Evaluations on the Regulation on the Provision of Distance Health Services

The Regulation on the Provision of Remote Health Services, which entered into force with the Official Gazette dated 10 February 2022, is a step taken in order for health services to catch up with technology and the present, and regulates the services to be provided remotely and the related issues, with the aim of serving to provide health services independently of space and geography and based on modern medical technology.

The Remote Health Information System (‘System’) is a system developed to enable the notification and transfer of the transactions determined by the Ministry within the scope of remote health services to the information management system of the health facility. In this context, healthcare facilities are obliged to provide the necessary infrastructure and technical equipment for healthcare professionals to connect to the system.

Health Services that can be provided remotely within the scope of the Regulation
First of all, it should be noted that the prerequisite for the remote provision of these services is the existence of a health service that is suitable for remote provision. Accordingly

Examination, medical observation, control of diagnosed diseases, medical counselling, consultation or request for secondary opinion,
Services for the protection and follow-up of health, promotion of healthy life, provision of psychosocial support services,
Multidimensional assessment and follow-up of people at increased health risk or older people,
Interventional or surgical operation services provided that the technological possibilities allow and the necessary permissions are obtained from the Ministry,
Necessary medical procedures to protect the health of people in line with national guidelines in endemic or epidemic outbreaks,
Measurement and monitoring of health data of the person requesting health services with wearable technologies and other medical devices,
Issuance of e-prescription and e-report to the person assessed by the physician
Can be performed. At this point, it is also stipulated that distance healthcare services may be provided to the person requesting healthcare services in another healthcare facility, provided that it has an operating licence in the same branch.

The Regulation also includes the conditions to be met by the healthcare facility and the application procedure in order to provide distance healthcare services.


Informing the Patient
The person who will provide distance healthcare services must inform the patient on certain issues. The Regulation addresses these points within the scope of Article 9. In particular, it is important to inform the person who will receive the service that audio and video recordings cannot be taken without the explicit consent of the parties, but that records will be kept in accordance with the legislation on the processing of health data and personal health data and that the records will be transferred to the information system of the Ministry of Health in accordance with the legislation on the protection of personal data. In addition, the information must be provided in a plain language that the person can understand. In this sense, it is extremely important that the person providing information on issues such as the nature and consequences of the health service, its scope, the conditions of remote service provision, and the fee is clear and understandable.

The healthcare professional will take the necessary measures to verify the identity of the person receiving the service in the provision of remote healthcare services, in this context, it may be requested to show the identity document from the camera, in case of doubt, a secondary identity verification may be requested, and if the request is not fulfilled, the service may be terminated.

Rights and Responsibilities
In the provision of distance healthcare services, if there are people who can hear or see the conversation about the service provided by both parties, the other party must be informed. In addition, the person who will receive distance healthcare services is obliged to explain his/her health condition and medical history in a detailed, accurate and understandable manner. The health facility and directorate are also held responsible for ensuring that healthcare professionals have the technological knowledge and equipment to provide the relevant service.

Protection of Personal Data
Healthcare facilities and healthcare professionals have important responsibilities in terms of patient privacy and protection of personal data in the provision of remote healthcare services. In this context, first of all, the processing of data in accordance with the Law No. 6698 on the Protection of Personal Data and the relevant legislation, taking all kinds of administrative and technical measures to ensure data security, and making the necessary clarifications must be fulfilled by those who have the title of data controller and data processor.

It is stipulated that video and audio recordings cannot be taken without the explicit consent of the parties, and photographs cannot be taken during the service. Audio and video recordings taken with explicit consent will also be stored in secure data centres permitted by the Ministry, the storage period will not exceed twelve months and the data will be deleted without further notification upon expiration of this period.

Article 14 of the Regulation regulates the prohibitions and limitations regarding the provision of distance healthcare services. To mention a few noteworthy points, it is not possible to provide services in an area where one is not authorised to provide distance healthcare services. However, here, the services of health institutions affiliated to the Ministry or state universities in the nature of consultation or secondary opinion are excluded from the scope and considered as exceptional.

Distance healthcare services cannot be provided by healthcare professionals who are not authorised to practice in Turkey.

As an important point, the healthcare professional and/or healthcare facility must refrain from directing the person to receive distance healthcare services. At this point, appointment schedules should not be arranged in a way that will complicate or prevent the service that people will receive face-to-face and by coming to the health facility. Personal data obtained during the provision of remote healthcare services cannot be processed and transferred except for the relevant legislation.

As in any legislation, the applicability and deterrence of the provisions and prohibitions are directly related to the regulation of sanctions. The relevant Regulation makes remote health services subject to the supervision of the Provincial Directorate of Health, and in addition, the violation of the Regulation is subject to administrative sanctions. It is also noteworthy that public health facilities will be handled separately and the violation of the Regulation will be evaluated according to their own legislation.

In cases where there is no provision in the Regulation, the provisions of other legislation on patient rights and protection of personal data and the provisions of the legislation to which healthcare professionals and healthcare facilities are subject shall apply.

The Regulation entered into force on the date of publication, and healthcare facilities providing distance healthcare services are required to obtain an operating licence for the service within six months at the latest. In this case, it would be correct to say that there is a period of time until 10 August 2022 to obtain activity permits.

The relevant Regulation includes compact provisions on the remote provision of health services. However, it is unclear what the functioning of the system will bring in terms of applicability. Although health service is a very sensitive service on its own, we believe that more regulations will be seen in the future in shifting the system online and in the compliance process.