David Ellis, partner at Mayer Brown, argues that with appropriate modifications to the regulations, digital healthcare could become a major factor in reducing healthcare costs and improving public welfare
Digital health implementation has accelerated as a result of the Covid-19 pandemic as members of the public avoid or are required to minimise face to face interaction. But the bigger story is that the ageing of the global population and constant development of new
treatments is creating a tidal wave of healthcare demand that will swamp government finances unless more efficient service delivery can be achieved. Hong Kong has made some progress but has yet to develop a comprehensive digital healthcare strategy.
The World Health Organization (WHO) has been developing a global strategy on digital health in order to support national efforts of member states to achieve universal health coverage.
Digital health refers to the development and use of digital technologies to improve access to healthcare.
The WHO classifies digital health solutions into the following categories:
- Census information data warehouses
- Data interchange and interoperability (for example, the exchange of medical records among different practitioners and between the practitioner and the patient)
- Emergency response systems
- Laboratory and diagnostics information systems
- Pharmacy information systems
- Public health and disease surveillance system
The enabling environment in Hong Kong
In Hong Kong, there are several ongoing digital healthcare platforms and digital health projects, including:
- Electronic Health Record Sharing System (eHRSS)
- Pulse by Prudential
- Quality HealthCare Patient Portal
The eHRSS was launched by the Hong Kong Government in 2016 and enables registered healthcare providers in both the public and private sectors, with the informed consent of the registered patient and proper authorisation, to view and share the electronic health
records of a patient within the ‘sharable scope’ on a ‘need-to-know’ basis for healthcare purposes.
The scope of sharable data includes personal identification and demographic data, allergies and adverse drug reactions, diagnosis, procedures and medication, appointments, birth and immunisation records, laboratory reports and healthcare referrals.
The scope is reviewed and updated from time to time. Participation in the eHRSS is voluntary for both practitioners and patients.
DoctorNow is a telemedicine service provider offering remote healthcare services such as health assessments and consultations. Video consultations are available for patients suffering from a prescribed list of ‘suitable conditions’ such as cough and fever, sore throat and diarrhoea, but for other or more severe illnesses, a face-to-face consultation would be required.
Pulse by Prudential is a digital health app offering various healthcare-related services including telemedicine, AI assessment, medicine delivery and connecting registered users to nearby clinics.
Quality HealthCare Patient Portal is an integrated online platform for digital ticketing and appointment booking as well as video consultation for telemedicine.
Digital healthcare legal considerations
Legal and regulatory barriers
The Medical Council of Hong Kong is the statutory appointed body to handle registration and disciplinary regulation of medical practitioners in Hong Kong. This includes regulation of the practice of telemedicine by medical practitioners to patients where at least one of them is located in Hong Kong.
‘Telemedicine’ is defined in the Ethical Guidelines on Practice of Telemedicine to include the following scope of activities:
(a) Tele-treatment of patients over a distance, in which interventions, diagnoses, therapeutic decisions and subsequent treatment recommendations are made;
(b) Collaboration between doctors and/or with other healthcare professionals through telecommunication systems;
(c) Monitoring of patients through telecommunication systems; and
(d) Dissemination of service information and/or health education to the public (including patients) through telecommunication systems.
Medical practitioners are held to high standards
The guidelines provide that a doctor who substitutes telemedicine for traditional modes of delivery of medical care remain fully responsible for meeting all legal and ethical requirements and must exercise due diligence when practising telemedicine, and the standards of care that protect patients during face-to-face medical consultations apply equally to telemedicine.
Moreover, they advise the practice of telemedicine only in cases in which a prior in-person relationship exists between a doctor and a patient and where a pre-existing “doctor-patient
relationship” is absent. A doctor must take appropriate steps to establish such a relationship before practising telemedicine. This applies with particular emphasis in the case of prescribing medicine for a patient via electronic means.
The guidelines effectively deter doctors from practising telemedicine by discouraging doctors from giving tele-treatment unless they have a pre-existing doctor-patient relationship with the patient.
Although it is important for patients to have the benefit of doctors being held to the same standard of care whether treatment is delivered electronically or in-person, the guidelines do not provide sufficiently detailed guidance on what is expected of doctors at the different
stages when telemedicine is given (i.e. examination, diagnosis, medical advice on treatment options and making therapeutic decisions and/ or prescribing medication).
In this regard, the guidelines appear to treat telemedicine as a temporary solution when physical consultation for an existing patient is not readily available for a short duration of time. If telemedicine is to be treated as a sustainable method of delivering healthcare (as it
should according to WHO guidelines), the guidelines will need to be revised to offer more detailed and specific guidance on the expectations required of doctors at each of the different stages of giving telemedicine.
Digital healthcare privacy issues
Medical records and healthcare data is particularly sensitive. As a result, digital healthcare providers must be very careful about how they handle this data. Existing rules already cover digital healthcare services.
Compliance with privacy laws
Under the Personal Data Privacy Ordinance obligations are placed on data users, those who control the collection, holding, processing or use of the data.
This includes all digital healthcare providers.
Data Protection Principle 1(3) of the ordinance requires all practical steps to be taken to ensure that the patient is informed of the purposes of collection of the health data. Accordingly, all healthcare providers are under an obligation to issue a personal information
collection statement to the healthcare recipient when it collects health data for the purpose of, among other things, sharing and using the healthcare recipient’s health data and medical records, including sharing with other medical experts.
There are also provisions under the ordinance for patients to make a ‘data access request’ to a data user to provide details of the information they hold in respect of that patient, and also to require corrections to be made.
Digital healthcare should be seriously considered as a viable alternative or supplement to traditional modes of delivering treatment. Hong Kong has the IT infrastructure and capability to develop and refine existing infrastructure to achieve the World Health Organization’s vision of a global digital healthcare strategy.
With appropriate modifications of the regulatory framework, digital healthcare will not only become a major factor in reducing healthcare costs, it will also improve public welfare.