Need ‒ and room ‒ for more than “DoctorOnline” and “Telemedica”
While the main challenge to the healthcare system has recently been COVID-19, this does not mean that other healthcare challenges have ceased to exist in our society. Stay-at-home orders have raised the issue of remote medical check-ups and consultations. This has led to more frequent use of telemedicine services.
Luckily, Latvia is one of those countries that envisaged telemedicine services in legal regulation as early as 2014, even before such services were readily available. At the same time, these services are not strictly regulated and hence are mostly offered in light of practical considerations. While the Medical Treatment Law recognizes and defines telemedicine as a remote health care service using information and communication technologies, there is not much detail about the process of its application. The law recognises the opportunity to provide these services in the form of text, sound, or pictures, for example. Telemedicine is also listed as one of the methods of healthcare. Thus, its form and abilities have been mainly left open for free discussion and development of technologies.
Currently in Latvia there are only two telemedicine services fully operating – “DoctorOnline” and “Telemedica”. However, the use of telemedicine in Latvia has been a subject of public discussion at least since 2012, when it was first presented to the Social and Employment Matters Committee of the Saeima. The main benefits are considered as being the opportunity to access medical support from any location and saving of financial resources by avoiding the need for medical personnel to use transport and leave their medical facility.
In practice, telemedicine is mainly used for medical consultations, avoiding queue time and potentially contagious contact in clinics. Modern audio-visual solutions give sufficient opportunity for face to face communication, as well as to indicate certain disease symptoms. Additionally, more developed solutions are available, including remote health monitoring devices that send information directly to healthcare professionals from a distance. However, the use of these technologies is still relatively rare and not specifically regulated.
Since the use of telemedicine includes electronic communication and transfer of patient data, data protection requirements must be met. Telemedicine service providers need the patient’s consent for use of the patient’s data and must react promptly if consent is withdrawn. Safety requirements also include protection against data protection breaches.
It remains to be seen whether in the face of more frequent use of telemedicine the current basic legal regulation should be supplemented.
E-pharmacies: why not extended to prescription medicines?
While the world is still experiencing the COVID-19 pandemic, the use of online services has gained significant public interest. This period has not only helped to develop new remotely available services, but also brought attention to services that existed before the pandemic. This includes more frequent use of e-pharmacies.
Distribution of medicines by means of electronic communication in Latvia is currently regulated by Cabinet Regulation No. 416 Procedures Regarding the Distribution and Quality Control of Medicinal Products and Cabinet Regulation No. 800 Procedures for the Licensing of Pharmaceutical Activity. These regulations envisage a list of requirements and restrictions with which anyone intending to sell medicines online must comply.
This includes the requirement to provide free of charge information and consultations to the public, develop a website that operates without regular interruptions and complies with the legal requirements of medicines advertising and receive a licence from the State Agency of Medicines for this purpose.
However, under Latvian law only medicines that are not subject to medical prescription may be distributed by means of electronic communication. As argued by the State Agency of Medicines this is due to the risks caused by operation of non-licensed pharmacies, which may distribute medicines of low quality or even counterfeit medicines. Therefore, patients are strongly advised to buy medicines only from e-pharmacies that have been approved and can be found on the list provided on the website of the State Agency of Medicines.
Since there is currently no list of prescription medicines that is common to all European Union member states, classification of some medicines may differ in each country. Accordingly, e-pharmacies registered in Latvia are obliged to distribute only medicines that do not require a prescription under Latvian law. However, this does not fully guarantee that prescription medicines cannot be obtained by ordering them from different internet sources.
Therefore, it would be in the interests of patient safety and development of local pharmacies for the Latvian state to consider whether prescription medicines should also be available for purchase in licensed e-pharmacies. Although it is clear that the operation of e-pharmacies should be closely supervised due to their specific nature and remote processes, the sale of prescription medicines could be a reasonable development in the years to come.
Since 1 January 2018 state-reimbursed medicines in Latvia are being prescribed in an electronic format, known as an e-prescription. This indicates that during recent years prescription of medicines has been guided towards an electronic format. However, these medicines are still being handed out in pharmacies, where the patient must identify themselves by showing their ID card or passport. Thus, the only factor currently preventing licensed pharmacies from selling prescribed medicines by means of electronic communication and delivering them is the requirement to identify the patient.
Therefore, we would expect that in the near future reimbursable and other prescription medicines could also be ordered online on the basis of an e-prescription, by using a proper and secure system of authorisation. For example, by using the portal “Latvija.lv” and delivering medicines to the patient’s address at their declared place of residence. However, there are also solutions that do not require fundamental changes in technologies and law. For instance, medicines could be delivered to the patient by pharmacy employees or delivery contractors at the patient’s request. However, the presence of the patient would still be necessary upon delivery.