DEVELOPMENT OF TELEMEDICINE IN

MALAYSIA

"Telemedicine" can be described as a delivery of healthcare and exchange of health care information across distance. Telemedicine is still very popular and widely used.

Conceptually, telemedicine can be defined as the practice of medicine by a medical practitioner who is physically away from where the patient is located.

World Health Organisation, telemedicine is defined as, “The delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities”.

Section 2 of the Telemedicine Act 2007 has defined 'telemedicine' as the practice of medicine using audio, visual and data communications.

It is obvious that the doctors diagnose an illness or an ailment once they have completed the physical examination of the patient.

This enables specialists in the major cities of a country or in the world to be consulted or to diagnose illness or patients, no matter where these patients are physically located.

One clear advantage of telemedicine

is the reduction or elimination of physical contact or movement by either specialist or patient to another location.

Telemedicine can be divided into three areas:

(1) aids to decision-making;(2) remote sensing; and(3) collaborative arrangements for the

real-time management of patients at a distance.

(1) Aids to decision-making Telemedicine includes areas such as

remote expert systems that contribute to patient diagnosis or the use of online databases in the actual practice of medicine.

(2) Remote sensing

Remote sensing consists of the transmittal of patient information, such as electrocardiographic signals, x-rays, or patient records, from a remote site to a collaborator in a distant site.

It can also include transmittal of grand rounds for medical education purposes or teleconferences for continuing education.

(3) Collaborative arrangements Collaborative arrangements consist of using

technology to actually allow one practitioner to observe and discuss symptoms with another practitioner whose patients are far away.

This raises important issues of referral and payment arrangements, staff credentialing, liability, and licensure potentially crossing state lines.

Two-way work stations that provide smooth digital motion pictures have been integral to the long-distance, real-time treatment of patients.

As new technology is found, collaborative arrangements are the future of telemedicine.

Development of Telemedicine in Malaysia

The function of telemedicine is to go beyond the traditional method of healthcare but still able to provide healthcare even there is problem of distance involved.

One of the main development is the MSC Flagship Application that will ensure that all Malaysian citizen able to enjoy high quality of healthcare and it also support Malaysia to become one of the global hub for telemedicine.

This application will be implemented over 5 year period and it will provide the most ideal environment due to its technology infrastructure.

The Telemedicine projects :

1. Mass Customised Personalised Health Information and Education (MSPHIE)

2. Continuing Medical Education

3.Teleconsultation

4. Lifetime Health Plan

1. Mass Customised Personalised Health Information and Education (MSPHIE)

The function is to provide information and education about health content in regard to mass and specific community by using the internet, multimedia technologies and mass communications.

They may take care of their own health. The services which were provided include information, advice, education and so on.

Mass Customised Personalised Health Information and Education (MSPHIE) will have access to the Lifetime Health Plan which include a component that will assess a person’s risk of developing certain illnesses and give reports to advise them on prevention and lifestyle habits. It will be accessible since it used the Internet and it provide 24 hours of access to the information.

2. Continuing Medical Education It combines virtual learning about quality

health education as easy as clicking on a few buttons to gather information such as OVID medical journals, the online version of Harrison's textbook, government health reports, local and international databases and links to accredited websites.

The purpose of CME is for the health and medical practice to perform better.

3.Teleconsultation

connect healthcare providers in a multipoint place in order to share opinions.The success factors include large number of users, faster services, lower costs and the extent of accessibility to the homes of individuals.

4. Lifetime Health Plan

It main focused is on the patients itself based on the lifetime health record. It will integrating the information in the lifetime health record to develop personalised lifetime health plans for each individual. It main goal is the PLHP (Personalised Lifetime Health Plan) which consists of computer generated healthcare plan which focus on the with the specific health needs of an individual.

The main components of LHP are:

• CSS (Clinical Support System) - to manage a healthcare facility's administrative and clinical process.

• PLHP (Personalised Lifetime Health Plan) - to deliver Health Plans and Care Plans

• GDS (Group Data Services) - to deliver data mining services and generate relevant reports

As a conclusion, telemedicine in Malaysia had show progress over the years. Perhaps more projects regarding telemedicine will be introduced and continue for the purpose of healthcare for the Malaysian citizen.

In Malaysia, telemedicine practice would not raise problems caused by state-based registration of health professionals.

This is due to the fact that the Malaysian Medical Council regulates the registration of all health professionals in all states.

However, section 3 of the Telemedicine Act 1997 provides that a medical practitioner who is registered or licensed outside Malaysia may offer telemedicine services in Malaysia if that person obtains a certificate to practice telemedicine from the Malaysian Medical Council.

This would mean that a medical professional residing outside Malaysia can only provide telemedicine services through a registered medical professional in Malaysia.

It would seem that this provision would not raise problems caused by the provision of telemedicine across national borders because only the Malaysian fully registered medical practitioner will remain primarily responsible to the patient.

It has also been argued that only the Malaysian fully registered medical professional will have the patient doctor relationship and be liable for medical negligence. It is up to the Malaysian medical professional to arrange for an indemnity agreement with the medical professional residing outside Malaysia.

It has also been argued that only the Malaysian fully registered medical professional will have the patient doctor relationship and be liable for medical negligence.

It is up to the Malaysian medical professional to arrange for an indemnity agreement with the medical professional residing outside Malaysia.

Introduction of Telemedicine Act 1997 The introduction of Telemedicine Act 1997

is one of the legislative initiatives by Malaysia to ensure that the law is keeping pace with the development of electronic medicine and telemedicine.

enforce in Mac 1997 with the objective to provide medical services from remote locations using electronic medical data and prescription standards, with knowledge that their treatment will be covered under insurance programs.

This act will read together with the Medical Act 1971 and also refer to the Malaysia Medical Council’s Code of Professional Conduct.

This act is divided to 6 sections, mainly focus of person who may practice telemedicine, certificate to practice telemedicine, consent of patient.

Telemedicine as define as the practice of medicine using audio,visual and data communications.

It show that telemedicine must include all these type s of communication in order to use this act.

This Act also requires fully registered medical practitioners to obtain a certificate to practice telemedicine, which is valid for three years, from the Malaysian Medical Council.

Medical practitioners must be fully licensed but can hold a license granted from within or outside Malaysia.

If a telemedicine service must be performed by a medical practitioner resides outside Malaysia, he must be a fully licensed medical practitioner holding both a practicing certificate and a certificate to practice telemedicine.

Failure to comply with the Act could result in a fine up to RM500,000 (US$125,000) and or imprisonment up to 5 years.

Besides, written consent of the patient before practicing telemedicine and ensures patient confidentiality of their digital records is also stated in the act. Failure to comply with this part of the Act could result in a fine up to RM100,000 (US$25,000) and or imprisonment up to 2 years.

Telemedicine is about the practise of giving health care by using internet, video conferencing and so on.

There is no need for the doctor and the patient to meet.

The main function of this Telemedicine Act 1997 is to provide the rules and regulation in regard of telemedicine.

This act must be read together with Medical Act 1971.

Telemedicine must include audio, visual and also data communication.

The main function of telemedicine is to provide health care even though there is an issue of distance between the patient and the doctor involved.

Basically the main issues regarding telemedicine is about the consent of the patients, the license of the practitioner and also the confidentiality of the information involved.

Section 3(3) stated about the punishment for the non-licensed telemedicine practitioner.

Before the pratitioner of the telemedicine may practise telemedicine, they must first obtained the consent of their patient. It was provided under Section 5 of the Act and the consent must be in writing.

Although the issue of confidentiality of the information was not stated in this act however the rules regarding it in the Malaysian Medical Council’s Code Of Professional Conduct.

There is a rapid development in Malaysia regarding telemedicine which include 4 stages which are Mass Customised Personalised Health Information and Education (MSPHIE), continuing Medical Education,teleconsultation, lifetime Health Plan.

However, the government may amend several section or added several section to provide the solution regarding what was the punishment for the telemedicine practitioner if they were negligence, whether the practitioner will be liable if the negligence is cause by the technology issue and the issue of jurisdiction since there is practitioner from the oversea involved.