomy to allow, plan, or limit their healthcare system, including the types of services they offer such as telehealth.
Furthermore, the professional code of the Doctors and Dentists Bar Association limits teledentistry to patient orientation (during medical revisions) and second opinions, and only as long as it is clear that mutual identification and privacy is ensured.
Yes, telehealth is permitted in Sweden.
Yes. In Thailand, telehealth is regulated as part of "telemedicine", which is the provision of healthcare services through the use of telecommunication technology. As there is no separate definition for telehealth under Thai law, any references to "telehealth" hereinafter will be covered under the scope of "telemedicine".
Recently, on 1 February 2021, the Ministry of Public Health ("MOPH"), which is the body responsible for overseeing public health in Thailand, has issued the Notification Re: Standards of Service in Respect of Medical Facility via Telemedicine System ("MOPH Notification") which effectively legalised telemedicine businesses for medical facilities in Thailand.
Yes, telehealth is permitted in the United Arab Emirates (UAE).
Yes. Telehealth has been active in the UK for a number of years. Since the COVID-19 pandemic, the use of telehealth has grown significantly, and a range of different healthcare providers are making use of new and innovative technologies in order to provide services to patients.
Telehealth in the U.S., while generally permissible, is very complex and highly regulated, both from a general practice and coverage perspective.
There is no federal law that governs the practice of telehealth. Telehealth is regulated at the state level and the question of what constitutes permissible telehealth practices varies greatly. States often have differing definitions of telehealth, with some permitting asynchronous communications and others permitting only real-time interactive audio and video communications.
Permissible telehealth practices can also differ by professional discipline, with state licensure boards adopting one standard for the practice of telehealth by physicians and another for the practice of telehealth by nurses or dentists. Licensed professionals are governed by professional licensing bodies in each state where they hold licenses. In order to provide licensed services to individuals, the professional must hold a license in the state where the patient is located. This means that a professional providing telehealth services to individuals in multiple states may be subjected to different standards of practice depending upon the location of the patient being served.
While requirements for an in-person examination prior to the use of telehealth have largely been abolished, in-person examinations often are still required in order to prescribe using telehealth.
In addition to the regulations on the practice of telehealth, there are great variances in the coverage and reimbursement of telehealth as well, at both the state and federal level.
The federal Ryan Haight Act requires healthcare providers to conduct an in-person examination before prescribing or otherwise dispensing controlled substances "by means of the Internet", except when engaged in the practice of telemedicine.
However, the telemedicine exemption to the Ryan Haight Act is extremely narrow and has not been revised since the law’s implementation back in 2008. For example, the telemedicine exception does not apply if the patient is at home, school, or work. The federal Drug Enforcement Administration ("DEA") is in the process of adopting a telemedicine special registration; however, this remains under development.
Yes, telehealth is permitted as, subject to privacy and medical ethics, there is no prohibition of telehealth under Zambian law. As such, medical practitioners have adopted, and the public has embraced, telehealth. Furthermore, the advent of the COVID- 19 pandemic has heightened the general acceptance of telehealth by the Zambian public.
Yes, in principle, telehealth in Zimbabwe is permitted.
The Public Health Act [Chapter 15:17] and the Health Professions Act [Chapter 27:19] currently regulate the offering of health services by medical practitioners and have several guidelines in place that must be met by the specific medical practitioner or service provider on a case-to-case basis. At times, these are widely interpreted to apply to service providers and practitioners offering telehealth services.
Is the use of telehealth permitted?
Yes, telehealth is permitted in Argentina.
How is telehealth regulated?
In 2019 the Argentine Ministry of Health published a guide of recommendations for the supply of ‘telehealth’ (Disposition No. 21/2019). The "Recommendations for the use of telehealth: meeting between the health professional and the patient using real-time ICT" were prepared by a group of healthcare providers, coordinated by the Ministry of Health, with the objective of creating a guideline for the provision of telehealth in a safe, efficient and ethical way. Before the COVID-19 pandemic, this guide of recommendations was voluntarily applied by private health insurers that offered this type of healthcare, but compliance with it was not mandatory. However, this has changed since the COVID-19 pandemic and the lockdown measures adopted by the Argentine Government.
Currently, the Government has ratified the application of these recommendations for diagnosing and treating COVID-19 and other general diseases. Pursuant to the General Resolution No. 282/2020 of the Superintendency of Health Services ("Superintendencia de Servicios de Salud"), all private health insurers must employ and promote the use of teleconsultation platforms in order to provide healthcare treatments. In all cases, they must guarantee that the data and information collected from the patient through the use of teleconsultation platforms would be protected in the terms of the Law No. 25,326 of Personal Data Protection. Moreover, telehealth platforms must, in all cases, be subject to a subsequent audit to carry out an effective control by the Superintendency of Health Services.
Are there specific fields of healthcare in relation to which telehealth services are currently available, and do they involve the use of proprietary technology or platforms?
Pursuant to Law No. 27,553, the healthcare services currently available through telehealth methods are: general practice, dentistry and collaborative activities related to them, and psychology. In all cases, these activities should be previously authorised by the competent authority and they should comply with the provisions of Law No. 26,529 of Patient Rights. These services are available through the use of proprietary platforms and general videoconferencing apps. As both forms are permitted, the platform used will depend on each particular case.
Currently, during the COVID-19 pandemic, private health insurers offer services related to general practice and the diagnosis and treatment of COVID-19 through the use of proprietary platforms such as apps and websites.
Does the public health system include telehealth services, and if so, are such services free of charge, subsidised or reimbursed? Where the public health system does not include telehealth services, are such services covered by private health insurance?
The public health system is free of charge but generally does not include telehealth services because it lacks the infrastructure to provide them. However, pursuant to Law No. 27,553 on electronic prescriptions of medicines and healthcare treatments, all the healthcare providers of the public health system are empowered to do so, and can issue electronic prescriptions.
Most of private health insurers offer some telehealth services such as appointments with a medical doctor via videoconference. No additional fees are charged to the patient as this is typically covered in the health insurance policy.
Do specific privacy and/or data protection laws apply to the provision of telehealth services?
There are no specific data protection laws relating to telehealth services precisely. However, the Ministry of Health’s guide of recommendations includes a section related to data protection and, in all cases, healthcare providers should comply with Law No. 25,326 of Personal Data Protection.
How should the cross-border transfer of personal information collected and processed in the course of telehealth services be carried out to ensure compliance with applicable privacy laws?
Pursuant to Law No. 25,326 of Personal Data Protection, the cross-border transfer of personal data of any kind is prohibited. However, this prohibition shall not apply in the following cases:
- International judicial collaboration;
- Exchange of medical data, when required by the treatment of the affected person, or an epidemiological investigation;
- Bank or stock transfers;
- When the transfer has been agreed within the legal framework of international treaties to which the Argentine Republic is a party; and
- When the transfer is aimed at international cooperation between intelligence agencies to fight organised crime, terrorism and drug trafficking.
In all cases, for the transfer of data, the owner’s consent is required.
Are there any currently applicable codes of conduct on the use of telehealth systems and/or security of telehealth data in your jurisdiction?
Yes, as discussed in Availability of Telehealth, the Ministry of Health has published the "Recommendations for the use of telehealth: meeting between the health professional and the patient using real-time ICT".
Are any specific laws, regulations, or self-regulatory instruments expected to be adopted in the near future?
The government has recommended that public and private healthcare providers implement and promote the use of teleconsultation platforms in order to provide essential health services. Moreover, further regulations will be issued to implement Law No. 27,553 as discussed in Regulation of Telehealth.