Tele-expertise – remote advice from doctor to doctor

When doctors exchange information with colleagues over digital media, this is known as tele-expertise or a teleconsultation. 

This can be necessary if

• a second opinion is desired in relation to difficult medical questions
• questions relating to another medical discipline arise in relation to investigations, diagnoses or the choice of suitable treatment

If there is no medical specialist available on site in these situations, doctors, dentists and psychotherapists can consult one another using telemedicine. 

Tele-expertise is requested using a digital referral. Depending on the chosen means of communication, it can take place immediately or in the future. Patients sometimes need to be present so that they can be examined during the video consultation.

As patients’ personal data and information are shared during tele-expertise consultations, patients must consent to them. There are also high data protection requirements: only communication services that guarantee end-to-end encryption during the transmission of videos, examination results and patient images can be used. 

Patients who present certain symptoms or medical conditions are often referred to other specialists for further investigations. This is often time-consuming and arduous, especially in rural regions where only a few doctors are available.

When doctors seek expert advice, they confirm results, diagnoses and the choice of treatment. Some medical conditions affect various organs or areas of the body. This can make it useful to request expertise from another discipline. 

If no appropriate specialist is available on site, tele-expertise can be used to quickly obtain the necessary expertise. The doctors consulted can also remotely direct examinations and evaluate results.

Tele-expertise simplifies and accelerate these processes, benefiting both doctors and patients: 

• There is no need to find a specialist or wait for an appointment.

• There is no need to travel to a specialist clinic or hospital, eliminating the cost of this.
• Duplicate examinations are eliminated.
• The results of a specialist’s assessment are available quickly.
• Tele-expertise can enable treatment to be started sooner. This increases the chances of patients recovering quickly.
• Telemedicine can help save lives in the event of serious illnesses or emergencies.

Since October 2020, doctors from all disciplines, dentists and psychotherapists have been able to use tele-expertise services providing they fulfill a number of prerequisites. 

These include:

• Tele-expertise must only be used with the patient’s consent.
• At least one of the doctors must be in personal contact with the patient.
• The consulted doctors (consultants) must have the necessary equipment, especially for reproducing images for diagnostic purposes.
• Strict data protection requirements must be met when using tele-expertise.

The use of tele-expertise is regulated in several laws, contracts and agreements. These include: 

• the Digital Healthcare Act (DVG)
• the Tele-Expertise Agreement (Vereinbarung Telekonsil) between the National Association of Statutory Health Insurance Funds (Spitzenverband Bund der Krankenkassen), the German Hospital Federation (DKG), the National Association of Statutory Health Insurance Dentists (KZBV) and the National Association of Statutory Health Insurance Physicians (KVB)
• the Federal Master Treaty for Medical Practitioners (Bundesmantelvertrag für Ärzte)

Tele-expertise services are also used during visits to intensive care units, rescue operations and the emergency treatment of stroke patients. 
For example, emergency responders can receive support with diagnosis and acute care: a tele-emergency doctor remotely directs the examinations, evaluates the digitally provided results and stipulates the types of treatment required. The rapid, on-the-scene care increases the chances of recovery and survival, especially for stroke patients. 

Tele-expertise services involving national tele-stroke units enable even smaller hospitals to provide high-level care for stroke patients. If necessary, the doctors consulted can also perform telemedical examinations, for example using a remote controlled camera.