A Maccabi HMO test in Kiryat Shmona.
A woman undergoing a test at an HMO in Kiryat Shmona. Lesbians are more reluctant than straight women to see a doctor. Photo by Yaron Kaminski
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A phenomenon known as "telemedicine" is on the rise in Israel and Western countries, as more people seek out health care via TV and the Internet. In order to regulate this growing trend, the Health Ministry has issued a protocol for the delivery of so-called telemedicine services, set to go into effect on June 1.

A draft of the new protocol was sent recently to the country's HMOs and hospitals by the director of the ministry's Medical Authority, Prof. Arnon Afek. The protocol specifies situations in which telemedicine may be used, types of services that may be provided, and individuals and institutions that are permitted to provide them.

Under the draft protocol, physicians are allowed to issue sick notes and to prescribe refills for drugs and medical supplies via the Internet. They may also refer patients to specialists, hospital emergency rooms and Magen David Adom first aid stations - with all of the benefits of the same documents issued in person, such as waiver of payment.

The draft protocol stipulates that the Health Ministry must approve any service provided through telemedicine by independent care providers.

"Telemedicine services are relatively new in Israel and are still in the early stages," the Health Ministry said in a statement. "Recently there has been a noticeable increase in use of telemedicine by medical institutions and service providers in the medical establishment. This gave rise to complex questions regarding professional, technological, legal and economic aspects, as a result of which the ministry decided to formulate professional standards."

While telemedicine gives people in remote communities access to specialists in the center of the country, and can ease the workloads of community doctors, detractors warn of the potential for overuse. Because of the obvious cost-savings for health maintenance organizations, they could be tempted to opt for remote visits in cases that require face-to-face physical examinations. Telemedicine could also become a factor in medical malpractice suits due to the increased risk of misdiagnosis.

Health care providers who use telemedicine are required, according to the draft protocol, to make themselves available to their patients during posted reception hours, and to fully document patient diagnostics and treatment, in the event of complications. In addition, care providers are specifically enjoined to refer patients for physical examinations "in cases requiring an unmediated impression, including a physical exam for the purposes of diagnosing and treating the patient's physical and/or mental condition."

In the event of an emergency, the provider is responsible for summoning rescue services or referring the patient to an emergency room.

HMOs and hospitals seeking to launch telemedicine services will be required to appoint an administrator who is responsible for coordinating the services and gathering information on the issue.

All providers of telemedicine, including physicians, nurses and other health professionals, will be required to undergo mandatory training.

"Like face-to-face medical appointments, remote health services also carry risks," the draft protocol states. "The limitations inherent to telemedicine mandate extreme caution when determining a diagnosis and treatment modalities, and require special training." All providers are to receive training before engaging in telemedicine and to participate in refresher courses at least once a year.

The need for guidelines regarding communication between physicians and patients via television and the Internet was brought up in May 2010 at the 11th annual Dead Sea conference of the Israel National Institute for Health Policy Research, which was devoted to the subject of telemedicine.