The doctor's no longer at the door

With the Chinese mainland leading the pack in online medical consultations and treatment, Hong Kong's healthcare sector is wasting no time embracing the shift but, seemingly, at a much slower pace. He Shusi reports from Hong Kong.

Telemedicine has been in the works even before COVID-19 took on the world, only to be given a knee-jerk by its onslaught. The changes have been inconceivably vast. The desire to stay clear of hospitals to avoid getting infected is strong.

Though projecting a promising outlook, healthcare industry players in Hong Kong think the city has yet to see a capacious adoption of telemedicine — the application of telecommunication in remote diagnosis and treatment of patients.

They think tight regulations, and yet-to-change social habits are to evolve gradually to enable Hong Kong to carve out a more efficient and cost-effective medical system under the purview of telemedicine.

According to the Medical Council of Hong Kong's Ethical Guidelines on Practice of Telemedicine issued in December, telemedicine covers consultation, monitoring and treatment of patients, as well as collaboration among healthcare professionals via telecommunication systems, such as video calls and instant chatting apps.

While the concept has been around for several years, the current public-health crisis exposes the vital role it can play as part of the wider healthcare network in Hong Kong, said Gordon Watson, chief executive officer of global insurance company AXA Asia.

Telemedicine helps to alleviate the burden on healthcare services and improve people's access to healthcare as a cheaper and more efficient alternative to in-person visits, Watson told China Daily.

Since the 1990s, public hospitals in Hong Kong have applied limited, video-based consultations for inhabitants of homes for the elderly, psychiatric patients and those in need of professional therapy and physiotherapy.

In the private sector, there have been virtual care services, where patients can meet doctors online, or have medicine delivered directly to their homes from the clinic.

Cigna Hong Kong, which provides medical insurance and healthcare solutions, has teamed up with healthcare app, DoctorNow, to offer such services. Likewise, April International Care has launched TeleHealth in partnership with Teladoc Health.

New regulations?

But, there are concerns over the practice. One obvious worry is that symptoms can be easily missed through online medical consultations, warns David Ellis, a Hong Kong-based partner with global law firm Mayer Brown. He focuses on healthcare services.

This leaves the medical service provider open to claims of negligence and difficulties with insurance coverage, while patients are open to undiagnosed or misdiagnosed problems, he said.

The Medical Council's telemedicine guidelines stipulate that a doctor who substitutes telemedicine for traditional modes remains "fully responsible" for meeting all legal and ethical requirements and must exercise due diligence when practicing telemedicine.

They are told to exercise the same standard of care in online consultations as for personal visits, and have to ensure that a patient is suitable for remote interaction.

The guidelines also state it's advisable, yet not mandatory, to have a prior in-person consultation before practicing telemedicine or prescribing any medicine for the first time. If a physical examination is likely to add critical information, the doctor should not proceed until a physical examination can be arranged.

Such requirements place the entire onus on medical practitioners as to whether telemedicine is appropriate which, undoubtedly, discourages many doctors from opting for the practice, Ellis pointed out.

In other jurisdictions, telemedicine is permitted in exceptional classes, such as mental health conditions, or where the patient requires a check-up for a repeat prescription after having previously been examined in person by a doctor, he said.

The Chinese mainland adopts such an approach. The Chinese National Health Commission promulgates that the permitted scope of telemedicine is generally limited to online diagnosis and treatment of certain common and chronic illnesses like dermatosis, chronic hypertension and diabetes in a stable condition.

The COVID-19 outbreak has brought about changes in social habits worldwide, and this is likely to have a permanent, positive impact on telemedicine, Ellis noted.

However, Hong Kong's medical system has not been placed under the same level of stress as that in the mainland, which is part of the reason why seeing a doctor through video calls or online chatting is not as popular, Ellis added.

Nevertheless, an aging population and rising costs in healthcare services have made it crucial for many countries and regions, including Hong Kong, to promote remote healthcare. But, for there to be real improvement, Hong Kong's regulatory position needs to be developed, he said.

For example, clear and safe harbors have to be in place, within which doctors are permitted to use telemedicine for particular types of cases without fear of breaching ethical rules or losing insurance coverage, said Ellis.

The government also needs to be more involved in encouraging and enabling the medical sector to adopt an improved regulatory regime, he added without specifying how.

Leung Chi-chiu, chairman of the Medical Council's Ethics Committee, replied to China Daily that the committee will see whether further field guidance can be provided on top of the basic framework unveiled in December.

Besides the ethical restrictions on doctors, Hong Kong has strict regulations on drug sales.

Patients must still return to the clinic to pick up the medication, or the clinic has to find a method to deliver medication to the patient, with few organizations licensed to perform such a service, AXA's Watson noted.

He said while telemedicine offers users a more discreet channel to explore health needs, some situations or specialties can still be better served by in-person consultations. As such, telemedicine will remain complementary to traditional clinic or hospital visits, he said.

Promising outlook

But industry players are positive about the future development of telemedicine in Hong Kong, and see great potential in their investment under the context of the mainland's medical reform.

Sigal Atzmon, founder and CEO of Medix Global — a healthcare service provider with offices in Europe and Asia — thinks Hong Kong has good accessibility of its healthcare services, with dense private clinics across the city.

But, the expenses vary, while private hospitals lack transparency in costs and the quality of services, Atzmon told China Daily.

She believes that with the trend of not going to hospitals accepted by more people, especially the tech-savvy younger generation, people will cut down on unnecessary trips to hospitals or even clinics downstairs, at a time when social distancing is the new etiquette.

While critical diseases must be diagnosed through in-person visits, Atzmon stressed the important role telemedicine can play in primary care.

Her business on the mainland covers more than 14 cities. Through Medix's global network, doctors or patients there are able to seek advice from medical professionals from across the world. The consultation process often takes place online, giving patients first-hand advice before they actually go overseas to obtain a second opinion on their illnesses, said Atzmon.

She thinks it will become a future trend for mainland patients planning to receive treatment in Hong Kong to have online consultations first.

Each year, among millions of visitors from the mainland, many come to Hong Kong for quality healthcare services — from surgery for critical diseases to getting the right vaccine — said Atzmon.

If they can communicate with a doctor before coming to Hong Kong, the user experience will have no doubt hit another level, and reduce unnecessary burdens on medical systems in the city, she said.

Furthermore, under mainland's medical reforms, medical professionals from Hong Kong can also contribute their expertise through telemedicine.

With the development of the Guangdong-Hong Kong-Macao Greater Bay Area, Atzmon believes the trend of telemedicine can facilitate cooperation on all sides for better healthcare services.

Projecting a promising future for digital healthcare, Atzmon plans to expand her business on the mainland, and is on the lookout for Hong Kong partners in the telemedicine market.

Danny Yeung, CEO and co-founder of Hong Kong-based global genetic testing and digital health company Prenetics, has high hopes for his remote healthcare services in Asia, especially in Hong Kong, the Chinese mainland and Southeast Asia.

By early this year, his company had recorded year-on-year revenue doubling, with its strong performance in Asia.

Prenetics recently partnered with companies from different sectors in Hong Kong, including insurance, venture capital investment, smart logistics, and the Chinese University of Hong Kong, in launching a home testing project for COVID-19.

The technology is approved by the World Health Organization. It allows anyone in the city to do a COVID-19 test at home, and have the sample delivered directly to the Prenetics lab, at a cost price of HK$985 (US$127), with a designated healthcare professional to follow up on the result.

It also provides a HK$300 subsidy for healthcare workers and their families, sponsored by Prudential Hong Kong.

With a capacity of testing about 5,000 samples per day, the project will carry out 100,000 tests in the first stage. Major clients included the Tung Wah Hospital and food delivery company Deliveroo, to provide free tests for their employees, said Yeung.

He said people with minor suspected symptoms also used the service.

Through collaboration between the private and public sectors, the project has helped ease the burden on the local public-health system amid the pandemic, Yeung said.

The collaboration mode in remote healthcare services should be further promoted in Hong Kong, so the city can be well prepared for the next crisis, or for the sake of a more efficient healthcare system in an aging society, he remarked.