Telemedicine Policy and Practice

Recommendations from Saudi Arabia’s Journey

Rana O Al-Khanbanshi

Rana O Al-Khanbanshi

More about Author

Rana O Alkhanbashi (Pharm.D, MHA) is an experienced Pharmacy Quality Coordinator, Certified Professional in Healthcare Quality (CPHQ), Lean Six Sigma practitioner and patient safety leader. She leads a Pharmacy Quality of Care and Patient Safety team that works to develop policies and implement plans to achieve the goals of the healthcare organisation in alignment with the Saudi Vision 2030.

The COVID-19 pandemic has positively influenced the uptake of telemedicine service provision, due to lockdowns, social distancing mandates and concern surrounding infection risks to healthcare practitioners (HCPs) and patients. Although the benefits of telemedicine have been proven in the recent shift to the ‘new normal’ post-COVID, there are significant barriers to adoption and successful implementation, such as HCP knowledge, skills, and attitudes, and health organisation administration clarity and communication of policy and procedures for telemedicine. We discuss some of these key issues in our article below.

Information and Communication Technology (ICT) has had a significant impact on the quality and safety of patient-centred healthcare delivery in diagnosis, management, and monitoring of communicable and non-communicable diseases. Modern technology has enabled HCPs to remotely monitor and record patient medical information, such as physiological vital signs, lab results, radiology images, and medication regimens. ICT plays a key role in re-engineering healthcare costs as well as reducing medical errors and patient complaints.

Patient-centred telemedicine platforms area potentially costeffective tool reducing travel expenses among both HCPs and patients, improving access to healthcare, and reducing disparities, particularly in resource-constrained medical departments and for rural and remote areas. Telemedicine technology increases service efficiency and patient satisfaction by reducing waiting times and ensuring HCPs are consulting with the right patient. Telemedicine has a remarkable impact on reductions of morbidity and mortality rates related to non-communicable diseases and improving health-related quality of life. Telemedicine technology helps to expand the scope of healthcare services in society from where it was previously treatment-focused to now increasingly incorporating elements of preventive healthcare, health education and promotion, and increasing opportunities for patients to take ownership of and collaborate with their providers in making their healthcare choices.

Several major regulatory, organisational, and technical barriers negatively impact the adoption of telemedicine technology. There is a lack of comprehensive policies and integrated regulatory frameworks to ensure the security, privacy, and confidentiality of electronically transmitted patient data. It is imperative to provide HCPs and patients with reassurance of the safety of their data. From that, even with some growing interest by HCPs in using the technology, there are concerns about using it appropriately and ethically, and a lack of visibility, clarity and understanding as to any existing policies and procedures for telemedicine implementation and use.

Another issue is the lack of robust information technology infrastructure, the quality and capacity of the internet, or intermittent coverage of wireless local area networks (WLANs) in rural and remote areas, along with electrical capabilities in healthcare facilities and the availability of necessary technical infrastructure. Furthermore, there is a shortage of experienced IT technicians and specialist health informaticians who can inform policy and decisionmakers, as well challenges in setting standards for quality in telemedicine practices, limited training opportunities, dedicated conferences, and symposia about advancesin telemedicine technology and how it impacts the HCP, care provision and the patient experience that can support the required upskilling and confidencebuilding of these capacities.

As it stands, HCPs may be reluctant to take up telemedicine, concerned with their lack of knowledge, experience and skills that would enable them to use the technology seamlessly and comfortably. Finally, consideration and respect must be incorporated for cultural and social factors that may affect successful telemedicine implementation, such as the social norms and expectations for doctor-patient interactions and the communication styles that are used during virtual consultations and in digital communications to avoid any confusion or misunderstanding.

These are all issues that enable a better understanding of the reasons for the as yet limited use of telemedicine technology and potentially areas we can work to more positively influence HCPs’ interest, attitudes and willingness to use telemedicine to provide care for patients and achieve the goals we have set out to achieve.

In Saudi Arabia (SA), rapid technological advances, and the ambitious National Health Transformation Program (NTP) are driving sweeping healthcare reforms towards the achievement of the Saudi Vision 2030. Several key initiatives, coupled with the imperatives imposedby the realities of operating a resilient healthcare system throughout the pandemic have facilitated the proliferation of telemedicine services throughout the country in recent years.

The earliest telemedicine system in SA was initiated in 1990 in collaboration with the Yale Telemedicine Center as a major source of consultations with physicians and follow-up with patients after face-to-face visits. In 2011, the first project for telemedicine, the Saudi Telemedicine Network (STN) was issued under the Ministry of Health (MOH) collaborated with Canada Health Infoway and the Ontario Telemedicine Network. The project aimed to provide recommendations for the development of a national telemedicine system. In 2013, the STN launched a list of standards in cooperation with King Faisal Specialist Hospital (KFSH) to provide exclusive, high-quality, tertiary telemedicine care services.

The National Health Information Center (NHIC) was established in 2016 as a national center for assessment and monitoring of healthcare technologies. The NHIC is using ICT to build and provide a network of health information to facilitate clinical care remotely, safely, and efficiently. The provision of telemedicine in the country is now expanding beyond merely data sharing and transferring information through video consultations, audio, picture, or text to support remote health service provision, it is now facilitating surveillance, education, and research as well. The NHIC published the Saudi Health Information Exchange (SeHE) policy in 2016 to monitor and evaluate the privacy and security of telemedicine services and their adherence to HIPAA regulations and guide the development of interoperability frameworks.

In 2017, King Fahd Medical City (KFMC) was launching diverse telemedicine services that met the STN standards, which resulted a key player in a high turnout telemedicine healthcare services for patients in all regions. Another significant initiative was the launch of the Saudi Patient Safety Center (SPSC) in 2017, which works to align healthcare regulators, payers, providers, patients, and communities to focus on patient safety with the goal of providing healthcare services that are free from harm, promoting a national culture of patient safety reporting, and awareness of safety issues. The Saudi Communications and Information Technology Commission (CITC) established a Cybersecurity Regulatory Framework (CRF) in 2019 to provide comprehensive cybersecurity regulations and privacy laws to safeguard patient data using ICT. CRF also maintains communications, information security, and confidentiality in compliance with the highest quality and security requirements, increasing the level of cybersecurity awareness in Saudi society.

Among the more recent initiatives is the National E-Health Strategy, with its strategic objectives to increase accessibility to healthcare services, improve service quality and promote preventive care of health risks via e-health technology. In 2019, the MOH established the National Healthcare Command Center (NHCC) as a central hub, to collect, visualise data and generate insights to drive the sustainability of health system operations using data-analytics, generating predictions and recommendations using a combination of artificial intelligence and human actions. Most recently in 2020, in response to the pressures of the COVID-19 pandemic, the MOH collaborated with NHIC to activate several transformative mobile applications that deliver high quality accessible healthcare services all over the country, such as Tawwakalna, Tabaud, Mawid, Sehhaty and many others that have achieved widespread international acclaim.

In 2022, the MOH launched the Seha Virtual Hospital, the first of its kind in the Middle East. A specialised hospital that utilizes the latest innovative technologies to provide 30 specialised services and support 130 hospitals nationally. The hospital employs the latest treatment technologies, such as virtual services for electroencephalogram (EEG) patients, virtual specialised clinics and medical support services for stroke patients, as well as critical care patients.

The COVID-19 pandemic has had a positive influence on the uptake of telemedicine service provision, due to lockdowns, social distancing mandates and concern surrounding infection risks to healthcare practitioners (HCPs) and patients. Although the benefits of telemedicine have been proven in the recent shift to the ‘new normal’ post-covid, there are significant barriers to adoption and successful implementation of telemedicine in practice, such as HCP knowledge, skills, and attitudes, and health organisation administration clarity and communication of policy and procedures for telemedicine.

The rapid developments in health technologies and implementation of telemedicine services must be underpinned with robust HCP capabilities to sustain them, encourage their uptake, and realise the improvements to outcomes for patients and providers according to our aspirations. Intense efforts must be put forward to orient and train HCPs on policies and procedures for telemedicine technology and its applications in practice. This training must be well-designed and developed in line with the advancements in the knowledge, science and evidence-base for telemedicine, and in alignment with HCP educational and professional competencies, as well as technological literacy and device access. The evaluation of training programme  outcomes needs to be built-in and reviewed frequently to keep pace with the developments. Telemedicine policies must be updated regularly and be readily available on hospital intranet systems, and should ensure to address HCP concerns on security, privacy and other legal and ethical aspects.


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