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“Until recently, mobile health (mHealth) was primarily the domain of consumer technology for tracking health conditions like diet and exercise. Today, mHealth and telemedicine are converging to make mobile telemedicine a reality.”
– Michael Morris
Introduction
The outbreak of the 5th wave of COVID in Hong Kong has left the city’s healthcare facilities stretched to the brink. The recent challenges faced by the SAR illustrated the important needs to establish reliable, resilient, and robust patient care and health services.
To this end, the implementation of telehealth and telemedicine technology as it can safely enable communication with physicians and health specialists through virtual channels to minimize the spread of infection, all the while, will provide Hong Kong with a potential channel to use mainland’s unutilized medical resources remotely. Application of Blockchain technologies in this approach further enhances the immutability of patient records.
As such, it is crucial to look into whether Hong Kong’s existing laws allows for the practice of telehealth as well as other legal developments across the globe, where if appropriate, mirroring of such approaches may be considered.
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What is Telehealth | Definition & Terminology
Telehealth or remote health is the delivery of healthcare services in a setting where patients and providers are separated by distance, using information, sensors and other integrated communications technologies for the diagnosis or treatment of diseases and injuries.
Initially made popular in places where travelling for healthcare is an issue (from the continent-wide nation of Australia to mountainous regions of Japan and Taiwan), COVID has spurred wide adaptation, bringing health services historically concentrated in urban centres to remote rural locations.
Global Legal & Regulatory Overview | Implementations & Progress
Telehealth is by no means a novel innovation and has been implemented in jurisdictions where long distance travel is a problem. The following are a list of notable early adaptors and their corresponding laws and regulations governing telehealth:
All in all, it can be easily seen that telehealth is by no means a new innovation and stands to be a significant asset especially in the face of COVID where visitation to a healthcare facility (by a number of persons with similar concerns) may end up becoming a nosocomial flashpoint.
Telehealth and Blockchain | Bottleneck Solutions | PDPO Issues
In recent times, the implementation of remote consultations in various countries enable efficient healthcare access and offer better care coordination and treatment outcomes. That said, centralization is a key impediment in existing telehealth and telemedicine systems which in turn, poses the risk of single point of failure. This factor is further worsened by the fact that centralized data is prone to a variety of external and internal breaches compromising the reliability and availability of systems.
To this end, Blockchain can address such crucial weaknesses given the fact that the decentralized distributed nature of blockchain can be leveraged to manage a shared ledger of health records with all ledger copies are kept verified and synced with every node affiliated with the blockchain.
Telemedicine enables healthcare professionals to remotely monitor, diagnose, and treat patients while mitigating the risk of exposure of physicians, staff, or patients to COVID. With an ever-increasing number of infections amongst medical staff in recent days, wider implementation of telehealth seems to be a natural solution.
Further, given the exceptional nature of the 5th wave, bridging of cross-border telehealth services may be employed in order to alleviate an already exhausted healthcare system, with medical practitioners being able to reinforce Hong Kong’s stretched infrastructure remotely. Patients can first be diagnosed remotely and only upon referral should those in actual need be diverted to physical facilities, thus resolving a critical bottleneck.
At the same time, the adoption of blockchain technology into existing telehealth systems can bring numerous possibilities and opportunities for secure digitization of healthcare, such as successfully establishing the provenance of clinical data, legitimacy of users seeking patient data, managing identities of devices used for remote patient monitoring, preserve patient anonymity, and automate the payments settlement. These includes:
Again, one of the chief complaints seen at recent measures include busy lines of newly set up facilities by the government. Implementation of pre-existing technology, enhanced by blockchain technologies, stands to provide the government with significant benefits.
Whilst immutable patient records offered by blockchain solutions will, undoubtedly be a benefit, issues of patient data privacy, which at present is governed by The Personal Data (Privacy) Ordinance (Cap. 486) (“PDPO”), will also have to be addressed.
The decentralized nature of blockchain data storage meant that the PDPO may also have to be updated in order to account for data stored on the blockchain and how such personal data may be adequately secured.
Under-Utilized Resources | Use of Artificial Intelligence and Smart Contract Solutions
Another underutilized technology (which is already in existence) includes Artificial Intelligence (“AI”) and smart contracts. The City’s current Leave Home Save App, is at best, an analogue innovation (despite the fact that Hong Kong remains an innovation incubation centre for the region).
An easy improvement upon existing application may be AI-assisted diagnosis whereby, aside from simply recommending users to undergo testing, a questionnaire can be sent to at-risk individuals to better gauge their situation and recommend the appropriate follow-up action at the appropriate levels. No doubt, the city’s stretched medical services will benefit greatly where raw data is automatically processed into actionable knowledge.
The effectiveness of virtual care and health monitoring depends on the integrity of the EHRs that include a patient's medical history, diagnosis, medication, and treatment plans. It remains to be seen whether the government will integrate the city’s pre-existing EHR systems to assist with COVID treatment.
Conclusion
“In an age where the average consumer manages nearly all aspects of life online, it’s a no-brainer that healthcare should be just as convenient, accessible and safe as online banking”
– Jonathan Linkous, American Telemedicine Association
All in all, both telehealth and blockchain technologies hold great potential to resolve (or at least alleviate partially) Hong Kong’s 5th wave COVID crisis. To this end, the traditional telemedicine systems mostly rely on outdated methods to store, maintain, and protect patients’ data which can be a vulnerability. Blockchain is a solution that can complete and trustworthy medical history of a patient can be maintained and tracked by the authorized users through immutable records.
In this connection, it should be noted that there has been a push by the Legislative Council to mirror the new implementation of Singapore’s Healthcare Services Act of 2022 in the Medical Registration (Amendment) Bill 2021 which may include the introduction of a licensing scheme for telehealth service providers. At the same time, the Bill will also aim to make it easier for overseas doctors to practice in Hong Kong in the hopes of solving the city’s shortages of medical practitioners.
All in all, it remains to be seen whether a comprehensive set of legislation will be made by the Medical Registration (Amendment) Bill 2021 targeting specifically telehealth in Hong Kong and how they may be delivered, and if appropriate, allow a channel for health resources overseas to be channelled into Hong Kong in situations of emergency.
“Despite the recent growth in usage of teleconsultations amidst the pandemic, the long-term development of telehealth services may require the Government to step up efforts on various fronts. These include laying down a clearer regulatory framework and guidelines on the applications of technology in the healthcare sector, encouraging service providers to develop innovative solutions, and boosting adoption of the solutions among healthcare professionals and patients.”
– Ivy CHENG, Information Services Division, Legislative Council Secretariat
This article was first published in the Hong Kong Lawyer, the official journal of The Law Society of Hong Kong.
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