On June 20, 2019, the Haute Autorité de la Santé (French Health
Authority) published a best practice guide for the implementation and exercise
of teleconsultation and tele-expertise activities. These recommendations,
intended for professionals, are designed to support the operational deployment
of telemedicine in France.

They concern all acts of teleconsultation and tele-expertise, regardless of
their location (city, health establishments, social and medico-social
establishments, patients’ homes, etc.) and methods of implementation (private practice,
employee, etc.). Acts not eligible for reimbursement by the Health Insurance
are also addressed.

At the request of the French Ministry of Health, the HAS has published
several documents to facilitate the implementation of telemedicine by health professionals,
and to inform patients.

It should be recalled that telemedicine is a form of remote medical
practice through a device that uses information and communication technologies^[1]. Teleconsultation and
tele-expertise are two of the five acts of telemedicine defined in the French
Public Health Code. The purpose of teleconsultation is to allow a health
professional to carry out a remote consultation with a patient. The purpose of
tele-expertise is to enable a health professional to seek the opinion of one or
more health professionals remotely because of their particular training or
skills.

After having identified the eligibility criteria for these types of medical
acts^[2], the HAS has now adopted a
best practice guide for “the quality and safety of teleconsultation and
tele-expertise acts”.

This guide details the prerequisites for a secure implementation of
teleconsultation and tele-expertise activities. The HAS insists in particular
on knowledge of the regulations governing telemedicine and the establishment of
a specific organization, such as time slots devoted to the performance of this
type of medical acts. It also recalls the need to have specific IT tools for
the exchange, sharing and storage of data, including a secure health messaging
system and a sharing platform guaranteeing the confidentiality and security
conditions required for the processing of health data.

The HAS also describes the steps to be taken before performing these remote
medical acts, such as informing and collecting the patient’s consent and
verifying the relevance of these acts based on the patient’s situation and the
availability of the latter’s data.

With regard to the conduct of the acts, the HAS insists on the need to
identify the patient and know his/ her geolocation. The health professional
must authenticate himself/herself via a strong authentication process.

The recommendations specify that the health professional must record the
teleconsultation report in its own patient file, as well as in the patient’s
shared medical record, wherever it exists. The report, as well as any medical
prescriptions and other correspondence, are transmitted to the patient in a
secure manner. Where appropriate, the report shall be transmitted under the
same conditions to the primary care physician and other health professionals
designated by the patient and involved in his/her care pathway.

The HAS thus makes it possible to establish a common framework of best
practices for the implementation of teleconsultation and tele-expertise
activities. It should be remembered that these recommendations may be adapted
by professionals to take into account the specificities of their profession and
their medical field, the pathology and local conditions of care of their
patients.

Both healthcare professionals and providers of specialized platforms must
ensure that all requirements applicable to telemedicine are duly met. As with
face-to-face medical practice, telemedicine must comply with the legal and
regulatory provisions applicable to the conditions of practice as well as with
the rules of ethics and confidentiality and clinical practice standards.
Security and protection of personal health data must also be ensured through
information and communication technologies.

[1] Article L. 6313-1 of the
French Public Health Code 

[2] Cf. data sheet entitled “Qualité
et sécurité des actes de téléconsultation et de téléexpertise” published by
the HAS in April 2018.