Quyết định 2628/QD-BYT

DECISION

APPROVING SCHEME FOR REMOTE MEDICAL EXAMINATION AND TREATMENT FOR 2020 - 2025

MINISTER OF HEALTH

Pursuant to the Law on Medical Examination and Treatment dated November 23, 2009;

Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 on functions, duties, powers and organizational structure of the Ministry of Health;  

Pursuant to the Prime Minister’s Decision No. 749/QD-TTg dated June 03, 2020 introducing program for national digital transformation by 2025 with orientations towards 2030;

Pursuant to the Circular No. 49/2017/TT-BYT dated December 28, 2017 by the Minister of Health on telemedicine;

At the request of the Head of the Department of Medical Services Administration and Head of the Department of Planning and Finance, Ministry of Health.

HEREBY DECIDES:

Article 1. Promulgated together with this Decision is the scheme for remote medical examination and treatment for 2020 – 2025 (hereinafter referred to as “the Scheme”).

Article 2. This Decision takes effect from the date on which it is signed.

Article 3. Chief of the Ministry Office, Heads of the Department of Medical Services Administration, Administration of Science, Technology and Training, Department of Organization and Personnel, Department of Planning and Finance and Department of Health Insurance; Directors of Departments of Health, Directors of hospitals participating in the scheme for remote medical examination and treatment and heads of relevant units shall implement this Decision./.

SCHEME FOR REMOTE MEDICAL EXAMINATION AND TREATMENT FOR 2020-2025

(Enclosed with Decision No. … /QD-BYT dated …, 2020 by Minister of Health approving scheme for remote medical examination and treatment)

Part 1.

SCHEME BACKGROUND

I. NECESSITY OF SCHEME

Recently, there have been many great achievements in the healthcare sector in general and the medical examination and treatment system in particular. Hospital facilities and equipment are further enhanced and many advanced medical technologies and techniques are applied to medical examination and treatment. Access to healthcare services has been improved with more critically ill patients saved compared to the past, where no treatment was available or overseas treatment was the only choice.

However, besides these feats, our medical examination and treatment system still faces many difficulties and challenges: double disease burden (communicable and non-communicable diseases); increase in healthcare investment is yet to meet demand; ratio of beds per 1,000 citizens is lower than that of other countries in the region, healthcare workforce is distributed unevenly, with most high-skilled officials practicing in developed societies, economic zones and cities while there is a shortage of healthcare workers in many localities; many advanced medical techniques have been applied but not evenly, mostly in large cities and central-level hospitals.

Healthcare quality at low levels of care and in remote and isolated areas is far behind that in developed economic zones, people have limited access to high quality medical services, leading to inequality in healthcare and people losing trust in the quality of medical services at low levels of care. Non-referral use of medical services is quite common with many people visiting central-level healthcare establishments for examination and treatment of diseases that could be effectively treated at provincial or district level, resulting in overload in hospitals providing high levels of care (hereinafter referred to as “high-level hospitals”), especially central-level hospitals.

To respond to the abovementioned difficulties and challenges, in the past few years, the Ministry of Health has introduced many solutions to enhance healthcare capacity of low levels of care via further directing healthcare establishment providing low levels of care, provision of professional guidelines and assistance, technique transfer and official rotation according to Scheme No. 1816 of the Ministry of Health and the Government’s schemes. Facilities and equipment of many  provincial-level hospitals and most district-level have been upgraded according to Scheme No. 225, Scheme No. 47 and Scheme No. 930 of the Government. However, these hospitals still lack qualified officials who can utilize the upgraded facilities and equipment.

Since 2005, the Ministry of Health has piloted the satellite hospital scheme with a focus on surgery and internal medicine. The scheme aims to enhance the capacity for medical examination and treatment of a number of satellite hospitals of Bach Mai Hospital and Viet Duc University Hospital and mostly involves training, technique transfer, provision of  medical equipment and telemedicine. In 2013, the Prime Minister promulgated Decision No. 92/QD-TTg approving scheme for hospital overload alleviation for 2013 - 2020. The scheme prioritized establishment of a satellite hospital network for 5 departments: oncology, surgery - traumatology, cardiology, obstetrics and pediatrics, which includes enhancement of medical examination and treatment capacity of satellite hospitals via healthcare official training and transfer of techniques and technologies to satellite hospitals; and remote medical examination and treatment consultation between nucleus hospitals and satellite hospitals via information technology systems.

Implementation of both the satellite hospital model and scheme for hospital overload alleviation according to Decision No. 92/TTg yields very good results, with many medical techniques and technologies delivered to the satellite hospitals and medical examination and treatment capacity enhanced. As proven by reality, the satellite hospital model is a way to associate hospitals providing low levels of care (hereinafter referred to as “low-level hospitals”) with the brands of high-level hospitals, promote training and technique transfer from high-level hospitals to low-level hospitals and support low-level hospitals in utilization of upgraded facilities.

During the war against COVID-19, the Prime Minister and National Steering Committee for COVID-19 Prevention and Control gave directions for social distancing, limiting number of patients visiting healthcare establishments; enhancement of medical examination and treatment at low levels of care, and avoiding transferring treatable patients to a higher level of care. These activities needed to be supported by remote medical examination and treatment.

In the war against COVID-19, the Ministry of Health applied information technology (IT) to hold remote treatment consultations very effectively. The National Steering Committee established Vietnam Telemedicine Center for COVID-19 Outbreak Control. The center frequently holds online consultations with the participation of leading professors across the country to give advice on critical cases, discuss optimal treatments and share experience in patient treatment and care. Therefore, IT application has assembled leading experts and hospitals as if there were no distance between the North and the South or high and low levels of care.

Such online consultations greatly contributed to the treatment of COVID-19 patients; as of June 15, 2020, there is no casualty. Establishment of Vietnam Telemedicine Center for COVID-19 Outbreak Control marked the development of the medical examination and treatment system following integration trends and application of scientific - technological advancements in treatment, especially for dangerous infectious diseases such as COVID-19.

On June 03, 2020, the Prime Minister signed Decision No. 749/QD-TTg introducing program for national digital transformation by 2025 with orientations towards 2030. The program outlines the vision towards 2030: “Vietnam becomes a prosperous digital country that pioneers trying out new technologies and models; has completed fundamental and comprehensive reforms in Governmental operation, economic activities of enterprises and the way people live and work, and has established a safe, civilized and widespread digital environment.”

The Prime Minister also identified prioritized fields in digital transformation such as healthcare, education, finance - banking, agriculture, etc. Healthcare is one of the most prioritized fields with main activities such as: “Develop telemedicine platforms to provide remote medical services to people, reduce in-patient visits, prevent mass gatherings and reduce risks of cross-infection; ensure that 100% of healthcare establishments have a telemedicine unit; facilitate digital transformation in the healthcare sector”.

Therefore, it is necessary and urgent that a scheme for remote medical examination and treatment be formulated and promulgated as Vietnam aims to become a digital country by 2030 and a stable and prosperous digital country in the future.

II. DEFINITIONS

In the Scheme, the terms below are construed as follows:

1. “remote medical examination and treatment center/unit affiliated to a high-level hospital (the core being centers providing training and directions for the level of care)" refers to a capable unit affiliated to a high-level hospital assigned the tasks of establishment and development of a remote medical examination and treatment network and remote examination and treatment coordination.

2. “remote medical examination and treatment department/unit affiliated to a low-level hospital" means a unit affiliated to a provincial- or district-level hospital or a private hospital that is engaged in remote medical examination and treatment.

3. “remote medical examination and treatment" encompasses remote medical advising; remote medical examination and treatment consultations; remote imaging consultations; remote consultations for paraclinical tests and anatomic pathology; remote surgery consultations; and other activities.

III. LEGAL GROUNDS FOR SCHEME FORMULATION

- Law on Medical Examination and Treatment dated November 23, 2009.

- Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 on functions, duties, powers and organizational structure of the Ministry of Health.

- Government’s Decree No. 109/2016/ND-CP dated July 01, 2016 on issuance of practice certificates to healthcare practitioners and operation licenses to healthcare facilities.

- Prime Minister’s Decision No. 749/QD-TTg dated June 03, 2020 introducing program for national digital transformation by 2025 with orientations towards 2030.

- Circular No. 49/2017/TT-BYT dated December 28, 2017 by the Minister of Health on telemedicine.

- Circular No. 22/2013/TT-BYT dated August 09, 2013 on continuous training in health sector.

Part 2.

SCHEME OBJECTIVES AND SCOPE

I. MAIN VIEWPOINTS

The main viewpoint for formulation of the Scheme is “examination and treatment quality reaching higher and farther”. This message shall encourage low-level hospitals to enhance their professional capacity to “reach higher” and high-level hospitals to share their professional knowledge to reach “farther” to people in all corners of the Fatherland.

II. GENERAL OBJECTIVES

All citizens are managed and receive advice, medical services and professional assistance from doctors from commune level to central level; people have access to quality healthcare services of higher levels of care at a low level of care. Healthcare establishments receive periodic and ad hoc professional assistance from tertiary hospitals via IT platforms; contributing to control of infectious diseases, high-level hospital overload alleviation, enhancement of medical examination and treatment quality and efficiency, and raise people’s satisfaction.

III. SPECIFIC OBJECTIVES

1. Establish and develop a network of high-level hospitals, which shall consist of tertiary hospitals and provincial-level hospitals qualified in terms of professional capacity and equipment, to support low-level hospitals with remote medical examination and treatment.

2. Establish and develop a network of low-level hospitals, which shall consist of some provincial-level hospitals, district-level hospitals and private hospitals, to carry out remote medical examination and treatment.

3. Adopt social distancing measures to fight against infectious diseases, avoid crowding hospitals and reduce number of visitors to healthcare establishments.

4. Promote access to quality healthcare services for people living in rural areas, especially those living in remote and isolated areas and areas with socio-economic difficulties.

5. Reduce costs of medical examination and treatment, health insurance reimbursements and people’s out-of-pocket expenses.

IV. MAIN ACTIVITIES

1. Remote healthcare advising (tele-health): establish and maintain remote medical examination and treatment units of hospitals; give doctor’s advice to people remotely, including Vietnamese and foreign doctors.

2. Remote medical examination and treatment consultation: hold consultations between high-level hospitals/low-level hospitals and district- and commune-level clinics, hospitals and medical centers.

3. Remote imaging consultation: images obtained from medical imaging at one location are sent to an imaging specialist at another location for fastest advice on the patient’s conditions.  

4. Remote consultations in hematology, blood transfusion, microbiology, biochemistry, immunology and anatomic pathology. Remote consultations in laboratory tests and anatomic pathology allow doctors and specialists to exchange information, share results, patient’s conditions, etc. for the purposes of diagnosis, treatment, research and training.

5. Remote surgery consultation: remote surgeries can adopt new technologies such as robot and be equipped with smart operating rooms that enable integration of information from smart terminal devices.

6. Technique transfer and training: develop programs for cooperation in training and technique transfer, enabling patients to access good services and techniques of healthcare establishments.

7. Use of smart handheld electronic devices in some healthcare services such as:

- Remote cardiology solutions, which provide systems for archiving and remote diagnosis of cardiovascular issues; especially an ECG signal archiving and transmission system, as well as data analysis tools that enable remote viewing by specialists.

8. Communicating about and encouraging people to use remote medical services.

9. Formulation of guidelines for remote medical examination and treatment, including professional guidelines and standards for consulting clinics and relevant technological standards, ensuring connection for remote medical examination and treatment.

V. SCOPE OF SCHEME

1. Professional scope: investment shall focus on departments with remote medical service users, especially overloaded departments based on statistics on disease burden such as cardiology, surgery, obstetrics, pediatrics, infectious diseases, oncology, hematology and blood transfusion, non-communicable diseases and other diseases in the community that affect people’s health.

2. Implementation phasing:

a) 2020-2021 phase: prioritize investment in the following departments: cardiology, surgery, obstetrics, pediatrics, infectious diseases, oncology, hematology and blood transfusion, non-communicable diseases, etc. Plan to invest in high-level hospitals and at least 400 low-level hospitals, including provincial- and district-level hospitals and private hospitals.

b) 2021-2025 phase: continue to invest in high-level hospitals having departments such as intensive care unit, respiratory, urology, neurology, endocrinology, dermatology, odonto – stomatology, etc. and other departments if needed. Low-level hospitals shall be expanded in proportion to departments and number of high-level hospitals.

c) Post-2025 phase: evaluate implementation of the Scheme, continue to uphold the achievements of the 2020-2025 phase and consider extending the Scheme based on actual demand.

Part 3.

SCHEME ACTIVITIES

A. ESTABLISHMENT OF LOW- AND HIGH-LEVEL HOSPITALS NETWORK

I. NETWORK OF HIGH-LEVEL HOSPITALS DESIGNATED BY MINISTRY OF HEALTH

High-level hospitals affiliated to the Ministry of Health include:

1. Bach Mai Hospital

2. Viet Duc University Hospital

3. Hue Central Hospital

4. Cho Ray Hospital

5. National Hospital of Obstetrics and Gynecology

6. National Hospital of Pediatrics

7. National Hospital of Tropical Diseases

8. Vietnam National Cancer Hospital

9. E Hospital

10. National Institute of Hematology and Blood Transfusion

11. National Hospital of Endocrinology

12. National Otorhinorarynology Hospital

13. Thai Nguyen National Hospital

14. Can Tho Central General Hospital

15. National Hospital of Odonto - Stomatology, Hanoi

16. National Hospital of Odonto - Stomatology, Ho Chi Minh City

17. Hanoi Medical University Hospital

18. University Medical Center Ho Chi Minh City

High-level hospitals of Hanoi and Ho Chi Minh City include:

19. Saint Paul Hospital, Hanoi

20. Hanoi Oncology Hospital

21. Ho Chi Minh City Oncology Hospital

22. Tu Du Hospital, Ho Chi Minh City

23. Children’s Hospital 1, Ho Chi Minh City

24. Hospital of Tropical Diseases, Ho Chi Minh City

II. CRITERIA FOR SELECTION OF LOW-LEVEL HOSPITALS

A low-level hospital may be selected if it meets the following criteria:

1. Has an operating license in accordance with regulations of the Law on Medical Examination and Treatment.

2. Is capable of performing high techniques and specialized techniques.

3. Meets requirements in terms of facilities, equipment, workforce and professional capacity; and has potential for development of the selected department(s).

4. Has high referral rate.

5. Leaders of the People's Committee and Department of Health of the province where the hospital is located and the hospital are committed to participating in the Scheme.

6. For private hospitals: the hospital’s leaders and investor are committed to participating in the Scheme.

7. Fulfills other criteria required of the selected department(s) at low levels.

Other high-level hospitals shall join the network gradually and based on actual demand. Public and non-public hospitals are encouraged to participate in the Scheme in a voluntary manner.

B. PRINCIPLES AND MECHANISMS FOR ASSISTANCE AND GUIDANCE

High-level hospitals shall provide professional guidance and assistance for medical examination and treatment for low-level hospitals or hospitals at the same level on the basis of the connection between hospitals or between hospital - doctor and patient and with the following methods and principles:

I. HIGH-LEVEL HOSPITALS ASSISTING LOW-LEVEL HOSPITALS

1. Central-level hospitals assisting provincial-level hospitals

Depending on actual demand and capacity, provincial-level hospitals draw up lists of departments needing assistance from hospitals providing higher level of care. Central-level hospitals connect with and provide professional assistance for one provincial-level hospital or more.

2. Central-level hospitals cooperating with provincial-level hospitals in assisting district-level hospitals

High-level hospitals cooperate with each other to provide remote professional assistance for medical examination and treatment and connect with district-level hospitals via digital platforms. A qualified district-level hospital will receive direct assistance from a central-level hospital and a provincial-level hospital concurrently, enabling the district-level hospital to improve its examination and treatment quality and people to access healthcare services with good professional quality at district level.

3. Provincial-level hospitals assisting district-level hospitals

A provincial-level general or specialized hospital connects with and provides assistance and advice for a district-level hospital based on the district-level hospital’s schedule for examination and treatment at its premises or at patient’s home. People receiving care at grassroots level are examined and treated with remote assistance from provincial-level doctors and do not need to travel far.

II. DOCTORS AT HIGH LEVELS ASSISTING DOCTORS AT LOW LEVELS

1. One doctor providing high level of care assisting multiple doctors providing low levels of care

To ensure quality of remote medical examination and treatment assistance and advising and based on demand from doctors providing low levels of care (hereinafter referred to as “low-level doctors”), one doctor providing high level of care (hereinafter referred to as “high-level doctor”) may apply for provision of assistance and guidance to 10 low-level doctors in a period of time (e.g., 6 months or 1 year). These low-level doctors shall include 4 provincial-level doctors, 4 district-level doctors and 2 commune-level doctors. At the end of each period, the high-level doctor shall evaluate each low-level doctor’s professional capacity, diligence and ability to meet demand. In case a low-level doctor is evaluated as not suitable for the following assistance period or as no longer needing assistance, the high-level doctor may find a replacement.

2. Multiple high-level doctors assisting one low-level doctor

Depending on scope of practice, professional capacity and examination and treatment demand from the hospital and people, one low-level doctor may apply for assistance and guidance from multiple high-level doctors.

C. SPECIFIC ACTIVITES AND SOLUTIONS

I. INFRASTRUCTURE AND EQUIPMENT UPGRADE

1. High-level hospitals

a) Survey infrastructure, equipment, etc. of low-level units to determine necessary upgrade.

b) Advise on investment in building and upgrade of essential equipment, infrastructure, etc. for remote medical examination and treatment of departments of low-level hospitals.

2. Low-level hospitals

a) Cooperate with high-level hospitals in surveying infrastructure, equipment, etc. to determine necessary upgrade for remote medical examination and treatment.

b) Invest in infrastructure building and upgrade and essential equipment provision for their departments.

II. DEVELOPMENT OF INFORMATION TECHNOLOGY APPLICATIONS FOR REMOTE EXAMINATION AND TREATMENT

1. Development of applications for online consultation

Telecommunications and IT corporations and enterprises shall cooperate with hospitals in developing IT applications for online consultations and online conversations that are uniquely Vietnamese, ensure cyber safety and security and are developed based on advanced digital technology platforms.

2. Development and use of applications for smart handheld electronic devices

Develop and launch applications for smart handheld electronic devices that allow conversations, exchange of images and meetings between multiple people on smart terminal devices. These applications shall enable doctors to exchange, store and share professional files with each other before meetings as well as enable their users to read news, set up examination and testing appointments, ask questions and receive answers, look up examination and treatment history, have audio/video conversations with doctors, photograph and send relevant documents, receive advice on disease prevention, diets, physical exercise, etc. every day.

3. Development and use of smart medical devices

Develop and use medical devices for patients connected with smart electronic devices for remote examination and diagnosis. People or family doctors/village healthcare workers may use medical devices to measure, test, monitor, etc. people’s health conditions at home. Medical parameters are sent to in-charge doctors at hospital.

III. TECHNOLOGY APPLICATION IN ADVISING

1. High-level hospitals

Adopt specialized solutions that enable remote medical examination and treatment using electronic health records and real-time vital signs with all necessary patient’s data sent to high-level doctors, who can then advise low-level hospitals.

2. Low-level hospitals

Build systems of medical technological devices to connect with IT systems and transmit real-time clinical and paraclinical data of patients to higher levels. Establish electronic health records systems to share real-time data with other hospitals participating in the Scheme.

IV. TECHNOLOGY APPLICATION IN MEDICAL EXAMINATION AND TREATMENT

1. Establishment and maintenance of remote advising, examination and treatment bodies

a) High-level hospitals

Establish and maintain remote examination and treatment bodies such as remote examination and treatment units and centers. Assign personnel to call centers supporting people with medical examination and treatment, especially upon epidemics or adverse weather conditions or acts of god, as well as providing advice for lower levels.

b) Low-level hospitals

Based on each hospital’s size and people’s demand, each low-level hospital shall establish and maintain a remote examination and treatment body to provide support and advice for people as well as receiving advice from high-level hospitals.

2. Medical examination and treatment consultation

a) High-level hospitals

High-level hospitals shall hold periodic and emergency consultations with departments of low-level hospitals approved by the Ministry of Health. Assign capable doctors and highly skilled experts holding practice certificates appropriate for examination and treatment consultation.

b) Low-level hospitals

Establish electronic health records systems replacing existing physical health records to quickly perform tasks concerning test, ultrasound, endoscopy and ECG results, prescription drugs, treatments, clinical summaries, etc. in accordance with Circular No. 46/2018/QD-BYT.

Establish specialized systems for centralized image and data transmission to higher levels, which allow for direct discussions with doctors of high-level hospitals.

3. Remote imaging consultation

PACS (Picture archiving and communication system) is a system for archiving and transmission of medical images. PACS data is shared between hospitals at the same level and at different levels of care.

a) High-level hospitals

Establish a system for accessing and reconstructing saved images in different formats, providing maximum support for consultations with and provision of assistance for low-level hospitals.

Establish a system for direct seminars with low-level hospitals for the purposes of consultation and assistance.

b) Low-level hospitals

Adopt solutions concerning software and hardware combination for receipt, archiving, display and transfer of X-Ray, CT, MRI, ultrasound, endoscopy, ECG and EEG images and other types of images by DICOM standard.

Establish a system for accessing and reconstructing saved images in different formats, providing maximum support for remote consultations.

4. Remote consultations in hematology, blood transfusion, microbiology, biochemistry, immunology and anatomic pathology

a) High-level hospitals

Adopt specialized solutions that enable direct real-time conversations with low-level doctors and image and data connection and viewing, from which, high-level doctors and experts can remotely assist with diagnosis of test results, tissue samples and biopsy results, and view specimens (blood, marrow fluid, histochemical staining, etc.) and cells for low-level hospitals.

b) Low-level hospitals

Establish specialized systems for archiving of images, data on tests, data on tissue samples, cells, etc.

Establish specialized systems for real-time transmission of images, data on tests, specimen images and data on tissues and cells (Real-time Telepathology Imaging System - RTIS) to higher levels, which allow for direct discussions with high-level doctors.

5. Surgery consultations

With the advent of 5G internet, remote surgery consultation can proceed without any delay in image (video) transmission and remote specialized device control, ensuring actions are carried out almost in real surgery time and bridging the spatial distance between the surgeon and the consultant. Patient's data is transmitted in real time for provision of timely and accurate advice.

a) High-level hospitals

Adopt specialized solutions that enable direct real-time conversations with low-level doctors and the surgery’s image and patient’s data connection and viewing, from which, high-level doctors and experts can remotely assist low-level hospitals.

b) Low-level hospitals

Use smart trolleys in operating rooms and specialized devices that enable transmission of patient’s images and data to higher levels for direct discussions with high-level doctors.

c) Smart operating rooms

High-level hospitals and low-level hospitals shall evaluate their current situations to build smart operating rooms that allow for detailed information monitoring via smart terminal devices. Smart operating rooms equipped with smart control systems for functions such as temperature, lighting, music, etc. will help surgeons feel relaxed and rest assured, which will improve surgery quality.

6. Training

a) High-level hospitals

- Conduct surveys, evaluate capacity, qualifications, training demand, organizational structure and workforce of relevant departments of low-level hospitals to formulate training plans and advise on organizational structure revision of low-level hospitals.

- Training contents:

+ Professional knowledge of the following departments of low-level hospitals: cardiology, surgery - traumatology, obstetrics and pediatrics, infectious diseases, oncology, etc.

+ Professional knowledge of supporting fields: anesthesia, surgical intensive care, medical imaging, endoscopy, hematology, blood transfusion, biochemistry, microbiology, immunology, anatomic pathology - cell biology, and other relevant fields;

+ Skills in hospital management, planning, teaching, etc.

- Material compilation and printing:

+ Formulate and standardize continuous training contents and programs concerning the fields involved in the Scheme;

+ Formulate, complete and apply diagnosis and treatment guidelines and technical procedures concerning the fields involved in the Scheme;

+ Ensure that diagnosis and treatment guidelines, technical procedures, and training programs and documents are approved by the Minister of Health before they are applied in a consistent manner in healthcare establishments.

- Organize theoretical and practical training in low-level hospitals and high-level hospitals with the trainees being doctors, technicians and healthcare workers of low-level hospitals who will receive transferred techniques.

b) Low-level hospitals

- Assign sufficient healthcare workers and officials to participate in training courses conducted by high-level hospitals to ensure efficient receipt of transferred techniques.

- Revise their organizational structure as advised by high-level hospitals.

- Offer suitable benefits to motivate their officials and workers to participate in training courses and receive transferred techniques.

c) E - learning center (assigned to the center for enhancement of medical examination and treatment capacity and Vietnam Telemedicine Center for COVID-19 Outbreak Control after the COVID-19 pandemic ends)

- Systematize teaching documents uploaded to the e-learning system.

- Establish a system for access authorization with open access and access upon request.

- Learning forms include self-learning, group learning via discussion forums or other forms of e-learning.

- Monitor learner’s learning progress and results.

- Create a system for learner interactions to enable learners to exchange knowledge, have discussions and learn from each other.

- Organize training sessions for professional capacity enhancement in operating rooms fully furnished with modern equipment of European standards via live television.

V. POLICY AND MECHANISM COMPLETION

1. Formulate and amend legislative documents and regulations on remote medical examination and treatment.

2. Formulate detailed guidelines for price of remote medical services and health insurance coverage.

3. Develop regulations on funding for implementation of the Scheme.

4. Formulate and complete regulations on classification and direction of levels of care, referral, technique transfer and remote medical examination and treatment via IT systems (telemedicine).

VI. COMMUNICATIONS ABOUT HEALTH ADVICE

1. Boost communications about proactive disease prevention measures for all people with the motto “Sức khỏe cho mọi người - Health for all”. Focus on communications and advice about measures against communicable and non-communicable diseases such as cardiovascular diseases, tumors, trauma via IT systems (tele-medicine).

2. Promote medical service provision capacity of low-level hospitals and persuade people to use medical services at the correct level of care according to regulations of the Ministry of Health.

VII. MANAGEMENT AND SUPERVISION

1. Develop supervision and evaluation criteria and tools to determine products and outcomes of the Scheme from each relevant department;

2. Annually inspect, evaluate, summarize, obtain new experience from and revise the Scheme’s activities, and develop the remote medical examination and treatment model.

Part 4.

SCHEME FUNDING

I. FUNDING ESTIMATE FOR 2020-2025 SCHEME IMPLEMENTATION

1. For high-level hospitals

a) Costs of equipment for telemedicine systems, which shall be covered by funding allocated to high-level hospitals affiliated to the Ministry of Health for implementation of the 2016-2020 satellite hospital scheme;

b) Funding for other activities such as connection establishment, remuneration for workforce, specialists, etc. contributing to achievement of the Scheme’s objectives.

2. For low-level hospitals

a) Costs of medical and IT infrastructure upgrade and equipment procurement;

b) Funding for other activities in low-level hospitals contributing to achievement of the Scheme’s objectives.

II. FUNDING SOURCES

The Scheme is funded by state budget, ODA and other legal funding sources.

1. Ministry of Health shall fund remote examination and treatment projects of high-level hospitals affiliated to the Ministry of Health according to regulations in the Law on State Budget and other regulations.

2. Projects of high-level hospitals affiliated to Department of Health of Hanoi and Department of Health of Ho Chi Minh City shall be funded by dedicated additional funding allocated from central government budget to government budgets of Hanoi and Ho Chi Minh City or by government budgets of Hanoi and Ho Chi Minh City according to regulations in the Law on State Budget.

3. People’s Committees of provinces and central-affiliated cities shall allocate funding from local government budgets and other legal funding sources for low-level hospitals to implement the Scheme.

4. Private hospitals shall invest in their own facilities and equipment and contribute funding to high-level hospitals.

Part 5.

IMPLEMENTATION

I. DEPARTMENTS AFFILIATED TO MINISTRY OF HEALTH

1. Department of Medical Services Administration shall:

a) Act as the standing contact point to assist the Minister of Health with directing implementation of the Scheme;

b) Act as the contact point for cooperation with relevant regulatory bodies and units in formulating a detailed 2020-2025 plan and annual plans for implementation of the Scheme. Report to the Minister for consideration and approval and organize approved activities intra vires; inspect, monitor and evaluate progress of the Scheme; submit semi-annual, annual and ad hoc reports to the Minister of Health for timely resolution of difficulties arising during Scheme implementation;

c) Provide directions and guidelines for project formulation (plans, cost estimate, etc.) by high-level and low-level hospitals;

d) Act as the contact point for consolidation and cooperation with the Department of Planning and Finance, Electronic Health Administration and relevant units in appraising projects of high-level hospitals affiliated to the Ministry of Health and propose these projects to the Minister of Health for approval;

e) Formulate and propose legislative documents, professional regulations and technical procedures related to activities of the Scheme to competent authorities for promulgation;

2. Department of Planning and Finance shall:

- Take charge and cooperate with Department of Medical Services Administration in consolidating and allocating funding and providing guidelines for the Scheme’s finance as per the law;

- Cooperate with Electronic Health Administration in determining price of remote medical services to provide grounds for out-of-pocket expenses and health insurance reimbursement. Facilitate reimbursement of costs of cross-hospital consultations.

3. Department of Health Insurance shall:

Take charge and cooperate with Vietnam Social Security and relevant departments in formulating regulations on reimbursement of remote medical services at low-level and high-level hospitals covered by health insurance; and propose these regulations to the Minister of Health for approval.

4. Administration of Science Technology and Training shall:

Take charge and cooperate with Department of Medical Services Administration and relevant units in developing and appraising Scheme-related continuous training and formal training programs and documents.

5. Electronic Health Administration shall:

a) Take charge and cooperate with Department of Medical Services Administration and relevant units in directing tasks of IT application for implementation of the Scheme. Act as the contact point for formulating economic-technical norms for determination of price of remote medical services;

b) Take charge and cooperate with Vietnam Social Security and Department of Medical Services Administration in connecting the individual health records systems with the remote medical examination and treatment system.

6. Department of Medical Equipment and Health Works shall:

Take charge and cooperate with Department of Medical Services Administration in proposing investment in medical devices and facilities for low-level hospitals and high-level hospitals to meet the Scheme’s requirements.

7. Department of Communications, Emulation and Commendation shall:

Cooperate with Department of Medical Services Administration, National Center for Health Communication and Education, Suc khoe va Doi Song Newspaper and relevant units in performing communications, emulation and commendation tasks of the Scheme.

II. HIGH-LEVEL HOSPITALS

A high-level hospital shall:

1. Based on contents of the Scheme, high-level hospitals shall draw up lists of low-level hospitals for each phase, cooperate with low-level hospitals in evaluating professional capacity and formulating their own projects, propose the projects to the Ministry of Health for approval and launch the approved projects effectively.

2. Actively improve their quality based on the criteria for hospital quality and act as models for low-level hospitals.

3. Submit all required reports and perform other tasks of the Scheme.

III. DEPARTMENT OF HEALTH OF HANOI, DEPARTMENT OF HEALTH OF HO CHI MINH CITY AND OTHER DEPARTMENTS OF HEALTH HAVING HIGH-LEVEL HOSPITALS

Department of Health of Hanoi, Department of Health of Ho Chi Minh City and other Departments of Health having high-level hospitals shall:

1. Provide directions and guidelines for each high-level hospital under their management to formulate its project according to the Scheme.

2. Consolidate and appraise projects of their affiliated high-level hospitals; propose the projects to Chairpersons of the People’s Committees of the central-affiliated cities/provinces where they are located for approval; and direct their affiliated hospitals to launch the approved projects actively.

IV. DEPARTMENTS OF HEALTH HAVING LOW-LEVEL HOSPITALS

A Department of Health having a low-level hospital shall:

1. Based on the Scheme, cooperate with high-level hospitals in formulating its own project; propose the project to the Chairperson of the People’s Committee of the central-affiliated city/province where it is located for approval, and ensure workforce and reciprocal funding for project launching.

2. Send a written request for approval of list of participants in its remote medical examination and treatment scheme to the Ministry of Health (Department of Medical Services Administration) to obtain legal grounds for investment.

3. Direct the low-level hospital to launch the Scheme effectively.

V. LOW-LEVEL HOSPITALS

A low-level hospital shall:

1. Based on the Scheme, proactively express the need for its own project to the provincial People’s Committee and supervisory Department of Health while requesting high-level hospitals to give their opinions, and report to the Ministry of Health (Department of Medical Services Administration) for consolidation.

2. Proactively improve its quality based on the criteria for hospital quality, prioritize capacity enhancement and preparation of workforce, facilities, equipment, etc. for receipt of professional assistance from high-level hospitals.

3. Carry out surveys on patient's satisfaction with remote medical services, detect areas for improvement and actively improve quality of remote medical services.

4. Maintain and enhance transferred techniques and technologies, ensuring sustainability of the Scheme’s results.

5. Submit all required reports and perform other tasks of the Scheme.

VI. PARTNERS OF HEALTHCARE SECTOR

1. Telecommunications and IT corporations and enterprises such as VNPT, FPT, DTT and Vmed and other capable IT units shall cooperate with hospitals in developing IT platforms, establishing communications channels, assisting remote medical examination and treatment and implementing the Scheme.

2. Develop IT applications that are uniquely Vietnamese to support remote advising, consultation and medical examination and treatment.

3. Develop applications for smart handheld electronic devices to support healthcare workers and people in remote questioning and answering, advising, consultation, medical examination and treatment, etc.

Part 6.

SOCIO-ECONOMIC EFFECTS

The Scheme will contribute to the realization of “examination and treatment quality reaching higher and farther”, help enhance medical examination and treatment efficiency at low levels of care and medical service provision capacity of hospitals, reduce rate of erroneous and slow diagnoses; quality of low-level hospitals will “reach higher”.

Professional knowledge of high-level hospitals will "reach farther” to people across all regions of the Fatherland. Reinforce people’s trust in low-level hospitals, increase rate of patients visiting low-level hospitals for medical examination and treatment, reduce rate of referrals from low-level hospitals to high-level hospitals, lower travel time, costs, etc.

Increase rate of appropriate referrals from high-level hospitals to low-level hospitals, alleviate central- and high-level hospital overload, contribute to accomplishment of the tasks of protecting, caring for and enhancing people’s health assigned to the healthcare sector by the Communist Party and the State.

Remote medical examination and treatment is one crucial solution group when the COVID-19 pandemic is still progressing unpredictably around the world and poses high risk to Vietnam.

The Scheme will also support successful implementation of the Prime Minister’s program for national digital transformation by 2025 with orientations towards 2030, aiming towards becoming a stable and prosperous digital country with a safe, civilized and widespread digital environment.