[co-author: Abrianne Marais]

The world of medicine, like numerous other industries, is also being disrupted by technology and apps like Hello Doctor and Medici are revolutionising the doctor-patient relationship.

These apps enable users to communicate virtually with medical providers via text, call or video, anytime and anywhere. South Africa is also the first country in the world to use pharmacy dispensing units, where people can collect their medicine through a "vending machine".

These apps, or telemedicine platforms, and other new technologies are growing in popularity in South Africa and have numerous benefits, including delivering healthcare services at a distance to South African communities in under-served areas.

With Hello Doctor, an individual must download the app to their smartphone and then they can talk to a doctor anytime and anywhere. According to IT News Africa, the messaging app Medici enables users to communicate virtually with medical providers via text, call or video; also anytime and anywhere.

With any new technology comes risks, and it would be wise to understand the relatively new regulations around telemedicine.

Telemedicine is currently regulated under the Health Professions Council of South Africa's (the "HPCSA") General Ethical Guidelines for Good Practice in Telemedicine (the "Telemedicine Guidelines").

The objective of the South African Telemedicine System is to deliver healthcare services at a distance to South African communities and widen access to reliable medical services. In addition, they seek to improve the links and communication between developed healthcare facilities and the underdeveloped rural areas.

Telemedicine Guidelines – what does it mean?

For the purpose of the Telemedicine Guidelines, "Telemedicine" is defined to mean: "The practice of medicine using electronic communications, information technology or other electronic means between a healthcare practitioner in one location and a healthcare practitioner in another location. This is for facilitating, improving and enhancing clinical, educational and scientific healthcare and research, particularly to the under- serviced areas in the Republic of South Africa."

This definition includes both asynchronous (e.g. email/website/etc.) and synchronous (e.g. video conferencing, etc.) modes of telemedicine. The Telemedicine Guidelines envisage that this may take the form of secure video conferencing or similar forms of technology which enables healthcare practitioners to replicate the interaction of traditional face-to-face consultations between healthcare practitioners and the patient.

Three parties will generally be involved, i.e. the Requesting Patient (the "Requesting Patient"), a Consulting Healthcare Practitioner (the "Consulting Practitioner") and a Servicing Healthcare Practitioner (the "Servicing Practitioner").

The Telemedicine Guidelines provide that Consulting Practitioners and Servicing Practitioners are held to the same standards of medical practice as healthcare practitioners who conduct face-to-face consultations. Treatment, including the issuing of a prescription, based solely on an online questionnaire, does not constitute an acceptable standard of care and is not allowed.

The doctor will see you now

Consulting Healthcare Practitioner refers to the [healthcare] practitioner who conducts a "face-to-face" interview or examination with the patient or refers patient's information to a remote location for further advice or intervention, and their obligations include ensuring that the Servicing Practitioner is competent; and that informed consent is taken in accordance with the standards of practice used in face-to-face issuing of prescriptions.

The Consulting Practitioner remains responsible for the treatment, decisions and other recommendations given to the patient, as well as for keeping detailed records of the patient's condition and information transmitted and received from the Servicing Practitioner.

The Servicing Healthcare Practitioner refers to the [healthcare] practitioner who offers advice or intervention or patient information from a "remote location", and their obligations include the keeping of detailed records of the advice that he/she delivers, as well as the information that he/she receives and on which the advice is based. This ensures that the advice or treatment suggestions given were understood by the consulting practitioner or the patient.

Informed consent is imperative and the Telemedicine Guidelines requires that patients are informed regarding the purpose of the telemedicine service(s), cost of the service(s) and implications thereof. It also further sets-out a list of prescribed documentation guidelines and the patients must at all times be assured that their confidentiality is protected.

Policies and procedures for documentation, maintenance and transmission of records regarding telemedicine consultations should be maintained at the same standard of care as face-to-face consultations.

It is further necessary that the above be considered in light of the South African consumer protection legislation (Consumer Protection Act), data privacy legislation (Protection of Personal Information Act and the Electronic Communications and Transactions Act), and other directives and guidelines issued by the HPCSA.

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