The COVID-19 pandemic presents opportunities for the tele health/medicine sector to expand the concept of remote healthcare services through technology platforms in the Middle East and beyond. Recently, the United States Federal Government is to push for telemedicine as a care option during the COVID-19 pandemic.
BSA's healthcare legal/regulatory practice often engages with numerous clients on the technical legal aspects of setting up and regulating a tele health/medicine business in the Middle East. This is often a challenge for many clients given the fragmented licensing requirements in the United Arab Emirates (UAE) between the Emirates of Abu Dhabi, Dubai, and Northern Emirates (which generally falls under the UAE Ministry of Health & Prevention) and Dubai Healthcare City (DHCC), which all, save for the Northern Emirates currently have different licensing requirements and regulations for tele medicine/health.
Will it be possible for the United Arab Emirates to take advantage of the existing legal frameworks for telemedicine and use this as a care option during the COVID-19 pandemic? We have seen the Emirates of Dubai take the lead with the “Doctor for Every Citizen” initiative, which is essentially doctors via video and voice calls, for free 24/7 consultation and queries regarding COVID-19. The project was initially rolled out for family medicine consultations for local nationals, but now covers all residents for free consultations related COVID-19 concerns. Virtual hospitals already exist and there is one in Abu Dhabi, called the Abu Dhabi Telemedicine Centre, which offers 24/7 medical consultations over the phone. Other initiatives include the Ministry of Health and Prevention (MoH) exploring projects for the wider UAE and especially the Norther Emirates. MoH is working with Emirates integrated telecommunication Company PJSC ("Du") to enhance options for tele based healthcare. These included "Virtual Hospital" where doctors and nurses can provide remote care to patients based at home, or in another location, via smart monitors or Artificial Intelligence devices.
Health insurance companies or insurance companies that offer specialist health insurance cover are also working through several initiatives to facilitate telemedicine offerings through third parties in the Middle East. Indeed, many global international private medical insurers offer tele medicine/health as a benefit under their policy terms and conditions.
Can the existing legal frameworks in the Middle East accommodate the option of virtual medicine and health services? For illustration purposes, we concentrate on the UAE's existing legal framework. As a general observation, most telemedicine systems do not provide or facilitate medical diagnosis or the issuance of prescriptions, which is procured through a person to person meeting consultation. This has been a thorny issue for some time, but with the advent of the COVID-19 pandemic, there is urgent scope to address this now.
Last year, in September 2019 the Emirates of Dubai, through the Dubai Health Authority (DHA) issued the Standards for Telehealth Services ('Standards') resulting from Dubai's 'Fifty-year Charter', declared in 2019 by H. H. Sheikh Mohammed bin Rashid Al Maktoum, Vice President and Prime Minister of the UAE and Ruler of Dubai. This repealed the Dubai telehealth regulations of 2017, which did in fact lack clarity as to whether telemedicine providers could issue electronic prescriptions without first completing a person to person consultation/examination. Historically, the DHA legislated telehealth regulations in 2017 having previously only licensed teleradiology. Any person or entity wishing to provide and operate telehealth/medicine in Dubai must be licensed by the DHA and the Dubai Economic Department. This also included existing medical care facilities, which can seek a license from the DHA. The 2017 Regulations were somewhat ambiguous on whether medical diagnosis and e-prescriptions could be provided. This ambiguity was cleared up with the new Standards, which clearly provides diagnosis and the issuance of e-prescriptions following the executive regulations to the federal medical liability law of 2016. The New Standards divided into six key functions or operations:
- Telemonitoring (remote patient monitoring);
- Mhealth (Mobile Health);
- Telerobotics and robot-assisted services; and
Dubai appears to be a leader in this initiative. It is hoped that other regulators will follow the same pattern. This may indeed be the case in the UAE as the UAE federal medical liability law of 2016 has opened a pure based remote healthcare service i.e. the previous medical liability law of 2008 required physicians to see patients face-to-face and to conduct a physical, in person clinical examination.
The Department of Health, Abu Dhabi implemented a legal framework for telemedicine back in 2013, which was a detailed and sophisticated framework. All entities that wish to provide telemedicine services and operations must be licensed by the Department of Health. The rules under the framework strictly preclude licensed telemedicine practices in Abu Dhabi from prescribing medication. However, this may change with the federal medical liability law of 2016 and the imposition of COVID-19.
A healthcare facility wishing to provide tele medicine/health services from Abu Dhabi must be licensed by the Department of Health.
Dubai Healthcare City
Dubai Healthcare City (DHCC), is one of the free zones in Dubai providing a free zone for all healthcare and healthcare related operations. "DHCA TELECONSULTATION POLICY" sets out the requirements for tele medicine /health operations from and within the free zone. Teleconsultation is defined under the Policy as: "remote telecommunications, generally for the purpose of diagnosis or treatment and may include services enabled by a range of secured telecommunications media such as, telephone, internet based video, email and other similar electronic-based communications provided by a DHCA Licensed Service Provider." The definition is broad and had originally led the way for tele medicine/health in the UAE. Paragraph 2.2.6 of the Policy provides: "Any and all medication prescribing, including over the counter, as a result of a teleconsultation visit can only be carried out by a DHCA licensed healthcare professional with prescribing privileges." This provision would suggest that telemedicine practice operating in the DHCC does not prescribe medication without an in-person consultation. We understand that only several entities have shown an interest in licensing for tele medicine/health in the DHCC but we suspect this is down to the fact that it is anticipated that the UAE Federal Government will legislate for a Federal tele medicine/health law in due course. This is particularly so due to the federal medical liability law of 2016 and its executive regulations, where we may see the Northern Emirates include legal tele medicine/health frameworks for their healthcare systems.
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