Telemedicine: our infographic with step-by-step instructions

Facing the public health emergency scenario, the Ministry of Health published on March 20 the MS 467/2020 Ordinance, regulating Telemedicine as a measure to confront the new coronavirus (COVID-19). In addition, the Federal Councils of Medicine, Psychology, and Nursing also took a position regarding the possibility of offering health care at a distance.
The repercussion also reached the Legislative Branch, which recently approved a Bill in this regard. Last Wednesday (15), Law No. 13,989/2020 was approved by the Brazilian President, which provides for the use of telemedicine during the crisis caused by Covid-19, with two vetoes in relation to the legislation that had been approved by the Brazilian National Congress.
The first one is about the validity of prescriptions with electronic or digitalized signature, under the argument that the measure would pose a health risk to the population, since it equates a signature that uses cryptography and has legal validity with another that can be easily falsified. The provision on the jurisdiction of the Federal Council of Medicine to regulate telemedicine after the period of crisis was also removed from the legislation, which according to the veto message should be done by law.

Check in the infographic below the step-by-step with the most recent rules for Telemedicine.

Teleconsultations with nurses, nutritionists and psychologists

The Brazilian Federal Council of Nursing (COFEN) also decided to allow nursing teleconsultations, in simultaneous or asynchronous modalities, for as long as the pandemic caused by the novel Coronavirus lasts.

According to COFEN Resolution No. 634/2020, published on March 27, 2020, the electronic means used in teleconsultation should be sufficient to safeguard, store and preserve the electronic interaction between nurse and patient. The electronic/digital records of the patient’s care must include:

• Nurse identification;
• Informed consent of the patient or his legal representative, which can be electronic (e-mail, communication apps or through the phone);
• Patient identification and data;
• Registration of date and time of start and end of consultation;
• Patient medical history;
• Clinical observation;
• Nursing diagnosis;
• Healthcare plan; and
• Nursing assessment and/or referrals.

In this same direction, the Brazilian Federal Council of Nutritionists (CFN) also decided to allow nutritional assistance through remote communication until August 31, 2020, as provided by CFN Resolution No. 646/2020.

Also, the Brazilian Federal Council of Psychology (CFP) recommended the provision of psychological services using information and communication technology and the following of the CFP Resolution No.11/2018 guidelines (which already provides for remote interactions among psychologists and patients), especially regarding the prior registration with the Regional Councils of Psychology (CRP).

Distance healthcare in the context of health insurance

In the context of supplemental health, the National Supplemental Health Agency (ANS) also issued Technical Notes No. 3/2020 and No. 7/2020, of March 31, 2020, on the use of distance communication to provide health care services. In addition, ANS also adapted the Supplemental Health Information Exchange Standard (TISS), with the inclusion of a new modality of care: telehealth.

According to Technical Note No. 7/2020, the service provided through remote communication is a mandatory coverage procedure that is already included in the List of Procedures and Events in Health, since it does not correspond to a new procedure, but rather to a remote medical consultation.

In order to conduct telehealth amidst the Covid-19 crisis, Note No. 3/2020 establishes that healthcare operators and service providers must agree mutually and in advance using any instrument (email for example) to do so, which must enable:

• Identification of services that can be provided through telehealth;
• Mention of remuneration values for the services provided in this type of care;
• Mention of procedures for billing and payment for these services; and
• Mention of procedures that will require prior authorization to perform these types of services.

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