Author(s):Several

Healing From a Distance:

A Robot Today Can Keep the Doctors Away

“In a few years, the idea of receiving medical treatment exclusively at a doctor’s office or hospital will seem quaint.”

- Harvard Business Review

In a time where technological advancement has revolutionized the spread of information and the way in which we communicate, the progress and impact of these technologies did not go unnoticed to the Healthcare sector. Telecommunication technologies are now being used to support the provision of healthcare services, namely through the delivery of virtual medical services. This new method has been coined telemedicine and was initially used to contact patients located in remote places. While telemedicine refers exclusively to clinical services, telehealth can also refer to non-clinical services such as administrative and educational activities. The World Health Organization found that telemedicine could be traced back to the mid-1800s with the military and space industries and that its modern form was adopted in the late 1960s and the early 1970s. The word “telemedicine” means “healing from a distance” and has allowed humans to deliver medical services even where distance is a critical factor, thus demonstrating the significant progress made by the healthcare sector.

Immediate Access to Specialized Consultation

The United Arab Emirates is not one to let innovative technologies slip past it, and has launched a wide range of telemedicine and telehealth projects. In July 2015, the Dubai Health Authority (DHA) initiated a “Robo Doc” trial at Hatta Hospital. The trial involved the use of a technology called “Robo Doc” that can examine patients from afar. In effect, use of this technology significantly reduces consultation costs for patients, namely from $90 to $30. Also, the “RoboDoc” technology proved to be extremely beneficial in emergency cases. The “RoboDoc” robot, a medical machine that can be controlled by a smartphone, on which a screen displays a doctor, was used to evaluate a patient severely injured as the result of a road traffic accident. The robot drastically sped up the patient’s treatment by generating the patient’s lab results, vital signs, and x-rays.

The groundbreaking method of diagnosing patients with “RoboDoc”, both prior to and after the occurrence of the harm, has allowed trauma teams to directly give information about a patient’s condition to the emergency room doctors, instead of requiring a specialist to visit the hospital to make these tests. Dr. Moin Fikree, head of the Dubai Health Authority’s Telemedicine initiative and Director of Trauma Centre, has explained that “through the robot, doctors can consult with two or more specialists in different health facilities at the same time to get immediate specialized consultation”. Healthcare professionals are now able to be in two places at once, thus reaching a larger segment of patients. By accelerating the treatment process, telemedicine technology can not only save a patient’s money but also time and therefore their lives. The trials proved to be a huge success and encouraged governmental authorities in the United Arab Emirates to invest in further telehealth technologies. The Dubai Health Authority announced that it would endeavor to extend telemedicine and telehealth projects across all of its medical facilities and that it is the first government health organization in the region to implement telehealth technologies.

The Regulation of Innovation

Initially, only limited regulations concerning telehealth were available in the United Arab Emirates. Healthcare professionals were unsure about whether or not they could engage in telehealth projects, which has had the effect of slowing down the development of these projects. The problem with regulating innovative technologies is that policymaking is a slow and rigid process that generally lags behind the rapid nature of these advancements. Previously in Dubai, the Dubai Health Authority Regulations only allowed the performance of teleradiology services and prohibited the licensing of other telemedicine services. The new DHA regulations issued on 21 February 2017 now authorize the licensing of telehealth services. Administrative Decision Number 30 of 2017 (the Decision) concerning the regulation of telehealth services has recently been issued by the Dubai Health Authority. Article 3 of the Decision states that its aim is to provide clarity on the requirements for conducting telehealth services and to provide the highest standards of safety and accessibility to its customers. Article 4 of the Decision states that a license must be obtained by anyone who wishes to provide telehealth services.

The Health Authority of Abu Dhabi (the HAAD) has had a regulatory framework for telehealth services since 2013, under which the Abu Dhabi Telemedicine Centre was issued a telemedicine license. HAAD authorizes a wide range of telemedicine services and a specific telemedicine facility license. Nevertheless, one limitation in the development of telemedicine services is that providers cannot prescribe medication to the patients they have examined. If a treatment plan requires medication to be prescribed, the patient will have to attend an in-person consultation at the hospital in order to receive their medication.

Standards for Tele-consultation in Abu Dhabi

In regard to teleconsultation services in Abu Dhabi, the HAAD has issued the Standards for Tele-Consultation in the Emirate of Abu Dhabi (“the Standards”) which came into effect in March 2014. As per article 8.1.1., healthcare facilities wishing to provide teleconsultation services must either be licensed by HAAD specifically with a license to provide teleconsultation or be authorized by HAAD to provide teleconsultation services. Tele-consultation allows the provision of the following services:

Triage (prioritizing patients based on the urgency of their needs) Diagnosis Video sighting of body symptoms Recommendation for self-care, excluding prescription medicines Request pathology, point of care testing, radiology investigation Tele-Referral, in accordance with the HAAD Patient Referral Policy Follow-up care and case management Home monitoring of patient health status and vitals Other medical services such as the provision of patient education, counseling and services associated with disease management programmes.

Article 2.3 of the Standards states that consultations can be done through a range of telecommunications media such as telephones, internet-based videos, emails and similar electronic-based communications. Article 3 of the Standards lists the duties teleconsultation healthcare service providers must abide by, such as the obligation to assure professionalism and confidentiality (3.1.3), and the obligation to ensure the services are accessible to all patients (3.1.2). In addition to these responsibilities which are similar to the responsibilities of healthcare professionals in general, some of the obligations more specific to teleconsultation services are the following: the obligation to assure the quality and safety of the teleconsultation services (3.1.4), the obligation to have Information and Communication Technology (ICT) policies (3.1.7), and the obligation to ensure that ICT technologies are offered and that they meet Abu Dhabi Systems and Information Centre and HAAD technical specifications and regulatory requirements. In addition, article 7.1.3.1. requires the establishment of a quality committee for quality assurance in the case where facilities are staffed with ten or more professionals. As for facilities staffed with less than 10 professionals, a responsible physician for quality must be assigned. There exist other standards that offer guidance on telehealth services such as the HAAD Service Standards for Tele-Consultation in the Emirate of Abu Dhabi.

The United Arab Emirates has taken several measures to regulate the dynamics of telehealth services but there are still areas in need of regulation. The government has shown a clear interest in using these innovative services to improve the health system’s efficiency. In emergency cases, where distance stands in the way of a person surviving, telemedicine has offered an affordable, efficient and revolutionary way of providing medical assistance to those in need.