Sebenzisa ulwazi nezinsizakalo ze-NEJM Group ukuze uzilungiselele ukuba udokotela, uqongelele ulwazi, uhole inhlangano yokunakekelwa kwezempilo futhi ukhuthaze ukuthuthukiswa komsebenzi wakho.
Ngesikhathi sobhubhane lwe-Covid-19, ukuthuthuka okusheshayo kwe-telemedicine kuphinde kwagxilisa ukunaka okusha engxoxweni mayelana nokunikezwa kwelayisensi yodokotela.Ngaphambi kwalolu bhubhane, izifundazwe ngokuvamile zazikhipha amalayisense odokotela ngokususelwa kunqubomgomo echazwe kuMthetho Wezokwelashwa Wesifundazwe ngasinye, owawubeka ukuthi odokotela kumele bathole amalayisense esifundazweni lapho isiguli sikhona.Kodokotela abafisa ukusebenzisa i-telemedicine ukwelapha iziguli ezingaphandle kombuso, le mfuneko ibadalela izithiyo ezinkulu zokuphatha nezezimali.
Ezigabeni zokuqala zobhubhane, izithiyo eziningi ezihlobene namalayisense zasuswa.Izifundazwe eziningi zikhiphe izitatimende zesikhashana eziqaphela amalayisense ezokwelapha angaphandle kwesifunda.1 Ezingeni likahulumeni, i-Medicare kanye ne-Medicaid Services ziye zahoxisa okwesikhashana izimfuneko ze-Medicare zokuthola ilayisense yomtholampilo endaweni yesiguli.2 Lezi zinguquko zesikhashana zenze ukunakekelwa okwatholwa iziguli eziningi nge-telemedicine ngesikhathi sodlame lwe-Covid-19.
Odokotela abathile, izazi, kanye nabenzi bezinqubomgomo bakholelwa ukuthi ukuthuthukiswa kwe-telemedicine kuyinhlansi yethemba ngalo bhubhane, futhi iCongress icubungula izikweletu eziningi zokukhuthaza ukusetshenziswa kwe-telemedicine.Sikholelwa ukuthi ukuguqulwa kwamalayisensi kuzoba ukhiye wokwandisa ukusetshenziswa kwalezi zinsizakalo.
Nakuba izifundazwe ziye zagcina ilungelo lokusebenzisa amalayisense ezokwelapha kusukela ngasekupheleni kweminyaka yawo-1800, ukuthuthukiswa kwezinhlelo zezempilo ezinkulu zikazwelonke nezesifunda kanye nokwanda kokusetshenziswa kwe-telemedicine kuye kwandisa ububanzi bemakethe yokunakekelwa kwezempilo ngale kwemingcele kazwelonke.Ngezinye izikhathi, izinhlelo ezisekelwe kuhulumeni azihambisani nomqondo ovamile.Sizwile izindaba mayelana neziguli ezishayele amamayela ambalwa ngaphesheya komugqa wombuso ukuze zibambe iqhaza ekuvakasheni kwe-telemedicine yokunakekelwa okuyisisekelo kusuka ezimotweni zazo.Lezi ziguli azikwazi ukubamba iqhaza ngesikhathi esifanayo ekhaya ngoba udokotela wazo akanalo ilayisensi endaweni ezihlala kuyo.
Sekuyisikhathi eside abantu bekhathazekile ngokuthi Ikhomishini Yelayisensi Yombuso inaka kakhulu ukuvikela amalungu ayo emiqhudelwaneni, kunokusebenzela izithakazelo zomphakathi.Ngo-2014, i-Federal Trade Commission yamangalela ngempumelelo i-North Carolina Board of Dental Inspectors, iphikisa ngokuthi ukwenqabela okungenangqondo kweKhomishini ngokumelene nodokotela abangewona amazinyo ekuhlinzekeni ngezinsizakalo zokuba mhlophe kwephula imithetho yokungathembeki.Kamuva, leli cala leNkantolo Ephakeme lafakwa eTexas ukuze inselele imithetho yelayisense evimbela ukusetshenziswa kwe-telemedicine esifundazweni.
Ukwengeza, uMthethosisekelo unikeza uhulumeni wobumbano kuqala, kuncike emithethweni yezwe ephazamisa ukuhwebelana kwamazwe.ICongress yenze okuhlukile kuhulumeni?Igunya elikhethekile lokulawula, ikakhulukazi ezinhlelweni zezempilo zikahulumeni.Isibonelo, uMthetho we-VA Mission ka-2018 udinga ukuthi izifundazwe zivumele odokotela abangaphandle kwezwe ukuthi baqeqeshe i-telemedicine ngaphakathi kohlelo lwe-Veterans Affairs (VA).Ukuthuthukiswa kwe-interstate telemedicine kunikeza elinye ithuba kuhulumeni wobumbano ukuthi angenelele.
Okungenani izinhlobo ezine zezinguquko ziye zahlongozwa noma zethulwa ukukhuthaza i-interstate telemedicine.Indlela yokuqala yakhela ohlelweni lwamanje lwezimvume zokwelashwa ezisekelwe kuhulumeni, kodwa yenza kube lula ukuthi odokotela bathole izimvume zangaphandle kwezwe.Isivumelwano selayisense yezokwelapha esiphakathi kwezifunda sasetshenziswa ngo-2017. Kuyisivumelwano phakathi kwezifunda ezingu-28 ne-Guam ukusheshisa inqubo evamile yodokotela abathola amalayisense ombuso wendabuko (bona imephu).Ngemuva kokukhokha imali ye-franchise engu-$700, odokotela bangathola amalayisense kwamanye amazwe abambe iqhaza, ngemali esukela ku-$75 e-Alabama noma eWisconsin iye ku-$790 eMaryland.Kusukela ngoMashi 2020, bangu-2,591 (0.4%) kuphela odokotela ezifundazweni ezibambe iqhaza abasebenzise inkontileka ukuthola ilayisense kwesinye isifunda.ICongress ingaphasisa umthetho wokukhuthaza amazwe asele ukuthi ajoyine inkontileka.Nakuba izinga lokusetshenziswa kwesistimu beliphansi, ukwandisa inkontileka kuzo zonke izifundazwe, ukunciphisa izindleko nemithwalo yokuphatha, nokukhangisa okungcono kungase kuholele ekungeneni okukhulu.
Enye inketho yenqubomgomo ukukhuthaza ukufana, lapho izifundazwe zibona ngokuzenzakalelayo amalayisensi angaphandle kwezwe.ICongress igunyaze odokotela abasebenza ohlelweni lwe-VA ukuze bathole izinzuzo ezifanayo, futhi phakathi nobhubhane, izifundazwe eziningi zisebenzisa izinqubomgomo zokubuyelana okwesikhashana.Ngo-2013, umthetho we-federal wahlongoza ukuthi kusetshenziswe unomphela ukuphindaphinda ohlelweni lwe-Medicare.3
Indlela yesithathu iwukwenza umuthi ngokusekelwe endaweni kadokotela kunendawo yesiguli.NgokoMthetho Wokugunyazwa Kwezokuvikela Kazwelonke wezi-2012, odokotela abahlinzeka ngokunakekelwa ngaphansi kwe-TriCare (Uhlelo Lwezempilo Lwezempi) badinga kuphela ukugunyazwa esifundazweni lapho behlala khona ngempela, futhi le nqubomgomo ivumela ukwelapha kwamazwe ngamazwe.Izigele u-Ted Cruz (R-TX) kanye no-Martha Blackburn (R-TN) basanda kwethula "Umthetho Wokufinyelela Ngokulinganayo Kumasevisi Ezokwelapha", ozosebenzisa le modeli okwesikhashana emisebenzini ye-telemedicine ezweni lonke.
Isu lokugcina -?Futhi isiphakamiso esinemininingwane eminingi phakathi kweziphakamiso ezixoxwe ngokucophelela - ilayisensi ye-federal practice izosetshenziswa.Ngo-2012, uSenator Tom Udall (D-NM) uhlongoze (kodwa awethulwanga ngokusemthethweni) umthethosivivinywa wokusungula inqubo yokukhipha amalayisense.Kule modeli, odokotela abanentshisekelo ekusebenzeni kwamazwe kufanele bafake isicelo selayisense yombuso ngaphezu kwelayisensi yezwe4.
Nakuba kukhanga ngokomqondo ukucabangela ilayisense yombuso eyodwa, inqubomgomo enjalo ingase ingasebenzi ngoba ishaya indiva umuzwa wezinhlelo zamalayisense ezisekelwe kuhulumeni ezingaphezu kwekhulu.Ikomidi liphinde libe neqhaza elibalulekile emisebenzini yokuqondiswa kwezigwegwe, lithathela izinkulungwane zodokotela izinyathelo unyaka ngamunye.5 Ukushintshela ohlelweni lwamalayisensi lukahulumeni kungase kubukele phansi amandla ombuso wokuqondisa izigwegwe.Ukwengeza, bobabili odokotela namabhodi ezokwelapha esifundazwe ahlinzeka ngokuyinhloko ukunakekelwa kobuso nobuso banentshisekelo yokugcina uhlelo lwamalayisense olusekelwe kuhulumeni ukuze kukhawulwe ukuncintisana kubahlinzeki abangaphandle kwezwe, futhi bangase bazame ukubukela phansi izinguquko ezinjalo.Ukunikeza amalayisense okunakekelwa kwezokwelapha ngokusekelwe endaweni kadokotela kuyisixazululo esihlakaniphile, kodwa futhi kubekela inselele uhlelo olunesikhathi eside olulawula ukusebenza kwezokwelapha.Ukushintsha isu elisekelwe endaweni nakho kungase kubangele izinselele ebhodini?Imisebenzi yokuqondiswa kwezigwegwe kanye nobubanzi.Ukuhlonipha izinguquko zikazwelonke Ngakho-ke, ukulawulwa kwezimvume zomlando kungase kube indlela engcono kakhulu eya phambili.
Ngesikhathi esifanayo, kubonakala kuyisu elingasebenzi ukulindela izifundazwe ukuthi zizithathele izinyathelo ngokwazo ukuze zandise izinketho zokuthola amalayisense angaphandle kwezwe.Phakathi kodokotela emazweni abambe iqhaza, ukusetshenziswa kwezinkontileka zamazwe ngamazwe kuphansi, okugqamisa ukuthi izithiyo zokuphatha nezezimali zingaqhubeka nokuvimbela i-interstate telemedicine.Uma kucatshangelwa ukumelana kwangaphakathi, mancane amathuba okuthi imibuso ishaye imithetho ehlala njalo yokubuyisana ngokwazo.
Mhlawumbe isu elithembisa kakhulu ukusebenzisa iziphathimandla zikahulumeni ukukhuthaza ukubuyisana.ICongress ingadinga imvume yokubuyisela esimweni solunye uhlelo lukahulumeni, i-Medicare, ngokusekelwe emthethweni wangaphambili olawula odokotela ohlelweni lwe-VA kanye ne-TriCare.Uma nje benelayisensi yezokwelapha evumelekile, bangavumela odokotela ukuthi banikeze izinsizakalo ze-telemedicine kubazuzi be-Medicare kunoma yisiphi isimo.Umgomo onjalo cishe uzosheshisa ukuphasiswa komthetho kazwelonke omayelana nokubuyisana, okuzophinde kuthinte iziguli ezisebenzisa ezinye izinhlobo zomshwalense.
Umqedazwe we-Covid-19 uphakamise imibuzo mayelana nokuba wusizo kohlaka lwamalayisensi olukhona, futhi sekucace kakhulu ukuthi izinhlelo ezithembele ku-telemedicine zifanelwe uhlelo olusha.Amamodeli angaba khona maningi, futhi izinga loshintsho elihilelekile lisukela ekwandeni kuya ekuhlukaniseni.Sikholelwa ukuthi ukusungula uhlelo olukhona lukazwelonke lokunikeza amalayisensi, kodwa ukukhuthaza ukucobelelana phakathi kwamazwe kuyindlela enengqondo kakhulu eya phambili.
Kusukela e-Harvard Medical School nase-Beth Israel Deaconess Medical Center (AM), nase-Tufts University School of Medicine (AN) -?Bobabili baseBoston;kanye neDuke University School of Law (BR) eDurham, North Carolina.
1. Inhlangano Yemikhandlu Kazwelonke Yezokwelapha.Izifundazwe nezindawo zase-US zibuyekeze izidingo zazo zelayisensi yodokotela ngokusekelwe ku-COVID-19.Februwari 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf).
2. Umshwalense wezokwelapha kanye nesikhungo senkonzo yosizo lwezokwelapha.Ingubo yesimemezelo esiphuthumayo se-COVID-19 yabahlinzeki bezempilo ikhululekile.Disemba 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. Umthetho we-TELE-MED 2013, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Abasekeli be-Norman J. Telemedicine benze imizamo emisha yomsebenzi wokunikeza ilayisense kadokotela emingceleni yombuso.E-New York: I-Federal Fund, Januwari 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. Inhlangano Yemikhandlu Yezokwelapha Kazwelonke.Amathrendi Nezenzo Zokulawula Kwezokwelapha zase-US, 2018. Disemba 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Isikhathi sokuthumela: Mar-01-2021