An internet portal allowing people to consult doctors via video-link – is this health services or is it not? This is the question that emerged as Janne German, Master’s student of health care technology at Tallinn University of Technology opened a digital service to ease the bottleneck of waiting-lines in Estonian medicine.
The portal netiarst.ee launched in June offers consultations with family doctors, nurses and medical specialists via video. One may set an appointment for same-day-eve and consultation with one’s own family doctor or nurse, and with any family doctor or nurse during the opening campaign, is free.
By today, over ten health care workers have joined the portal including family doctors and nurses, an urologist, a gynaecologist, a clinical psychologist, a gynaecologist-sexologist, and a psychiatrist-sexologist.
Though Janne German claims netiarst.ee is no health services provider but rather an environment through which doctors are able to counsel people, officialdom is astir.
At end of June, Health Board pointed out that a provider of health care services ought to possess an activity licence. Meanwhile, Estonia features web portals where doctors write to answer questions posed by people. However, as pointed out by Health Board registers and licences chief Evi Lindmäe, counselling via internet or telephone is not under licence requirement being as good as anonymous.
Having met with Janne German, the Board’s family medicine department head Pille Saar said the service provided by OÜ Netiarst is covered by its licence only if used by family doctor to advise people in own list while documenting it all.
«Health Board is continually expecting that by July 27th OÜ Netiarst provide written explanations regarding their activities with TV medicine solution via portal netiarst.ee,» she said. Ms German, however, claimed she was encouraged at the meeting to be able to shape the service so as to not need the health services licence.
Meanwhile, family doctor and Estonian Health Foundation head Eero Merilind, as well as social ministry’s e-developments and innovation vice chancellor Ain Aaviksoo think that TV-medicine as domain needs to be regulated.
Mr Merilind himself founded docline.ee to counsel patients via Skype, over a year ago. He doesn’t have the licence either, but has filed an application as spurred by the Netiarst debate.
«This is a matter of principle, with a company not having its own doctors mediates medical consultations – should a company like itself possess the activity licence or not. I, as representative of Docline, sit on both chairs, but to regulate the legal vacuum I filed the application,» said the doctor.
«As we are having to do with activity that touches human health, clarity is better than the lack of it,» said Ain Aaviksoo, adding that legal norms regulating TV-medicine are currently lacking, actually.
«On other occasions, health care provider is defined by location; but while the location is virtual, requirements are lacking. For a family doctor’s reception room, for instance, a list of requirements have been set to ensure quality of the service,» he explained.
Asked if the web portal in question is health care service provider or mere mediator thereof, Mr Aaviksoo drew parallels with debates around the car-sharing app Uber which recently set up shop in Estonia.
«What is the role of Uber, what is the role of the people driving the cars? I think this makes for an exciting legal debate. I do not know if mediation of money or creation of conditions makes one a participant in the service or not,» said he.
Mr Aaviksoo thinks that with medical consultation, it all boils down to whether the consultation leads to a definite medical decision and/or writing a prescription or not. With anonymous counselling this cannot happen, but in other instances it can.
«The brave newcomers will create a greater stimulus for the regulation of TV-medicine. At the moment, putting it mildly, they are testing the legal boundaries,» he added.
Having joined Netiarst, Island of Vormsi family doctor Madis Tiik thinks this a wonderful way to use the human and time resources. «Today, such solutions are elementary in a way. Also, rather many Estonian family doctors are working in Finland where the load is different – they are bored at night and have time to spare,» he said.
He said the new service is also an excellent opportunity for doctors on child leave or wanting to work part-time.
Ms German said the solution allows doctors to choose the time they have available to communicate with patients. That might be in the evenings or even week-ends. That will also be a blessing for patients who might be hard pressed to get away from work. Also, netiarst.ee is helpful to those in their summer homes, or whose family doctor is on vacation.
As added by a well-known urologist Gennadi Timberg, the advantage regarding written communication is that via video additional questions can immediately be posed by doctors – such as patients may not be thinking to ask.
Meanwhile, the screen could be switched off when people are embarrassed by having to touch certain sensitive topics, so the patient remains anonymous.
Whether or not a doctor invites the patient for a reception afterwards will depend on the situation. As assured by Mr Timberg, he never tells a patient he should necessarily come to himself. «I open up the issue for him, and recommend the right specialist. A consultation should be neutral.»
According to Madis Tiik, experience of other nations says quite a large share of health problems can be solved over a distance. «The bravest suggest 80 percent, others 30. Must be somewhere in the middle,» he said.
While free of charge during the opening campaign – and continually so with own family doctor – on other occasions netiarst.ee will ask for a «visit fee» of €15 to €45. Even so, Ms German would not exclude cooperation with Health Insurance Fund (Haigekassa). «But that’s for the future, because these processes are so time-consuming,» she observed.
HIF communication specialist Katrin Romanenkov said they are yet to analyse the video consultation service. She added that the fund is currently financing such no-contact services as family doctor counselling line and e-consultations between family doctors and medical specialists.
Netiarst.ee
-Services provided by family nurses Ada Ojasaar, Marina Kondoja, Adda Voitk; family doctors Külli Paju, Madis Veskimägi, Madis Tiik, Liina Pilv; family doctor/infectiologist Juta Kogan, urologist Gennadi Timberg, gynaecologist Galina Litter, gynaecologist-sexologist Mare Pruks, psychiatrist-sexologist Imre Rammul, and clinical psychologist Kärt Lust-Paal.
-The prices are in the €15 to €45 range. To compare: in major hospitals, reception by medical specialist is €35 to €55. Consultation by own family doctor or nurse is free.
-The portal can be accessed by ID-card or mobile ID. With authenticated consultations, doctors are able to view at patient’s medical record at digilugu.ee which will also retain a summary of the consultation mediated by netiarst.ee.
-With anonymous consultations, the patient will remain unknown to the doctor. Having booked a time, a patient is e-mailed a link to enter for consultation. With anonymous consultations, video is switched off; if so desired, a patient may turn it on during the session.
-When booking, a patient may briefly describe the problem to doctor. That will only reach the doctor in question.
-Payments always come before the session, via link to bank.
Source: Netiarst OÜ