Shandisa ruzivo rweNEJM Boka uye masevhisi kugadzirira kuve chiremba, kuunganidza ruzivo, kutungamira sangano rehutano uye kusimudzira basa rako.
Munguva yeCovid-19 denda, kukurumidza kusimudzira kwe telemedicine kwadzoreredza kutarisa kutsva pagakava rekupihwa rezinesi kwavanachiremba.Denda iri risati raitika, nyika dzaiwanzopa marezinesi evanachiremba zvichibva pagwaro rakatsanangurwa mumutemo weMedical Practice wedunhu rega rega, waiti vanachiremba vanofanirwa kupihwa marezenisi mudunhu mune murwere.Kune vanachiremba vanoshuvira kushandisa telemedicine kurapa varwere vari kunze kwenyika, ichi chinodiwa chinogadzira zvipingaidzo zvakakura zvekutonga uye zvemari kwavari.
Mukutanga kwedenda, zvipingamupinyi zvakawanda zvine chekuita nerezinesi zvakabviswa.Nyika zhinji dzakapa zvirevo zvenguva pfupi zvinoziva marezinesi ekurapa ekunze.1 Padanho remubatanidzwa, Medicare neMedicaid Services vakaregera kwenguva pfupi zvinodiwa neMedicare kuti vawane rezinesi rekiriniki mudunhu remurwere.2 Idzi shanduko dzenguva pfupi dzakagonesa kutarisirwa kwakagamuchirwa nevarwere vazhinji kuburikidza ne telemedicine panguva yeCovid-19 denda.
Vamwe vanachiremba, nyanzvi, uye vanoita zvemitemo vanotenda kuti kusimukira kwe telemedicine kupenya kwetariro yedenda, uye Congress iri kufunga nezve mabhiri akawanda ekusimudzira kushandiswa kwe telemedicine.Isu tinotenda kuti kuvandudzwa kwemarezinesi ndiko kuchave kiyi yekuwedzera kushandiswa kwemasevhisi aya.
Kunyangwe nyika dzakachengeta kodzero yekudzidzira marezinesi ekurapa kubva mukupera kwema1800s, kuvandudzwa kwemaitiro makuru ehutano hwenyika nematunhu uye kuwedzera kwekushandiswa kwenharembozha kwakawedzera chiyero chemusika wehutano kupfuura miganhu yenyika.Dzimwe nguva, masisitimu ehurumende haaenderane nepfungwa.Takanzwa nyaya dzevarwere vakatyaira mamaira akati wandei kuyambuka mutsara wenyika kuti vatore chikamu mukushanya kwekutanga telemedicine kubva kumota dzavo.Varwere ava havagone kutora chikamu mukugadzwa kumwe chete kumba nekuti chiremba wavo haana rezinesi munzvimbo yekugara.
Kwenguva yakareba, vanhu vanga vachityirawo kuti State Licensing Commission iri kukoshesa zvakanyanya kuchengetedza nhengo dzayo kubva kumakwikwi, pane kuita zvido zvevanhu.Muna 2014, Federal Trade Commission yakabudirira kumhan'ara North Carolina Board yeDental Inspectors, ichipikisa kuti kurambidza kweKomisheni zvisiri pamutemo kune vasiri vemazino kupa mabasa ekuchena kunotyora mitemo yekusavimbana.Gare gare, iyi nyaya yeDare Repamusorosoro yakamhan'arwa kuTexas kupokana nemirau yemarezenisi inorambidza kushandiswa kwenharembozha mudunhu.
Pamusoro pezvo, Bumbiro reMitemo rinopa hurumende yemubatanidzwa pamberi, zvichienderana nemitemo yenyika inovhiringa kutengeserana kwenyika.Congress yakaita zvimwe zvisiri izvo kune nyika?Inopihwa marezenisi ega ega, kunyanya muzvirongwa zvehutano zvemubatanidzwa.Semuenzaniso, iyo VA Mission Act ya2018 inoda kuti nyika dzibvumire varapi vari kunze kwenyika kuti vadzidzire telemedicine mukati meVeterans Affairs (VA) system.Kuvandudzwa kweinterstate telemedicine kunopa mumwe mukana wehurumende yemubatanidzwa kuti ipindire.
Anosvika marudzi mana eshanduko akakurudzirwa kana kuunzwa kusimudzira interstate telemedicine.Nzira yekutanga inovaka pamusoro pehurongwa hwemvumo yekurapa, asi inoita kuti zvive nyore kuti vanachiremba vatore zvibvumirano zvekubuda kunze kwenyika.Chibvumirano cherezinesi rekurapa chepakati chakaitwa muna 2017. Chibvumirano pakati penyika makumi maviri nesere neGuam kuti vakurumidze kuita kwechinyakare marezinesi ehurumende (ona mepu).Mushure mekubhadhara mari yemadhora mazana manomwe emadhora, vanachiremba vanogona kuwana marezinesi kubva kune dzimwe nyika dziri kutora chikamu, nemari inotangira pamadhora makumi manomwe neshanu muAlabama kana Wisconsin kusvika pamadhora mazana manomwe nemakumi mapfumbamwe muMaryland.Kubva munaKurume 2,591, chete 2,591 (0.4%) yevanachiremba mumatunhu atora chikamu vakashandisa chibvumirano kuwana rezinesi kune imwe nyika.Congress inogona kudzika mutemo kukurudzira nyika dzasara kuti dzipinde muchibvumirano.Kunyangwe chiyero chekushandisa chehurongwa chave chakaderera, kuwedzera kontrakiti kumatunhu ese, kuderedza mitengo uye mitoro yekutonga, uye kushambadzira kuri nani kunogona kutungamirira kukupinda kukuru.
Imwe sarudzo yesarudzo ndeyekukurudzira kudzoreredza, pasi peiyo nyika dzinongoziva marezinesi ekunze.Congress yakabvumidza varapi vari kudzidzira muVA system kuti vawane mabhenefiti, uye panguva yedenda, nyika zhinji dzakaita kwenguva pfupi mitemo yekudzoreredza.Muna 2013, mutemo wehurumende wakakurudzira kushandiswa kwechigarire kwekudzokorora muurongwa hweMedare.3
Nzira yechitatu ndeyekudzidzira mushonga zvichienderana nenzvimbo yechiremba kwete nzvimbo yemurwere.Zvinoenderana neNational Defense Authorization Act ya2012, varapi vanopa rubatsiro pasi peTriCare (Chirongwa cheUtano hweMauto) vanongoda kupihwa rezinesi mudunhu ravanogara, uye mutemo uyu unobvumira maitiro ekurapa epakati.Maseneta Ted Cruz (R-TX) naMartha Blackburn (R-TN) munguva pfupi yapfuura vakaunza "Equal Access to Medical Services Act", iyo ichashandisa iyi modhi kwenguva pfupi kune telemedicine maitiro munyika yose.
Nzira yekupedzisira -?Uye chirevo chakanyanya kutsanangurwa pakati pezvirongwa zvakanyatsokurukurwa - rezenisi remubatanidzwa richaitwa.Muna 2012, Senator Tom Udall (D-NM) akakurudzira (asi asina kuunzwa zviri pamutemo) bhiri rekutanga serial rezinesi maitiro.Mune iyi modhi, varapi vanofarira kuita zvepakati penyika vanofanirwa kunyorera rezinesi rehurumende kuwedzera kune rezinesi renyika4.
Kunyangwe zvichifadza kufunga nezverezinesi rimwe chete remubatanidzwa, mutemo wakadaro unogona kusashanda nekuti unoregeredza chiitiko chemakore anopfuura zana emarezinesi ehurumende.Dare racho rinoitawo basa rinokosha mumabasa ekuranga, richitora matanho kune zviuru zvevanachiremba gore negore.5 Kuchinjira kune federal rezinesi system kunogona kukanganisa masimba ehurumende ekuranga.Pamusoro pezvo, vese vanachiremba uye mabhodhi ehurumende ezvekurapa ayo anonyanya kupa rubatsiro rwekutarisana kumeso ane chishuwo chekuchengetedza hurongwa hwekupa marezenisi ehurumende kudzikamisa makwikwi kubva kune vanopa kunze kwenyika, uye vanogona kuedza kukanganisa shanduko dzakadaro.Kupa marezinesi ekurapwa zvichienderana nenzvimbo yachiremba mhinduro ine hungwaru, asi zvakare zvinopokana nehurongwa hwenguva refu hunodzora maitiro ekurapa.Kugadzirisa iyo nzvimbo-yakavakirwa zano kunogona zvakare kuunza matambudziko kubhodhi?Zviito zvekuranga uye chiyero.Kuremekedza shanduko yenyika Naizvozvo, kutonga kwenhoroondo kwemvumo kunogona kunge iri nzira yakanaka yekumberi.
Panguva imwecheteyo, zvinoita sekunge zano risingashande kutarisira kuti nyika dzitore matanho ega kuti dziwedzere sarudzo dzekunze-kwe-state rezinesi.Pakati pevanachiremba vari munyika dziri kutora chikamu, kushandiswa kwezvibvumirano zvepakati kwakadzikira, zvichiratidza kuti zvipingaidzo zvekutonga uye zvemari zvinogona kuramba zvichikanganisa telemedicine.Tichifunga nezvekupokana kwemukati, hazvigoneke kuti nyika dziite mitemo yekudzoreredza zvachose ivo pachavo.
Zvichida zano rinonyanya kuvimbisa kushandisa masimba ehurumende kukurudzira kuwirirana.Congress inogona kuda mvumo yekudzoreredza mukati meimwe chirongwa chemubatanidzwa, Medicare, zvichibva pamutemo wapfuura unodzora varapi muVA system uye TriCare.Chero bedzi vaine rezinesi rekurapa rinoshanda, vanogona kubvumidza varapi kupa telemedicine masevhisi kune vanobatsirwa neMedicare mune chero nyika.Mutemo wakadaro unogona kukurumidza kupasiswa kwemutemo wenyika pamusoro pekuenderana, izvo zvichabatawo varwere vanoshandisa mamwe marudzi einishuwarenzi.
Denda reCovid-19 rakamutsa mibvunzo nezve kubatsira kweiyo iripo yekupa marezenisi, uye zvave kuwedzera kujeka kuti masisitimu anovimba ne telemedicine akakodzera hurongwa hutsva.Mienzaniso ingangove yakawanda, uye dhigirii reshanduko inosanganisirwa kubva pakuwedzera kusvika pakurongwa.Isu tinotenda kuti kumisikidza iripo yenyika yekupa marezenisi system, asi kukurudzira kuwirirana pakati penyika ndiyo nzira yechokwadi yekumberi.
Kubva kuHarvard Medical School uye Beth Israel Deaconess Medical Center (AM), uye Tufts University Chikoro cheMishonga (AN) -?Vose vari muBoston;uye Duke University Chikoro cheMutemo (BR) muDurham, North Carolina.
1. The Federation of National Medical Councils.Nyika dzeUS nenzvimbo dzakagadziridza rezinesi radzo rezinesi maererano neCOVID-19.Kukadzi 1, 2021 (https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf).
2. Inishuwarenzi yezvokurapa uye nzvimbo yebasa rekubatsira kurapwa.Iyo COVID-19 chiziviso chechimbichimbi chegumbeze chevanopa hutano chinoregererwa.Zvita 1, 2020 (https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf).
3. The 2013 TELE-MED Act, HR 3077, Satoshi 113. (2013-2014) (https://www.congress.gov/bill/113th-congress/house-bill/3077).
4. Vatsigiri veNorman J. Telemedicine vakaita nhamburiko itsva dzebasa rekupa rezinesi rachiremba kumiganhu yenyika.New York: Federal Fund, Ndira 31, 2012 (https://www.commonwealthfund.org/publications/newsletter-article/telemedicine-supporters-launch-new-effort-doctor-licensing-across).
5. The Federation of National Medical Councils.US Medical Regulatory Trends and Actions, 2018. Zvita 3, 2018 (https://www.fsmb.org/siteassets/advocacy/publications/us-medical-regulatory-trends-actions.pdf).
Nguva yekutumira: Mar-01-2021