The Sindh Telemedicine and Telehealth Act 2021 (the Act) is a first-of-its-kind, which aims to facilitate and improve access to healthcare through distant platforms and to counteract the shortage of both healthcare professionals and facilities in the province of Sindh.
The Act defines “telehealth” and “telemedicine” broadly, to include the provision of medical care and patient education, as well as health information services and self-care via telecommunication or digital communication technologies. The provision of services is enabled through secure two-way audio or video connections or video conferencing, use of storage and forward technology, electronic media or other forms of telecommunication technology. Although artificial intelligence is highly unrecognized and underdeveloped in Pakistan, the Act conceives the use of online adaptive interviews and remote patient monitoring devices for the exchange of diagnostic, treatment and prevention information, along with the research and evaluation of these communications.
In order to ensure regulatory oversight, the Act requires that practitioners (RMPs) be registered with the Pakistan Medical and Dental Council and presently restricts access to patients within the limits of the Sindh province. As such, practitioners’ profiles and verified registration status are made transparent to consenting patients. The RMPs are also obligated to make professional judgments as to whether an in-person consult would be preferable in each case, keeping the patient’s interest and the complexity of the patients’ condition paramount. For this purpose, RMPs must consider the mode/technologies available to them and their adequacy for diagnosis, before choosing to proceed with any form of health education, counselling or medication. Additionally, due recognition has been given to the patient’s right to confidentiality of information. The Act provides that no data or information shall be shared without the consent of the patient or authorized caregiver, prescribing penalties for breach.
With the inception of the Act, the need for remote access to and delivery of medical and healthcare services was tested through its implementation during the COVID-19 pandemic. Again, with the recent and unprecedented calamity of floods in the Sindh province, the Government of Sindh has aimed to set up a tele-mental health centre at the largest public hospital in Karachi (Jinnah Post Graduate Medical Centre). Two pilot projects are also in the works to serve the severely affected Dadu and Kambar-Shahadkot districts.
Significantly, the Act brings within its ambit, medical consultants and practitioners from outside of Pakistan. While this effort certainly widens the potential for a higher standard and quality of healthcare to the inhabitants of Sindh, the potential for enforcement in cases of negligence or misconduct committed by practitioners offering services from abroad, is at best very limited. The intention to regulate cross-border interactions at a provincial level is also open to debate, given that healthcare is a jurisdictional realm over which the Federal Government of Pakistan has the Constitutional mandate to exercise authority.
From the patient’s perspective, there also exists some room for improvement. For instance, in cases where a patient requires urgent or emergency medical care, telemedicine – which only has remote access to such patient – may delay efficient delivery of treatment. While the benefits of technological intervention cannot be undermined, the administration of medical care through in-person diagnoses may prove more comprehensive and reliable. To address such concerns, the Government of Sindh may consider complementing its initiative with introducing telehealth medicine centres in each district of the Province of Sindh with on-duty practitioners.
All in all, the Act has enabled patients to benefit through a regulated telehealth service, ensuring a wider patient base …….