In Saudi Arabia, there are approximately 400,000 outpatient appointments every week (almost 80,000 per day), comprising a mix of new referrals and follow up patients. Covid-19 has significantly impacted the ability for specialists to manage care and maintain continuity of treatments, either through transitioning patients to second line treatments (if first line treatments are ineffective) or to re-prescribe some pharmaceuticals for patients who have run out. The use of telemedicine can play an important role to reduce the risk of patient harm and mitigate some of the growing risks, associated with a steadily increasing workload backlog. The Kingdom has done some great work over the past year to pave the road for this new way of working.
As it is unlikely that healthcare facilities will be fully operational in the near future, at a high level there are four categories of patients that present the greatest risk:
- New referrals, with symptoms suggesting a serious condition (e.g. sarcoma)
- Patients requiring multi-disciplinary management (e.g. chronic disease, patients with multiple comorbidities)
- Follow up patients who have just initiated a new treatment model
- Post-cancer treatment follow ups
There will be other patients with urgent needs, specific to individual specialties, in all cases the risk profile and potential solutions need to be carefully considered.
In June 2019, new regulations on telemedicine were published in the Kingdom, providing a comprehensive framework for all clinical staff, overseen by the Saudi Telemedicine Unit of Excellence (STUE) as part of the National Health Information Centre. The publication of these regulations provides a foundation to rapidly implement video consultations across the Kingdom.
The regulations1 prescribe some clear requirements that will need to be considered:
- All consultations must include a video component, and audio consultations alone are not sufficient
- All the legal requirements that are relevant for face-to-face consultations apply equally to video consultations
- Clinical staff must document all activities (e.g. date and time of consultation, prescribing, requests for investigations, etc.)
- All staff involved should be trained in video consultations (e.g. application to the specialty, the video consultation IT platform being used etc.)
- Healthcare professionals using telemedicine need to declare this to STUE using the online form
- Patients need to provide informed consent (preferably online) before the consultation occurs
The potential value of video consultations during the Covid-19 response and recovery phases should not be underestimated; they provide an opportunity to maintain the health and wellbeing of a significant proportion of the population, and the service can still be provided if clinicians are self-isolating. Countries around the world have seen a major surge in the use of video consultations since the start of the Covid-19 outbreak, with policymakers indicating that in the restoration phase (post Covid-19) the solutions implemented now will mean that the only ‘door’ to access some healthcare will be digital.
The next articles will focus on some of the factors that should be considered as healthcare providers establish video consultations, based on the experience of health systems around the world.
Director - Healthcare
KPMG in Saudi Arabia