Cedars-Sinai Medical Center

The Covid-19 pandemic led to an explosion of telehealth adoption in the United States.1 The regulatory and reimbursement barriers that have typically hindered the growth of telehealth dissolved almost overnight. This has substantially increased the bandwidth, availability, and willingness of U.S. providers to conduct patient visits via telehealth. Additionally, the overwhelming positive experiences of both patients and providers are indicating that telehealth is here to stay. Globally, trends have been similar, as regulations have been either relaxed or waived, to allow for additional flexibility within the respective countries. However, for patients seeking care outside of their own home countries, this period has increasingly proven to be complex and confusing due to regulatory uncertainties around conducting telehealth across international borders. Considering the time and expense required for in person consultations and improved patient satisfaction with virtual modalities, this pandemic has highlighted the importance of global regulations to keep pace with demand.

“As virtual care and modalities continues to gain prominence, further research will be critically needed to shape global policy and inform regulations to improve access to the best care available for patients, regardless of location”

Prior to the pandemic, approximately 100,000 to 200,000 unique patients travelled to the U.S. annually for medical care, many of whom are seen at major U.S. Academic Medical Centers (AMCs).2 With medical travel significantly disrupted by the pandemic due to border closures and travel restrictions, U.S. AMCs with major international programs have increasingly been grappling with understanding global telehealth regulations to maintain access for these patients. At Cedars-Sinai Medical Center, a leading AMC in Los Angeles, we’ve been working to address these uncertainties well before the pandemic and have been actively working with other major U.S. hospitals through a collaborative initiative led by the U.S. Consortium for International Patient Programs (USCIPP), to collectively obtain top legal counsel for several priority countries around the various interpretation of telehealth regulations, as well as “practice of medicine” and data laws. To maintain access for international patients, the Cedars-Sinai International, Legal and Risk divisions have been working together to inform clinical departments on the medico-legal risks of conducting international virtual visits based on this guidance.

Generally, there is often no specific regulator or legislation regarding telehealth and remote second opinions globally. However, while many countries have no specific laws on telehealth, regulatory frameworks governing traditional “practice of medicine” and physician codes of conduct generally apply to all direct physician-patient healthcare services—including remote services. An increasing number of countries are considering telehealth laws and regulations, while others are already in the process of updating existing rules and guidance. However, cross-border telehealth is often not addressed. For those that do, telehealth regulations are generally tolerant of some cross-border consultations such as doctor-to-doctor (i.e., peer-to-peer) video consults and written remote second opinions.

Despite pandemic related travel restrictions, many U.S. hospitals with major international patient programs have been able to maintain access for its patients through telehealth, primarily informed through industry collaborations and consultation with some of the leading international legal firms. However, with no clear certainty on permissibility of cross-border telehealth, this level of access has been variable across the U.S. and an area that must be addressed. As virtual care and modalities continues to gain prominence, further research will be critically needed to shape global policy and inform regulations to improve access to the best care available for patients, regardless of location.