Hong Kong is compact, blessed with district-level health clinics, but the COVID-19 pandemic forced clinics, hospitals, and specialist centers to switch to online protocols for patient-doctor consultations. He Shusi reports from Hong Kong.
The Medical Council of Hong Kong issued its Ethical Guidelines on Practice of Telemedicine in December 2019. It’s the city’s first telemedicine policy framework of five pages and 38 articles for doctors adopting virtual consultations.
The guidelines call for the same standards of legal, ethical and professional care as for personal visits. A prior in-person consultation before adopting telemedicine for a first-time patient is advised, although primary face-to-face consultations are not mandatory yet.
Along with the telemedicine policy guidelines, the city’s Hospital Authority launched its HA Go mobile app for patients of public hospitals and clinics to schedule appointments, pay bills, access prescriptions, get dispensary alerts and access allergy records remotely.
Some private insurers, hospitals, and clinics also began piloting telemedicine on a small scale till the COVID-19 pandemic accelerated virtual consultation adoption.
Joanna Pang, HA’s chief manager of the Information Technology and Health Informatics Division, says the city’s rapidly aging population adds pressure to supplement the physical healthcare system with virtual consultations. In 20 years, one-third of Hong Kong’s over 7 million population will be more than 65 years old, according to census projections.
Furthermore, over 2 million Hong Kong residents suffer chronic diseases which require constant monitoring and medication. Common diseases like hypertension, high cholesterol and diabetes require regular follow-up visits to adjust prescriptions and dosages.
Telemedicine will save the elderly and chronic disease patients the physical hassle with follow-up consultations online, said Pang, adding that COVID-19 has speeded up measures to reduce social contact in hospitals and clinics.
In early 2020, remote consultation through HA Go was piloted for the ear, nose and throat (ENT) department of Tseung Kwan O Hospital. “We thought people might be reluctant to use the service. But it was well received by patients, who didn’t want to visit a hospital during the pandemic,” said Pang.
“The HA GO App has saved patients time and anxiety waiting in hospital lobbies. The ultimate goal is to improve healthcare through technology, and provide patients with more options.”
Joanna Pang, chief manager of the Information Technology and Health Informatics Division
In January 2021, remote medical consultation was officially launched on HA Go for patients to book subsequent visits at Tseung Kwan O Hospital’s ENT department, and Queen Elizabeth Hospital’s neurosurgery department.
The app has saved patients time and anxiety waiting to be called in crowded hospital lobbies, said Pang. By December 2020, over 170,000 Hong Kong residents registered as members of HA Go with over 380,000 downloads.
HA Go also provides rehabilitation programs for patients through videos and games. Healthcare staff assess patients to tailor programs for them to systemically exercise at home, or in the community, for rehabilitation. Through 2020, over 15,000 monthly users were recorded, according to Pang.
Pang said the HA is drafting detailed policy and guidelines on telemedicine, including drug deliveries after virtual consultations. “The ultimate goal is to improve healthcare through technology, and provide patients with more options,” noted Pang, without specifying quantitative targets, or timelines, for the progressive rollout of virtual services.
Since 2019, private hospitals, clinics, and insurers have steadily deployed online consultation, drug delivery, and specialist referral services. That value-adding is evolving fast in the private sector, improving efficiencies and the range of options for patients.
“Between January 2020 and January 2021, Cigna saw a tenfold increase in online users. If a virtual consultation is inadequate for a diagnosis, a physical visit can follow at no extra cost. Future virtual consultations with psychiatrists and social workers are planned.”
Fiona Ip, Cigna Hong Kong senior manager for health, wellness and clinical services
Cigna Hong Kong launched its Telehealth Service in 2019 to facilitate virtual doctor consultations, prescriptions, medicine deliveries, and specialist referrals, with healthcare app DoctorNow. The delivery fee for medicine is waived to promote the service.
Cigna recorded a tenfold increase of online service users in January 2021 from January 2020. The most common illnesses diagnosed were upper respiratory tract infections such as colds and flus, digestive disorders, allergies, and skin problems, according to Fiona Ip, Cigna Hong Kong senior manager for health, wellness and clinical services.
If a virtual consultation is inadequate for a diagnosis, Cigna will arrange a physical consultation, at no extra cost. Cigna partners with over 30 general physicians and specialists who have adopted telemedicine services, covering general medicine, general surgery, orthopedics and traumatology, clinical oncology, and cardiology, etc. Future virtual consultations with psychiatrists and social workers are also in the plan, said Ip.
The latest Cigna COVID-19 Global Impact Study indicates a lack of accessibility and knowledge of virtual healthcare as the key reasons for the relatively low usage in Hong Kong — 67 percent of respondents don’t have access to digital healthcare, and 43 percent of non-virtual health users don’t know enough about the service.
But the city’s acceptance of telemedicine has risen since the COVID-19 pandemic, noted Elaine Chu, general manager of Quality HealthCare Medical Services, one of Hong Kong’s largest private clinic operators. Quality HealthCare Medical Services, insurer Bupa’s subsidiary, introduced a video consultation and drug delivery service in April 2020.
So far, more than 5,000 patients’ use of online services was recorded, with over 1,000 in a single month, when Hong Kong’s COVID-19 infections increased. The company plans to expand online with more specialists, partners, group clients, and insurers.
“Telemedicine needs policies and regulations specific to each segment of the ecosystem, from medicine delivery, to digital sick leave, referral letters, and prescriptions. A virtual consultation platform will expand access beyond fixed hours, weekends and public holidays.”
Elaine Chu, general manager of Quality HealthCare Medical Services
Chu believes Hong Kong lags five years behind the United States and some European countries as far as telemedicine advances are concerned, partly due to the city’s convenient neighborhood medical service network.
Chu suggests virtual consultation needs policies and regulations specific to each segment of the ecosystem, from medicine delivery to digital sick leave, referral letters and prescriptions. “Telemedicine is the trend globally for healthcare development that won’t reverse,” said Chu. She expects a comprehensive virtual consultation platform to eventually expand patient access beyond fixed hours, weekends and public holidays.
David Ellis, a partner at law firm Mayer Brown, believes greater clarity of legal liability in the policy and regulatory framework is vital, for more doctors to adopt telemedicine. This includes identifying scenarios where telemedicine is appropriate rather than a physical consultation, to protect doctors from being wrongly deemed negligent if a problem arises, he explained.
On the Chinese mainland, leading platform Ping An Good Doctor registered 373 million users by the end of 2020, accounting for almost one-quarter of the population, with a daily consulting volume of 903,000 cases. The mainland’s efficient logistics network also facilitates online pharmacies, led by JD Health and Alibaba Health.
The Chinese mainland telemedicine ecosystem is supported by an integrated policy and regulatory framework, noted Wilson Chow, PwC global technology, media and telecommunications industry leader. It includes social media registration, social health insurance coverage, and prescriptions through e-pharmacy platforms, he said.
Revenue of the online healthcare market on the Chinese mainland will reach 70 billion yuan ($10.8 billion) by 2022, according to iResearch. To advance telemedicine, China’s National Healthcare Security Administration in November 2020 announced it will implement social health insurance, or Yibao, for online healthcare.
Kenneth Tsang, CEO of Gleneagles Hospital Hong Kong, observes that in the past 10 to 15 years, Hong Kong has focused on highly specialized healthcare services, bringing many overseas medical visitors without giving enough attention to the primary healthcare needs of local residents.
Tsang, who worked at the HA for eight years, points to the mainland’s comprehensive social health insurance Yibao for the robust development of telemedicine. “At the end of the day, whether patients use a particular service depends on whether they can claim costs, or have to pay for it themselves.”
“The Chinese mainland has its comprehensive social health insurance, or Yibao, for the robust development of telemedicine. At the end of the day, whether patients use a particular service depends on whether they can claim costs, or have to pay for it themselves.”
Kenneth Tsang, CEO of Gleneagles Hospital Hong Kong
Specialist services in Hong Kong are available in the private sector, but are unaffordable for most. Public health patients queue for up to two years to get limited specialist treatment, HA statistics show. Hong Kong doesn’t have a social health insurance system like the mainland.
In December 2020, Gleneagles engaged insurer AIA for direct billing of online patients. Gleneagles has been working with DrGo, a digital healthcare platform of Hong Kong Telecom since mid-2020, to provide online consultations, case archives, digital payments with a strict data and privacy protection.
These collaborations serve as a win-win to all parties, said Jens Ewert, life science and healthcare industry leader with Deloitte China. Healthcare platforms can expand user coverage and add medical resources; insurers can offer comprehensive medical coverage; offline hospitals and clinics can leverage digital tools to reduce operational costs, said Ewert.
Gleneagles has over 15 doctors covering family medicine, emergency medicine, oncology, and other specialties, for virtual consultations of first-time patients with common illnesses, and for repeat visits of chronic disease patients. Doctors who want to practice telemedicine are insured by the company. Tsang noted they need medical malpractice insurance to work in the private sector anyway.
A virtual consultation costs the same as a physical one at Gleneagles. Tsang says he hopes the price can be reduced eventually, through establishing service centers at cheaper locations in Hong Kong for doctors to practice online. In this case, patients who could not previously afford private healthcare would have more options.
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