TELECONSULTATION: HEALTH INSURANCE PUBLISHES A CHARTER OF BEST PRACTICES

Put online at the beginning of April on the www.ameli.fr website, this charter is intended for all doctors, whatever their status and their medical specialty. It recalls that the teleconsultation meets the same professional requirements as the face-to-face consultation, the latter remaining the reference act for the care of a patient. Face-to-face meetings should therefore be preferred, especially when it comes to a first consultation. The text nevertheless recalls that all medical situations are potentially affected by teleconsultation, in particular the most common reasons such as prescription renewal. Without being an obligation, it is recommended that doctors undergo training, if only to learn how to communicate and perform a clinical examination remotely. It is also recalled that a doctor must limit the share of his teleconsultation activity: he cannot carry out, during a calendar year, more than 20% of his volume of agreed overall activity
remotely, teleconsultations and combined tele-expertise.

Development of e-prescription

In addition to the reminder of the technological prerequisites, the charter provides details on the
e-prescription, mandatory by December 31, 2024, for all acts and care services performed in city medicine (ordinance no. 2020-1408 of November 18, 2020). However, doctors are advised not to wait for this deadline.
and to use electronic prescriptions as soon as possible, either directly from their business software or from the teleconsultation tool used, which must comply with the Health Insurance e-prescription specifications. With a view to complete dematerialization of documents exchanged with patients, Health Insurance is asking doctors to add the e-prescription in their DMP or to send it to their secure “My Health Space” messaging system, via their own MSSanté . Another encouraged digital use: the use of the Carte Vitale application, which has the advantage of securing invoicing and facilitating third-party payment.

Coordinated care pathway and rules of territoriality

Although many exceptions are allowed, the initial orientation by the attending physician remains the rule in terms of teleconsultation. This principle is strongly defended by doctors’ unions, who wish to limit the development of platforms and private providers of extraterritorial telehealth solutions. The teleconsultant doctor must “be able to ensure continuity of care” by being the patient’s treating doctor himself or by directing him, as far as possible, towards doctors practicing in his territory. However, 7 exceptional cases are provided for, linked to the situation of the patient himself (under 16, prisoner, having no attending physician, resident in an nursing home, etc.), emergency cases, authorization of direct access for certain medical specialties or the unavailability of the doctor. Teleconsultation can therefore be offered as a first resort, within the framework of a coordinated territorial organization of telemedicine, such as a CPTS, a home or a health center, a primary or specialized care team (article 28.6.1.2 of the medical agreement ).

According to this same logic, the charter recalls the principle of territoriality, namely that the teleconsultant doctor “must be located near the patient’s home”. Except when the latter resides in an under-medical territory, a qualified area
“priority intervention” or in the absence of coordinated territorial organization of telemedicine. Thus, even if the charter does not express it so clearly, teleconsultation is indeed a response adapted to medical deserts and necessary to improve access to care.

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