Development of Telemedicine Activities in Turkey

Telemedicine is one of the areas that are not explicitly regulated under Turkish law. Within the scope of the existing legal framework, the Medical Deontology By-law and Ethical Principles for Physicians prohibit remote examination, diagnosis, and treatment of patients.

During the COVID-19 pandemic, the legal gap in telemedicine became a more serious issue as private hospitals especially started to provide online healthcare services to patients who cannot visit the healthcare centres due to COVID-19 risk. The fact that the number of hospitals providing telemedicine services increased also attracted the Ministry’s attention. Accordingly, the Ministry prepared a highly anticipated Regulation on Remote Provision of Healthcare Services, published in the Official Gazette dated February 10, 2022, numbered 31746. The basis of the Regulation is shown as Articles 9 and 11 of the Fundamental Law on Healthcare Services No. 3359 and Articles 335 and 508 of the Presidential Decree No. 1 on the Presidential Organization, allowing Ministry to publish regulations within the scope of its authority.

Within the scope of the Regulation on Remote Provision of Healthcare Services, a remote healthcare information system infrastructure will be developed or authorized by the Ministry, and healthcare centres will use healthcare information systems to enable written, voice or video communication. The developed remote healthcare information system infrastructure shall be registered to the Ministry’s database.

In accordance with the Regulation on Remote Provision of Healthcare Services, the healthcare centres that would like to provide remote healthcare services shall obtain authorization by applying to the General Directorate of Healthcare Services (the “General Directorate”) with the required documents. The Ministry shall issue an authorization certificate if the healthcare centre’s information system is registered in the Ministry’s database and its application is appropriate by the General Directorate. In addition, for healthcare centres affiliated with the Ministry, a remote authorization certificate for healthcare service may be issued by the Ministry ex officio.

Regarding the scope of the provision of remote healthcare services, numerous activities may be conducted remotely, including examination, consultation, prescription, follow-up of parameters such as blood sugar and blood pressure, provision of services supporting healthy life and psychosocial health, conducting invasive and surgical operations upon receiving approval from the Ministry, protection of people’s health during endemic and epidemic outbreaks, monitoring the health status of elderly and high-risk groups and people requesting monitoring of their health data via wearable technologies. Also, the healthcare centres authorized for international healthcare tourism may provide remote healthcare services internationally.

Considering the provision of remote healthcare services, the physician shall inform the patient of his/her expertise, the scope of the service, the differences between remote and applied healthcare services and data protection-related matters. The healthcare centres shall be responsible for protecting patient privacy and health data within this framework. Accordingly, the healthcare centres store and send the transactions and activities regarding remote healthcare services to the Ministry’s database.

The entry into force of this Regulation will lead to the beginning of a new era in the digitalization of the healthcare services industry in Turkey. There are also criticisms on the fact that the Regulation on Remote Provision of Healthcare Services is prepared as a regulation prepared by the Ministry instead of a Law prepared by the parliament, contradicting the principle that constitutional rights such as the right to live and healthy living right can only be limited by law. There are also some concerns about implementing this Regulation as the Ministry still did not publish a guideline on how to standardize the technical infrastructure required for the provision of remote healthcare and the training to be provided to staff in healthcare centres providing services at different care levels. Nevertheless, it is indisputable that healthcare services will become more accessible, a crucial step for improving public health overall.