Boost for digital health in Germany – restrictions on remote treatment could be overturned in May 2018

At the next Annual General Meeting of the German Medical Association (Deutscher Ärztetag), the current restrictions on remote treatment by German physicians will most likely be overturned. Until now, physicians in Germany were only allowed to offer follow-up treatment by telemedicine (e.g. video consultation) if the patient had already been treated in their practice before. Looking forward, physicians may be able to provide advice and diagnosis in simple cases of illness also by telemedia, without having seen the patients in person in the practice beforehand.

Scrutinizing the current restrictions on remote treatment is an explicit goal of the new German Federal Government. The coalition agreement, a document summarizing the new government's main policies, states: “We will continue to expand the telematics infrastructure (...) [and] will put the restrictive regulations for remote treatment to the test.”

The provision on medical treatment by telemedia, commonly referred to as the "ban on remote treatment", is stipulated in Section 7 (4) of the (Model) Professional Code for Physicians in Germany (Musterberufsordnung für Ärzte – MBO).  Under these rules, physicians may not provide individual medical treatment, in particular advice, solely via print and communication media. In telemedical procedures it must also be ensured that a doctor treats the patient directly. Telemedical treatment is not totally banned by these rules. Rather, remote treatment is prohibited by professional rules where no personal (direct) contact in the physician-patient relationship takes place at all. The purpose of the provision was that the physician should gain a face-to-face impression of the respective patient through his own perception and not rely solely based on descriptions. This should prevent a loss of treatment quality and endanger patient safety.

Several thousand Germans are said to be already circumventing the ban and communicating digitally with doctors abroad - but at their own expense. In Great Britain and Switzerland, for example, telemedicine has long been part of standard care. The situation could change for German patients in the near future.

In the future, it could become possible in justified exceptional cases to carry out treatment without prior personal contact with the patient. The physician would be able to decide individually and at his discretion when a justified exceptional case exists. The aim is to improve and accelerate the quality of medical care for the population. In structurally weak or remote regions, telemedical treatment could ensure good health care despite a lack of doctors. The care provided by highly skilled specialists, who are not available equally across the country, is to be improved. At the same time, the possibility of remote treatment of patients should relieve the burden on overcrowded clinics and general physicians. However, direct doctor-patient contact will probably remain the “gold-standard.”

The digital health industry could gain further traction in Germany due to this potential change. In the future, efficient patient treatment will be based on digital support to a certain extent. Digital health providers therefore have potential. However, the digitalization of the health care sector continues to bring risks and presents the digital health industry with challenges: these include compliance with strict regulatory requirements for products in the (digital) health care sector to ensure patient safety, handling product liability risks with devices for telemedical monitoring, and the potential for cyber abuse and attacks with regards to health data.

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