Telemedicine: A Guide for the Public

Telemedicine may be more convenient and accessible than an in-person appointment.

Telemedicine can

• Help maintain continuity of care which could avoid the negative consequences from delayed preventive, chronic or routine care
• Increase participation for those who are medically or socially vulnerable or who do not have ready access to providers
• Help preserve the patient-doctor relationship at times when an in-person visit is not practical or feasible
• Be a safer option for doctors by reducing potential infectious exposures

Telemedicine services can be used to

• Access primary care providers and specialists, including mental and behavioural health, for chronic health conditions and medication management
• Provide coaching and support for patients managing chronic health conditions, including weight management and nutrition counselling
• Participate in physical therapy, occupational therapy, and other modalities as a hybrid approach to in-person care for optimal health
• Monitor clinical signs of certain chronic medical conditions (e.g. blood pressure, blood glucose, other remote assessments)
• Engage in case management for patients who have difficulty accessing care (e.g. those who live in very rural settings, older adults, those with limited mobility)
• Follow up with patients after hospitalisation
• Deliver advance care planning and counselling to patients and their carers to document preferences if a life-threatening event or medical crisis occurs
• Provide non-emergency care to residents in long-term care facilities
• Provide education and training for doctors through peer-to-peer professional medical consultations (inpatient or outpatient) that are not locally available, particularly in rural areas

Yes, there may be occasions where telemedicine may not be suitable, such as:

• Situations in which in-person visits are more appropriate due to urgency and/or underlying health conditions.
• An inability to perform an appropriate physical exam. Doctors are expected to exercise their professional judgement in determining the appropriateness of telemedicine services to support the best outcomes for patients, based on context and symptoms.
• The need to address sensitive topics, especially if there is patient discomfort or concern for privacy.
• Limited access to technological devices (e.g. phone, smartphone, tablet, computer) needed for telemedicine, or connectivity issues.
• Risk of diminished continuity of care where commercial/online telemedicine services are utilised and notes are not proactively shared with a patient’s GP, should they have one.

• Telemedicine may be provided by your GP/ family doctor, a hospital doctor or a consultant.
• Your doctor may refer you to a consultant or another healthcare professional for a telemedicine consultation, or your doctor may have a telemedicine consultation with another doctor or healthcare professional for them to consider your healthcare needs.
• Telemedicine services may be provided via online commercial organisations, such as private health insurance companies or online doctor services.

Some tips on using these services include:
• Checking that a doctor is registered to practise medicine in Ireland, you can search the register here.
• If you make contact with a doctor who is not your GP, make sure you tell the doctor the name of your GP.
• Ask the doctor to send a note to your GP so that your medical record is kept up to date.

• Telemedicine consultation fees are set by your doctor or health service provider and should be made available prior to consultation/treatment.

• These fees are often in line with normal consultations, and Medical Cards and GP visit cards can be used.

• Private online doctor services and apps often charge directly, either on a pay-per-visit basis or through a monthly fee.

• Private health insurance may help pay these costs, be sure to check with your health insurance provider.

Patients have the best outcomes when their care is coordinated, so it’s really important to tell your GP if you’re receiving care or advice from any other doctor, or any prescriptions from any other source regardless of format or location. Do not be embarrassed to do this, it is important for your safety.

In these instances, doctors must, unless you do not consent, provide an update to your GP as soon as possible and include such information as is necessary and appropriate to facilitate continuity of care. You can also ask for a summary record of your care from online doctor services and provide it to your GP yourself. Either way ensures that your doctor will better understand your medical needs and be able to coordinate care for you. This is particularly important if you have multiple sources of medical care such as different clinics or out of hours care.

• Doctors who are working from Ireland and are providing telemedicine services to patients in Ireland must be registered with the Medical Council.

• As a member of the European Union, doctors practising within the EU are also permitted to provide telemedicine services to patients in Ireland, on the basis that they are registered in their country of practise (described also as where they are established) and are permitted to practise telemedicine.

• Doctors registered to practise in countries outside of the EU may provide telemedicine services to patients in Ireland, but you should be aware that when accessing these telemedicine services, legal protections applicable under local and EU laws may not apply.

Here are some tips on preparing for your telemedicine appointment

Choose a private space
Finding privacy can sometimes be difficult, especially if you live with other people. Before your appointment, choose a quiet room and try to ensure you are not disturbed.

Consider technical aspects
Whether you are using a phone, smartphone, computer or tablet, it is recommended that you check with the doctor’s practice or clinic as to what may be required for the consultation when requesting an appointment. This will help ease any stress or worry you might have about any technical issues.

Prepare your medical history
Be sure to gather relevant information regarding your medical history ahead of time. Your doctor may also ask you questions about your lifestyle, job and family life and, if appropriate, your mental health history. Like with face-to-face consultations, the purpose of the appointment is to provide you with the best possible care and treatment.

Sharing personal details allows the doctor to diagnose and provide quality care. As part of engaging in a telemedicine service, you may be required to provide such information in advance to help the doctor support you with your needs. This may also include being asked to send in a photograph of a physical sign such as a rash to help with the diagnostic process.

Have your information ready
Like any doctor’s appointment, you should be ready with the following pieces of information:
• Your list of prescriptions, over-the-counter medications and supplements (the HSE’s My Medicines List is a useful tool to record your information).
• Your pharmacy name and address
• Your GP/family doctor’s name and contact information
• Payment method (health insurance/ medical or GP card/ credit or debit card)

Jot down questions in advance
It’s natural for a doctor’s appointment to make you a little nervous and you may forget to ask crucial questions during your visit. That’s why it is recommended to make a note of your symptoms and questions to ask your doctor. The My Health, My Voice resource from the HSE is a useful tool to aid preparation for your medical appointment.

At the appointment
• During the consultation the doctor will ask about your health concerns, take a history (the background story and its context) from you and conduct an appropriate examination. The doctor may request diagnostic tests if considered necessary and may suggest referring you to another doctor for further treatment. As part of the consultation the doctor should provide you with a possible diagnosis and explain the plan of management including the benefits and risks of treatment options if a treatment is suggested and ensure there is appropriate follow-up.
• If possible, take notes on the treatment plan and what your next steps are during the appointment.
• If the doctor prescribes medication for you as part of your treatment, it is important that you tell the doctor if you have any allergies; also let them know what other medications, you are taking.
• The doctor should also advise you what to do in case of an emergency or if you need medical attention between appointments.

After the appointment
• Your prescription will be sent electronically to your nominated pharmacy of choice where you can collect your medications.

• Your GP/family doctor, a hospital doctor or a consultant will keep notes of the consultation to include in your medical file in the same way they would in a face-to-face consultation.

• In relation to online telemedicine services, providers must keep your health information private and secure and may ask you to use a specific app or other technology to ensure you are protected.

• If you’re using an online service or app, take the time to read and understand the privacy policy.

• You may be asked if you agree to the terms and conditions of the policy when you sign up. The best policies are written in plain language and are easy to understand. If you feel that you do not understand the content, you might want to reconsider whether or not you are comfortable using the service.

• You should be informed if your information is to be shared with any other healthcare professionals as part of your ongoing care.

• Providers must also comply with the Data Protection Act 2018 and ensure your personal information is stored and processed in line with the seven key principles of GDPR.

You may choose to engage with telemedicine services from a doctor practising from outside of Ireland. If you do so, it is important that you consider the following:

Check the Register
The registration requirements for telemedicine vary country to country. Within the EU, the Directive on Patients’ Rights in Cross-Border Healthcare (Directive 2011/24), also referred to as the cross-border directive, stipulates that doctors must be registered with the relevant authority where they are established, as opposed to where the patient resides. In addition to this, some countries may have specific requirements around the use of telemedicine, such as separate registers, or specific requirements for telemedicine such as only being able to prescribe alongside an in-person appointment.

What will happen to my personal data?
The processing and storing of personal data must be managed in accordance with relevant legislation. In the EU for example, this is specified under the General Data Protection Regulation (GDPR).

Legislation and Liability
The relevant legal frameworks around liability will need to be considered. For example, the jurisdiction of the Medical Council in this case extends only to doctors practising from Ireland.

Reimbursement of costs
You will need to familiarise yourself with any processes for seeking the reimbursement of costs and whether these are appliable to telemedicine or solely applicable to accessing in-person healthcare. Within the EU for example, National Contact Points can provide information for Member States.

Accessing your prescription in Ireland
• Prescriptions are issued via Healthmail in Ireland and can only be dispensed in pharmacies in Ireland. Prescriptions issued by other electronic means such as email or fax are not legally valid.
• E-prescriptions issued from outside of Ireland such as from another EU/EEA Member State, or from outside of the EU/EEA (including the UK) are not legally valid for dispensing in Ireland.
• Original, paper prescriptions written by a registered practitioner practising in another EU/EEA Member State, or the UK, may be dispensed in Ireland if they meet certain legal requirements and the type of medicine is available. Original paper prescriptions from outside the EU/EEA (other than the UK) are not permitted for dispensing in Ireland. Further information is available from the Pharmaceutical Society of Ireland.
• There are different requirements for the prescribing of controlled drugs in Ireland, such as doctors needing to be registered to practise in the State and have a practice address in Ireland. A prescription for a controlled drug which has been prescribed by a practitioner or prescriber in another EU/EEA State or from the UK is not valid for dispensing in Ireland (our joint guidance with the Pharmaceutical Society of Ireland on this is accessible here for further information).

• If you have concerns about the service you received, you should consider discussing these with the doctor in the first instance as it may have arisen from a misunderstanding, pressure of time or poor communication.

• You may also contact the telemedicine service provider directly to make them aware of your concern and have the matter addressed locally in the first instance.

• Anyone can make a complaint to the Medical Council about a doctor who is registered in Ireland. This includes members of the public, employers and other healthcare professionals. Action can only be taken where complaints are of a serious nature and raise concerns over a doctor’s fitness to practise. The Medical Council regulates doctors only, it does not deal with complaints against nurses, dentists or other healthcare professions, hospitals or clinics. The Medical Council cannot pay you compensation or help you make a claim for compensation. More information on how to make a complaint is available here.

• If you have concerns about a telemedicine service provided by a doctor from outside of Ireland, where resolution with the health service provider is not possible, you should contact the appropriate professional regulatory body (Medical Council equivalent) in the doctor’s country of practise.