A Complete Rules and Regulations to start a telehealth services in the UAE

With the Covid-19 situation, the doctor-patient video consultations or telehealth consultations were widely used, as there was challenging to visit face to face the doctor to avoid social contact. In addition, nowadays that everything seems to be returning to normal, telehealth consultations are standard because, in some situations, it is not mandatory to be present in the doctor’s cabinet; for this reason, the Dubai government have issued rules and regulations to improve the scope, effectiveness, efficiency and quality and safety of telehealth services in Dubai. One of them is the Standards for telehealth services, and according to this telehealth is divided into six (6) key areas, and we will define each one:

• Tele diagnosis: to determine the nature of the disease and facilitate a faster and accurate diagnosis of the patient, the physician will use the information and remote telehealth technology.
• Telemonitoring: it is used to remotely monitor and collect patient data to manage his/her condition
• Telepharmacy: it is used to deliver pharmaceutical care through telehealth technology and includes prescribing and dispensing medical products, herbal, food supplements, patient counseling, formulary compliance, medication therapy management, and cosmetic product.
• Telerobotic and robot-assisted services: is the implementation of non-autonomous, remote-assisted robotic medical devices for consultation, surgery, or diagnosis where the doctor is at a remote site for patient consultation, diagnosis, and/or perform a surgical task by a robotic system controlled by the doctor at the remote site.
• Mobile health (Mhealth): is the implementation of applications, technologies, wireless mobile devices, for example, tablets, laptops, mobile phones, for the provision of telehealth services and self-care management.
• Teleconsultation: to offer medical advice and treatment to patients, it will be used information and communication technologies, such as voice over internet protocol and high-resolution video-conferencing services and telephone). This method may be conducted between a physician and a patient, between two (2) physicians, or between physicians and patients with another physician where either party is not on the same site.

To regulate telehealth services in Dubai, the Dubai Health Authority (DHA) issued Administrative decision Number 30 of 2017. Furthermore, in 2019, a fifty-year Charter with nine articles for Dubai and its article 5 lays down a doctor for every citizen, providing medical consultation 24/7, facilitated by intelligent government application. On the other hand, an addendum to Cabinet Decree number 40 of 2019, concerning the Executive Regulations of the Federal Law Number 4 of 2016, concerning Medical Liability, set out the regulations and conditions for providing telehealth services in the UAE. This Addendum lays down that a facility that provides telehealth services must adhere to the following:

• Obtaining a license from the Health Authority for the provision of such services
• Providing an integrated technical network that guarantees the adequate provision of telehealth as per the standards set by the Health Authority
• Providing sufficient bandwidth
• Providing alternative methods of communication between the service provider and the recipient
• Provide a backup power system
• Providing servers inside the State to store and save the information and backup storage for it
• Providing internet technologies and systems that respond to the requirements of giving telehealth service
• Compliance with high-quality standards for telephone and call recording systems
• Proving the technical devices necessary to record and document the telehealth services that are provided
• Recruiting human resources qualified to provide telehealth service by providing them with special training that commensurates with the nature of the telehealth service
• Providing insurance cover for medical errors arising from or due to that service.

Furthermore, the Addendum lays down that Telehealth consultations are subject to the special controls of the Health Authority. In all cases, the health professional who deals directly with the patient is responsible for any health care that he/she performs towards the patient. The control of telehealth prescription are: telehealth treatment must be prescribed by a doctor licensed by the Health Authorities in the State, and works in facility licensed to provide telehealth services; the doctor who prescribes the telehealth treatment shall conduct an electronic examination of the patient through the use of electronic technology and shall adhere to the standards of State-level healthcare; files and documents must be certified according to the applicable rules and regulations; the prescription of treatment shall be based on a diagnosis, ensuring that there are no medical contraindications of the prescribed medicine for receiving the treatment ; the doctor should discuss the treatment plan with the patient, unless his physical or mental condition does not allow so; drugs are prescribed according to the legislation in force in the State; the doctor may prescribe a treatment without being bound by the rules of Telehealth Treatment Prescription with regard to diagnosis and discussions of the treatment with the patient only in the following cases:

• If a consultation is made with another physician who has a direct relationship with the patient while providing continuous supervision over the treatment
• If the physician is attending or through coverage via phone, the doctor prescribing the treatment reviews the patient's health records.

Concerning the Telemonitoring, these are the control that the Law established: submission of a full application to install and activate the Telehealth Monitoring Service at home or the place where the patient is; submission of a Telehealth Monitoring Services request or order signet and dated by the physician treating the patient; ensure that telehealth monitoring data I collected accurately and in a reliable manner; data must be stamped with the date and time in order to be protected from alteration; ensure that monitored data is include in the patient’s Electronical Medical Records; a patient’s clinical data may not be re-monitored by any other service provider; maintain the system documents and use of information; the data must be reviewed by the nurse or assistant physician, and each of them shall me responsible for reporting the data to the physician issuing prescriptions ; submit scheduled periodic report on the patient’s data to the doctor; the patient may stop the telemonitoring service from home at any time; telemonitoring providers must be available around the clock; the telemonitoring includes the number of times, the type of monitoring, the timing, the method and how to obtain and transmit the data; determine the timing of the expected response to patient data; determine the coverage policy outside working hours to download a data and use the Automatic Alert System; procedures for dealing with ‘unwanted events must be established and made available to the concerned persons; monitoring standards should be provided for both manual and electronic analysis, separately and altogether; making sure that all telemonitoring devices are working well; the sensor should not cause any damage or irritation to the skin of the patient and they should not bother while sleeping or pose danger to him/her while swallowing food; define protocols for responding to alerts from the telehealth monitoring system; provision and maintenance of telemonitoring equipment, and this is the responsibility of the home care provider or hospital. Do not hesitate to seek legal guidance from healthcare lawyers in case of any negligence from the hospital or healthcare professional.

In conclusion, the benefits of telehealth consultation are a lot, such as saving time and money, reduced risk of infectious, efficient and continuous monitoring of chronic patients, the proper care at the right time, frequent interaction, better management of vulnerable patients, enabling patient with better access and efficient by the healthcare system, expand access to remote and rural regions and better utilization of hyper-connected telemonitoring devices. The UAE Ministry of Health and Prevention cooperated with DU to set up the first virtual hospital in the Middle East to provide remote care to the patient in March 2020. Moreover, in May 2020, UAE’s MoHAP promoted all its hospitals’ outpatients’ clinics to virtual. Numerous leading public and private hospitals in the UAE recognized their virtual clinics, such as Aster DM Virtual Outpatient Department (OPD) and TruDoc 24×7’s Health & Wellness Virtual Clinic. The UAE’s main telemedicine actor Abu Dhabi Telemedicine Centre services offer access to Medgate qualified physicians to approx. 1.2 million Daman Enhanced and Thiqa cardholders in the country. Many private companies provide telehealth services such as Health at Hand, TruDoc 24×7, and InstaPrac.