Telemedicine Consultation & Second Opinion for International Patients

Healthcare across Borders

While telehealth technology is not new, the demand for this type of service increased because of the COVID-19 pandemic in an effort to help the fight against this deadly virus.  The goal of is to enhance patient care experience by offering live video consultations bundled with tele-pharmacy service.

Technological developments have made our lives easier and safer in many ways, and now it gives us a chance to even schedule and see an online doctor.

Taiwan Adventist Hospital (TAH) delivers consistent, high quality, remote medical assistance that meets rigorous health and security requirements.  With the current state of the world today, seeing one of our doctors on line is one of the safest, convenient, and easiest ways to get medical care you need.

Our board certified physicians in all areas of medicine are able to provide video-based clinical consultation and remotely prescribe medication when necessary.  This provides simple, direct access to clinical care, just like a regular office visit.

Physician Patient Relationship

Current regulations require that any provider and patient doing a telemedicine visit have a pre-existing relationship. Usually this means that the provider and patient need to have had at least one in-person visit. This regulation is slowly changing during the COVID-19 pandemic.

However, Responsibility for a patient’s care remains the same as the traditional practice.  During Telemedicine encounters, the patient remains the responsibility of the referring provider.  If a specialist sees a patient initially in clinic and then via Telemedicine in follow-up, his/her responsibilities to the patient are the same as if the patient had come to the specialty clinic for the follow-up visit.  If the interaction is patient teaching, the Hospital has the same responsibility as when the patient visits in person.

Telemedicine services, like appointments, prescriptions and diagnostic testing are delivered online through board-certified licensed doctors.  It connects you with medical professionals in real-time online.  But it's important to note that telemedicine is used for non-emergency health situations.

Privacy and Confidentiality

Institutional policies governing Privacy and Confidentiality are in effect for Telemedicine.  Transmissions in which the patient is identifiable will be treated the same as having the patient present and the patient will be afforded appropriate privacy.

Most countries have regulations governing which types of services and prescriptions a resident can receive online, especially for a first-time prescription or therapy.

Under Taiwan law, the Personal Data protection Act (PDPA) is the main law governing personal data protection.  A consent form that states the patient is aware of the potential of the visit may be used for reach or later analyzed for quality assurance purposes is to be signed by the patient before the visit with the provider.

Telemedicine Consultation

1. Scheduling a Telemedicine Appointment & Hours of Operations
   1. Contact TAH Point of Contact (POC) at tahihc@tahsda.org.tw or tahihc@gmail.com determining date and time of consultation, and consultant’s availability.
   2. The Telemedicine consultation is open for consults from 08:00am – 05:00pm, Monday through Friday.
      
   
   
2. Preparing for the Consultation
   To ensure the best assessment & recommendation can be provided during the Telemedicine appointment, the following information should be provided to the POC prior the consultation:
   1. Patient Information
      1. Completed Patient Information Sheet
      2. Copy of Passport/ID
   2. Medical Information
      1. Information/reports about the patient’s chief complaint and history of problems, etc.
      2. Copy of the most recent consult dictation with previous specialist or primary care provider. 
      3. Recent Medical Report (required for all requests)
      4. Lab Test Results
      5. Radiology (X-Ray, CT, MRI) films and all corresponding reports
      6. Pathology slides and corresponding reports (with serial numbers)
      7. List of usual medications.  If the patient is unsure of the name of the prescription, have the patient bring all medications with him/her to the Telemedicine session.
      8. If the patient has injured on the job and been identified as a worker’s compensation case, the work ability report must provide to the specialist, completed by the specialist and sent back to the originating location.
      9. Other
   3. Referral Letter, if any
   4. Authorization for Release of medical Information
      1. Authorization & Consent to Participate in Telemedicine Consultation
      2. Authorization for Release of Medical Information
         
   
   
3. Charges & Direct Billing
   1. Charges for a Telemedicine consultation appointment is NT$6,200.  The standard length of a Telemedicine consultation is up to 30 minutes.  Additional NT$900 will be applied for every each 15 minutes and/or fewer.
   2. This charges mentioned above include the consultation with one physician.  Any additional physician’s consultations will result in additional charges.
   3. International Priority Care Center (IPCC) will notify a more accurate estimate in advance.
   4. The cost is payable by cash and most major credit cards. 
   5. We accept various insurance plans as long as your insurance company offer telemedicine benefits and provide us Guarantee of Payment/Letter of Authorization prior to the consultation.
   6. While many insurance companies are currently accepting those claims, the requirements were not universal and varied in the levels of service covered.  Be sure to check with your insurance company if you have any questions about how your Telemedicine visit will be billed.
      
   
   
4. Tips for a Successful Virtual Visit
   • Tools You'll Need
     1. Laptop, smart phone or tablet, and ensure the internet connection status is stable (WIFI connect is most recommended), or;
     2. Camera-enabled computer, with speakers or a headset with a microphone.
     3. Make sure that both your video and audio settings are turned on.
        
   • Mobile device and computer browser recommendations:
     

     If you are using a mobile device, we recommend Chrome or Safari. Internet Explorer will not work.

     If you are using a laptop or desktop, we recommend testing using Chrome. Apple/MAC users should use Safari.

   • Log in 15 minutes before your appointment time.
     

     Once the telemedicine appointment is scheduled and confirmed, TAH IPCC will send a link to you.

     Please click and connect through the link at least 15 minutes before the scheduled time for your appointment. To answer all check-in questions before your appointment begins. This ensures you get the focused attention that you need, and other patients aren’t kept waiting.

     Then you are ready to conduct telemedicine with our specialist(s).

   • Conduct the video visit in a well-lit room so your doctor can see you.
     Bright light, such as from a window, should be in front of you, not behind you, so your doctor can see you clearly.

• Make sure the space is private, so you can discuss personal medical information.
  

  You should be in a private space, where personal medical information can be freely discussed.

  Avoid distractions: Turn off devices not needed for the appointment, especially things that make noise. Choose a location away from pets and other people who will not be included in your visit.

• Dress in a way that you are comfortable been seen by your doctor.
  

  Wear clothes that let you stand, sit, and walk, if these actions might be part of your exam.

  Please remember that this is a two-way video visit.  Dress in such a way that you are comfortable being seen by your doctor.

• Write down any questions for your doctor before the visit.
  

  Make a list of items you would like to discuss with your doctor in advance of the visit.

  Have a paper and pen ready to take notes.

• Accompanied consultation in Telemedicine
  1. Patients can invite loved ones to participate in the video visit.
  2. For patients younger than 13, both the child and parent/guardian should be present for the video visit.
     For patients 13-17 years of age, the teen patient should generally be with their parent/guardian for their virtual visit except when receiving legally protected confidential care (e.g. mental health, reproductive health, or substance abuse related care) in which case they can be seen without a parent/guardian.

Second Opinion – Written Consultation Only

The Second Opinion program at TAH connects you with the expertise of TAH specialists, who can review your diagnosis and offer additional consultation, quickly and securely, without the time and expense of travel. This unique service gives patients secure, online access to TAH experts for virtually every possible diagnosis.

You can use a second opinion to:

• Make the most informed decision about your healthcare or that of a loved one.
• Ensure your diagnosis is correct and your treatment plan is optimal for you.
• Eliminate the need for additional expenses and lost time with travel for a second opinion.
• Get peace of mind and confidence you are pursuing the best possible outcome.
• Assurance: Many cases reviewed result in a revision of diagnosis or change in treatment plans.
• Convenience: Receive a second opinion from an expert at Taiwan Adventist Hospital without traveling to Taipei.
• Speed: Comprehensive, expert opinion will be provided within two weeks of receiving all of your records.

1. To begin a Second Opinion process, please complete the following steps:
   1. Complete Patient Information Sheet and Authorization for Release of Health Information.
   2. You will provide information about your case and specify the questions you would like to ask the TAH specialists, including your existing diagnosis and recommended treatment, as well as your medical concern and questions.
   3. Gather the most recent typed medical records in English.  Radiology images and corresponding report(s) are required for most clinical specialties.  Images sent on CD should be in DICOM format.  If possible, please send copies, not originals, of all documents and images.
   4. Forward via fax, international courier, or e-mail the completed information and medical records to: 
      

      Taiwan Adventist Hospital
      ATTN: Second Opinion Program – Sabrina Wang
      ADD: No. 424, Ba De Road, Section 2,
      Songshan District 10556, Taipei, Taiwan
      TEL: +886-2-2771-8151 ext: 2776
      FAX: +886-2-2721-0825
      E-mail: tahihc@tahsda.org.tw // tahihc@gmail.com

2. Once the documentation received:
   1. We will review the information.  The second opinion will base on the information that was sent, so it is essential that the documents are accurate and as up-to-date as possible.
   2. The medical second opinion process will not begin until TAH POC confirms that the information received is adequate and complete, and that no further information is forthcoming.
   3. We will triage all of your information to the most appropriate medical specialist.  But you can also request a specific specialist.  Our specialist will review all aspects of your diagnosis and treatment plan, and you’ll receive an in-depth, educational second opinion report.
   4. The specialist’s second medical opinion is typically completed within two weeks.  TAH POC will keep you updated on the completion of your second opinion consultation report.
   5. If we receive additional medical records and/or questions after the physician has started the review, an extra charge will apply.  The review of additional information will depend on the discretion and willingness of the physician assigned to the case.
   6. Upon completion of the medical second opinion, the patient’s case will be closed.  If the patient would like to schedule an in-person consultation with a Taiwan Adventist Hospital physician, the case will be forwarded to TAH IPCC, who can assist in this process.
      Please note that obtaining a medical second opinion does not guarantee an in-person consult.
      
   7. No medical information provided by the patients will be returned up completion of the medical second opinion, unless specifically requested by the patient, in which an additional processing fee of NT$500 will be charged.  The medical records will be appropriately discarded by following TAH Medical Record Room’s medical chart filing criteria.
3. Cost and Insurance
   1. The cost of this service is determined by the complexity of the case.  A more accurate estimate will be notified in advance by TAH IPCC.
   2. The cost is payable by cash and most major credit cards.
   3. We accept various insurance plans as long as your insurance company offer telemedicine benefits and provide us Guarantee of Payment/Letter of Authorization in advance.
   4. While many insurance companies are currently accepting those claims, the requirements were not universal and varied in the levels of service covered.  Be sure to check with your insurance company if you have any questions about how your Second Opinion will be billed.