Aborto na Nuvem comes to serious relationships established and standardized within this site and its systems shape. Due to that, this document covers these relationships and the context in which they occur in Telemedicine.

1. About the Definitions:

“Telemedicine” means the practice of medicine using electronic communications, information technology or other means between a licensed medical practice in a location, and a patient in another location, with or without an intervening healthcare provider. It has as one of its objectives replicate the iteration between patient and medical provider.
“Telemedicine Technologies” means technologies and/or devices that enable secure electronic communications and exchange of information between a licensed medical practice in a location and a patient in another location, with or without a health provider intervened.
“Medical” is licensed to practice medicine professional. We understand that a licensed medical practice can exert its function in any place where it becomes necessary due to the absence of qualified graduates in place of the patient.
“Healthcare provider” means a company or organization acting as the intermediary organizing of or necessary for a patient to receive care for her and requested to provide medical service which is asked.

2. On the Establishment of Medical x Patient Affairs

A doctor-patient relationship is clearly established when the physician agrees to make a diagnosis and/or treatment of a patient, and the patient agrees to be treated, whether or not there a meeting in person between the physician (or another health professional adequately supervised) and the patient.
A doctor is discouraged from providing medical advice and/or care using telemedicine technologies without:

• Full authentication and verification of location and, to the extent possible, the identification of the requesting patient.
• Disclosure and validation of the identity and credentials of the health care provider.
• Obtaining the appropriate authorizations for patients, after exposure to delivery models and methods of treatment or restrictions thereof, including information about any proper consents concerning the use of telemedicine technologies.
• A doctor-patient relationship is not properly established when the identity of the physician or health care provider may be unknown to the patient.
• The extent possible, where appropriate, the patient should be able to select a physician identified by telemedicine services and not be assigned to a doctor at random.

3. Guidelines for the proper use of telemedicine technologies in medical practice

Aborto na Nuvem adopted the following guidelines for physicians using telemedicine technologies in providing patient care, regardless of a pre-existing patient-physician relationship:

A – Graduation:

A licensed physician should be under the jurisdiction of your residence. The practice of medicine occurs where the patient is located at the time of telemedicine technologies are used. Doctors who treat or prescribe through the online service are practicing medicine as far as possible, must possess appropriate licensure in all jurisdictions where patients receive care when the service already has licensees authorized on-site of the patient.

B – Establishment of a doctor-patient relationship:

When a pre-existing patient-physician relationship is not present, a doctor or health care provider should take appropriate measures to establish a patient-physician relationship following the guidelines set out in section (02). Because each circumstance is unique, such doctor-patient relationship can be established using telemedicine technologies, since the standard of care is met.

C – Evaluation and Treatment of the Patient:

Before providing treatment (including issuing prescriptions, electronically or otherwise), a medical evaluation documented and proper collection of relevant clinical history consistent with the presentation of the patient should be taken to establish diagnoses and identify underlying conditions and/or contraindications to the recommended/supplied treatment.
Treatment and consultation recommendations made in an online environment, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional settings (meeting in person). Treatment, including issuing a based solely on an online questionnaire prescription does not constitute an acceptable standard of care.

D – Enlightened and free consent:

Should be informed and documented appropriate patient consent for the use of telemedicine technologies. The appropriate consent must include the following terms:

• Identification of the patient, physician or health provider and credentials of the doctors.
• Types of transmissions allowed the use of telemedicine technologies (e.g., prescription refills, appointment scheduling, patient education, etc.).
• The patient agrees that the physician will determine if the condition to be diagnosed and/or treated, is suitable for a gathering of telemedicine.
• Details about the security measures taken to make use of telemedicine technologies such as data encryption, password-protected data files, or any other reliable authentication techniques as well as potential risks to privacy, notwithstanding these measures.
• The clause of denied responsibility for lost information due to technical failures.
• Express consent of the patient to transmit personally identifiable information to a third.

E – Continuity of care:

Patients should be able to browse, with relative ease, follow-up care or information. They are given by the physician or designee.
Medical service providers using telemedicine technologies without pre-existing physician-patient relationship before the meeting or health care providers should make the encounter documentation readily available to the patient and/or any other care provider identified and authorized by the patient.

F – Referrals to emergency services:

A contingency plan is required and must be provided by the physician to the patient when the care provided using telemedicine technologies indicates that a referral to an acute care unit is necessary for patient safety. The plan shall include appropriate formal protocol services that are being provided through telemedicine technologies.

G – Medical Records:

The records shall include, where applicable, copies of all electronic communications related to the patient, including the patient-physician communication, prescriptions, laboratory test results, evaluations and consultations, records of past care and instructions obtained or produced in connection with the use of telemedicine technologies.
Consents achieved concerning a meeting involving telemedicine technologies must also be filed in the medical record. The patient record established during the use of telemedicine technologies should be accessible and documented for both the doctor and the patient, following all laws and regulations enacted to regulate the patient’s health records.

H – Privacy, Security, and Exchange of patient information:

Defined in Privacy Policy of the site.

I – Features of Online Services offering Telemedicine Technologies:

The online service used by physicians who provide medical services using telemedicine technologies must clearly disclose:

• The particular services rendered.
• Contact info.
• Qualifications of doctors.
• Exchange services and how payment is made.
• Financial interests (except charges) in any information, products or services provided by a physician or healthcare provider.
• Terms of use and limitations of liability of the site, including emergency health situations.

Online services used by physicians who provide medical services using telemedicine technologies should provide a clear mechanism for patients:

• Supplement and amend personal health information from the patient.
• Provide opinion about the site and the quality of information and services.
• Registering complaints.

Online services must be accurate and transparent information about the owner or operator of the site, location and contact details, including a domain name that accurately reflects the identity. It prohibited the advertising or promotion of goods or products from which the physician receives direct remuneration, benefits or incentives (other than fees for medical services).
Nevertheless, online services may provide links to general health information sites to improve patient education; however, the physician should not benefit financially, by providing such links or the services or products marketed by those links. By providing links to other sites, physicians should be aware of the inherent information, services or products offered by sites such endorsement. It is forbidden to maintaining preferred relationships with any pharmacy. Doctors do not transmit prescriptions to a particular pharmacy or recommend a store in exchange for any compensation or benefit.

J – Prescription:

Technologies for telemedicine, where the prescription can be contemplated, shall implement measures to protect patient safety in the absence of traditional physical exam. Such measures should ensure that the identity of the patient and the healthcare provider is clearly established and detailed documentation for clinical and resulting prescription and implemented and maintained independently reviewed.
To further ensure patient safety in the absence of physical examination, telemedicine technologies should limit the use of medication forms to those that are considered safe. The statement, adequacy and security considerations for each prescription through telemedicine, should be evaluated by your doctor or health care provider, by current standards of practice and consequently adopt the same professional liability used in prescriptions delivered at a meeting in person.
However, where such measures are supported, and appropriate clinical consideration is performed and documented, physicians may exercise their judgment and prescribe medications as part of the care of telemedicine.

K – Parity of professional and ethical standards:

Physicians are encouraged to comply with nationally recognized standards for online health services and codes of ethics. There should be parity of ethical and professional applied to all aspects of medical practice patterns.
The professional judgment of a physician regarding diagnosis, comprehensiveness of care, or treatment should not be limited or influenced by non-clinical considerations of telemedicine technologies or their remuneration. Treatment recommendations should not be based on the delivery of material desired by the patient (a prescription or referral) results or expectations of the same.

L – Patient Rights

1. The patient has the right to receive information and discuss the benefits, risks, and costs of appropriate treatment alternatives. Patients also have the right to obtain copies or summaries of their medical records, have your questions answered, to be advised of potential conflicts of interest that may have their doctors and receive independent professional opinions.
2. The patient has the right to make decisions about health care recommended by the physician or healthcare provider. Thus, patients may accept or refuse any recommended treatment.
3. The patient has the right to courtesy, respect, dignity, responsiveness and timely attention to your needs. The patient has the right to confidentiality. The doctor or health care provider should not reveal confidential communications or information without the patient’s consent, except in cases provided by law or by the need to protect the welfare of the individual or the public interest.
4. The patient has the right to continuity of health care. The doctor or healthcare provider has an obligation to cooperate in the coordination of care with other providers of health care who treat the patient.
5. The patient has the fundamental right to receive the adequate medical care. The doctors, along with the entire society must continue to work toward that goal. Fulfillment of this right depends on a company that provides resources for no patient is deprived of necessary care for whatever reasons, being them political, social or economic ones.

This document is based:  Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.