Introduction
Telemedicine has gained popularity all over the world due to its ability to improve access to healthcare services for those living in remote areas, those with limited mobility or transportation, and those with persistent health conditions that require ongoing care. It is reported that telemedicine has been in existence since the late 1950s to early 1960s, however, its usage was not very pronounced. As a result of the COVID-19 outbreak in 2020, hospitals over the world began to seek other means of providing medical services while also ensuring the safety of practitioners and patients. This has made telemedicine to become an increasingly popular option for healthcare providers to connect with patients who are unable to visit a physical office. The outbreak of COVID-19 in 2020, however, saw its rise to prominence as hospitals around the world began to seek alternative means of providing medical services while ensuring the safety of practitioners and patients. Today, telemedicine has become an increasingly popular option healthcare providers utilize in connecting to patients who are unable to visit a physical office.
Despite its numerous benefits and advantages, this innovative approach to healthcare delivery has also brought about a number of legal and regulatory challenges that must be carefully managed.
In this article, we will briefly explore the benefits and challenges of telemedicine, the current legal landscape of telemedicine in Nigeria, and also provide practical tips and strategies that can be used in managing the risks it presents.
The Concept of Telemedicine
According to the World Health Organization (WHO), Telemedicine is described as, “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals, using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.”
There are three major types of telemedicine, which are – store-and-forward, remote monitoring, and real-time interactive services.
The use of technology in the provision of healthcare presents a variety of opportunities for both medical practitioners and patients, as it is cost-effective, helps improve access to healthcare, enhances patient outcomes, provides comfort and convenience, prevents transmission of chronic diseases, and a host of other benefits.
Adoption of Telemedicine
In 2010, a telemedicine project was launched at Lagos University Teaching Hospital, in partnership with Indian universities. The Chief Medical Director of the Lagos University Teaching Hospital, Professor Akin Osibogun, said as follows “On an interactive screen, the patient sees and speaks with his Indian medical consultant. His Nigerian counterparts are also involved in the interactive session. Diagnosis of the ailment of the patient is undertaken, and solutions are jointly agreed upon by both doctors.”
In the same vein, a teleconferencing technology linking university-based medical experts working at National Hospital in Abuja and the National Sickle Cell Foundation in Lagos, was established by an Indian communications provider, the IT company – Suburban West Africa. The two institutions successfully performed a live interactive diagnostic on a 13-year-old sickle cell patient in Lagos. THISDAYLIVE also reported that between 2nd February, 2020 to 3rd of May, 2020, Hudibia, a Nigerian telemedicine app, experienced a 400% increase in downloads, which had been accelerated by the COVID-19 pandemic.
Recently in Nigeria, the Nigerian Federal Ministry of Health instituted the e-Health/Telemedicine Programme which provides services such as health-related internet information sites, automated online therapy, online consultations (real-time), virtual clinics and pharmacies.
There are several companies that have adopted the use of Telemedicine (Nigerian companies inclusive) and they include: Sesame Care, MeMD, Amwell, MDLive, Health Tap, telehealth ambassadors, Medisr, MyMedicalBank, 1Dokita Healthcare Ltd, Medtech Africa, and many others.
A Critical Examination of the Legal Landscape of Telemedicine in Nigeria
In Nigeria, the regulatory framework for telemedicine is still evolving. Currently, Nigeria has no specific legislation governing telemedicine. However, several existing laws and guidelines provide guidance on the practice of telemedicine.
They include:
- Code of medical ethics, 2008: The Medical and Dental Council of Nigeria’s (MDCN) Code of Medical Ethics 2008, recognises the importance of telemedicine as a means of improving healthcare delivery in the country. The Code addresses telemedicine in Guideline 22 and provides guidelines for its use.
The Code also acknowledges the risks attached to the use of technology and provides that practitioners should continuously assess and avoid medico-legal pitfalls in areas such as confidentiality, professional competence, legal and registration status of the specialist being consulted, equipment reliability, sustainable continuity of patient management and timely referral of patients.
The Code further emphasises the need for practitioners to make appropriate arrangements for the security of personal information when it is stored, sent or received by fax, computer, e-mail or other electronic means.
- Nigeria Data Protection Act 2023: The Nigeria Data Protection Act, 2023, is the legislation which provides a legal framework for the protection of the personal data of Nigerian citizens. Being the main data protection legislation in Nigeria, it sets out guidelines and standards for the collection, processing, storage, and transfer of personal data in Nigeria. The act applies to all data controllers and processors who collect, process or store personal data in Nigeria, including healthcare providers who engage in telemedicine.
- The National Information Technology Development Agency (NITDA) Act 2007: The NITDA Act 2007 plays a crucial role in the development and regulation of telemedicine services in Nigeria. The Act provides a legal framework for the development of ICT systems that support telemedicine, sets the standard for these systems and services, and also regulates their deployment and use.
The Act further recognises the importance of ICT in the delivery of healthcare services and the need to develop and regulate ICT systems that support telemedicine services. Section 6 of the Act mandatesNITDA to develop guidelines for the deployment of IT systems in all sectors of the economy, including healthcare.
- Evidence Act, 2011: The Evidence Act in Section 84(1) recognises the admissibility of all forms of electronic evidence, -including evidence generated by telemedicine systems – in legal proceedings. This means that medical records generated by telemedicine systems can be used as evidence in legal proceedings. Furthermore, it provides for the authentication of electronic evidence and also addresses the issue of confidentiality and privacy of electronic records
Other laws regulating Telemedicine include:
- Medical and Dental Practitioners Act.
- 1999 Constitution of The Federal Republic of Nigeria (as amended).
Management of Potential Liability Risks for Telemedicine Providers
The adoption of telemedicine in Nigeria is not without risks as medical providers may find themselves facing a variety of liabilities, including issues with patients’ confidentiality, managing regulatory compliance, breach of privacy, security, and communication issues.
However, in order to curb these risks to the barest minimum, some of the practical steps to take include:
- Implementation of security measures to protect patient data.
- Obtaining appropriate insurance coverage.
- Obtaining informed consent from patients before providing telemedicine services.
- Maintaining accurate records.
- Development of policies and procedures for telemedicine practice.
- Provision of high-quality care.
- Compliance with the standard of care for in-person meetings.
- Ensuring that all privileged information remains confidential.
Conclusion
The emergence of telemedicine has brought about significant benefits to healthcare delivery but it has also introduced new liability risks. By managing regulatory compliance and mitigating liability risks, providers can offer high-quality telemedicine services that benefit patients and the healthcare system as a whole. It is therefore essential for healthcare providers to take proactive steps in managing these risks in order to ensure patients’ safety and protect themselves from legal and financial consequences. One of such steps is to work closely with legal and regulatory experts in order to navigate this landscape successfully and provide high-quality care to patients wherever they may be. With careful attention to regulatory compliance and patient safety, telemedicine has the potential to revolutionise healthcare and improve the lives of millions. Needless to say, telemedicine is the future.
Amala Umeike is a Partner at Stren & Blan Partners and supervises the Firm’s Health and Pharmaceutical Sector. Clara Eze is an Associate in the Firm’s Dispute Resolution and Intellectual Property Departments, while Emmanuel Ughanze is an Associate in the Firm’s Health and Pharmaceutical Sector.
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