How to Mobilize
Telehealth4Ukraine, led by CTeL and its partners, is working to compile a living database of healthcare clinicians who are interested in mobilizing to provide virtual humanitarian healthcare services in Ukraine and the surrounding region. This living database will be provided to a NGO on the ground who understands the critical and complex medical needs of Ukrainians and displaced citizens. Please complete this no-obligation interest form to learn more about the next steps and receive updates
Delivering lasting impact
Ukrainian Health Law FAQs
CTeL and the Telehealth4Ukraine Coalition
CTeL is a not-for-profit 501(c)(3) research institute that examines and analyzes the state and federal laws and regulations pertaining to telehealth.
UKRANIAN LAW, GENERAL
Ukraine’s health care laws and regulations are established by Ukraine’s legislative body, Verkhovna Rada (Supreme Council of Ukraine) and the Ukrainian Ministry of Health. Ukrainian health care law and regulations are governed by national law, not political subdivisions.
No. Ukrainian health law is uniform across the country. We need not worry about variations from one region, or oblast, or town to another.
There are 3 types of medical workers in Ukraine.
3. Help staff or service staff. (They are considered medical workers, but are unqualified to furnish health care services.)
Liability regulations are covered by the Supreme Council of Ukraine.
Yes. Martial law was declared in all territories of Ukraine on February 24, 2022.
UKRAINIAN TELEMEDICINE LAW, PEACETIME
Medical entities that possess specific licenses, or doctors who are registered as private entrepreneurs and possess specific licenses, can provide telemedicine services. A doctor in a medical entity that possesses such a license does not need his own individual license.
Under pertinent legislation, a medical entity that provides telemedicine services should have a telemedicine room, equipped with proper facilities. This requirement does not apply to a doctor (private entrepreneur). Such a physician need but have proper facilities
A special platform administered by Ukrainian Association of Development IT in medicine, https://esemi.org/, provides electronic communication between the participants and records all stages of consulting remotely. There is no obligation to register to provide telemedicine services, however.
Not at this writing.
No. There is no legal obligation to use this platform specifically. Moreover, there are many private platforms, where one can register as a consultant as well as a patient. A provider may also establish its own platform, provided it follows the legislative rules.
An attending physician prepares a Request for telemedicine consultation in the form of an electronic message with an electronic digital signature. (The officially required form is available here: https://centerdp.statinfo.com.ua/wp-content/uploads/2021/03/forma- 001-zaput.pdf). Any pertinent information, such as the results of a work-up of the patient, should be sent to the Consultant together with Request. The Attending physician informs the staff of the telemedicine office about the Request. The doctor at the telemedicine office registers the Request in the journal according to the Form № 003 / tm (https://docs.dtkt.ua/download/pdf/1216.2677.1 ). After registration, the staff of the telemedicine office informs the Consultant about the Request and submits a document [to the Consultant] in the form of a printed copy or electronic media. On the day of receipt of the Request, the Consultant prepares a response in accordance with the form of primary accounting documentation № 002 / tm (https://zakon.rada.gov.ua/laws/show/z1403-15#n3 ).
No. The consultant may accept or reject such a Request.
In practice, it is quick. All these issues, request and documents are submitted by electronic means. Many Ukrainian doctors (especially those aged 25-40) have good knowledge of English, because in Ukrainian medical universities it is obligatory to pass final exams in English as well as Ukrainian. Accordingly, the vast majority of Ukrainian doctors (especially those experienced in telemedicine) will be able to translate relevant medical documents into English.
Not at this writing. But the gist of the text is as follows: The information provided should include the patient’s last and first name, age, results of work-up, diagnosis, and questions to the consultant.
No. Telemedicine services can be provided synchronous online or just on an asynchronous remote basis, where the Consultant prepares his response exclusively on the basis of sent documents and the attending physician’s work-up
Yes. The Consultant may communicate with the attending physician, a patient and any other staff. There are no pertinent legislative requirements, so the foreign Consultant may choose a mutually agreeable type of communication.
LICENSURE AND CREDENTIALING
If you are acting as a consultant to a Ukrainian physician, you do not. If you were caring directly for a Ukrainian patient, you probably do.
The MOH website says that the country has waived the usual rules:“Registration [the equivalent of licensure there] remains open to all health professionals from our friendly countries who wish to assist Ukrainian hospitals in providing assistance to victims….” See, Ukraine MOH, “Dear partners and friends of Ukraine ‒ representatives of different countries!” 3 March 2022, https://en.moz.gov.ua/article/news/dear-partners-and-friends-of-ukraine-‒-representatives-of-different-countries.
Project Aimee (see below) is in receipt of a writing from the Ukrainian Ministry of Health stating that professionals aiding Ukrainians through the project may rely on their domestic US licenses and will enjoy immunity from tort claims arising out of their wartime services.
The Attending physician is the clinician who is making the diagnosis and prescribing medications. The Consultant is an advisor to the Attending, but does not issue orders of make the diagnostic or therapeutic decisions.
If a Ukrainian doctor is on the call, the Ukrainian physician would be the attending physician. If no Ukrainian doctor is on the call, this would be considered direct-to-patient care because the foreign doctor is making final decisions.
The foreign doctor providing the consult will not bear responsibility because he is not the attending physician. The Ukrainian doctor will make final decisions and bears responsibility
The Ministry of Health supplemented its original order on telemedicine with a new provision. The updated order allows Ukrainian heads of health care institutions, hospital clinics, and other in-country providers to engage with foreign doctors with sufficient experience and education to provide telemedicine services to Ukrainians. The previous order was silent on telemedicine. This updated letter expressly allows it.
The MOH letter outlines no formal procedure for approval. Heads of health care institutions have broad authority to decide on a provider’s credentials.
An English translation is not available at this time. Dexis Partners will translate the updated order for the Coalition.
Yes, with the approval of the head of a health care institution or a hospital clinics.
The only problem, which may occur is the suspicion of labor relations between doctors and retired doctors. However, as retired doctors will not provide help to the Ukrainian patients, but American doctors, so that the retired doctors have no connections to Ukraine personally, no legal issues may arise in this case.
Acorn Credentialing https://acorncredentialing.com has offered to verify the licenses of our coalition volunteers. Acorn Credentialing is able to quickly verify the licenses for all medical licensure groups.
Acorn Credentialing (“Acorn”) describes itself as “a complete solution that goes beyond basic functionality to create value through process efficiency and eliminating costs and risk. Providers, credentialing specialists, and insurance payers get tailored views of the information they need while Acorn streamlines workflows, automates tasks, and manages data.” https://acorncredentialing.com/about/.
The Telehealth4Ukraine Coalition is grateful to Acorn for its help in facilitating telehealth support for Ukrainians. Please note that the Coalition does not, and is not equipped to, offer services akin to those of Acorn, nor to evaluate the quality of those services nor of its business practices more generally, specifically including Acorn’s privacy practices, and makes no representations or warranties concerning them.
Once you complete the licensure verification process, the Telehealth4Ukraine Coalition will reach out to you directly to get you onboarded to the VSee Aimee platform. We anticipate training to take no longer than 30 minutes. The Coalition will also work with its volunteers to develop a schedule.
CTeL has enlisted the help of two former VA telehealth consultants, Stephanie Bidstrup and Kendall Adler, who have access to the VSee Aimee platform and have worked with the Aimee team to develop the onboarding and scheduling process. Once Acorn verifies the licensure of our volunteers, Stephanie and Kendall will host open meetings to get the volunteers onboarded and trained on the platform.
When the state of war in Ukraine is over, unless other laws on this matter are enacted, a US provider will be authorized to provide medical consultations only on the behalf of a medical establishment licensed in Ukraine
No. Only doctors can serve as independent providers in Ukraine. For example, nurses in Ukraine cannot make any decisions without oversite of their attending physician. Only doctors are provided medical authority under Ukraine law.
Yes. Nurses can provide medical services on their own in Ukraine.
According to the applicable Ukrainian legislation, a nurse who is going to start her own “medical” practice, has to:
1. Correspond to the requirements of the Decree of the Cabinet of Ministers of Ukraine “About the statement of Licensing conditions of carrying out economic activity on medical practice “ (available in Ukrainian here: ДКХП № 78);
2. Register as a private entrepreneur (the Ukrainian equivalent is FOP); and
3. Receive a license in the Ministry of Health of Ukraine.
Yes, if the head of a health care institution believes the nurse practitioner is able to play the role of consultant. Under such circumstances, the NP could provide services to patients or provide consultation to her colleagues without obstacles.
Yes. Doctors may bear responsibility for incorrect consultations based on negligence in providing services.
Plaintiff must prove the illegality of the actions of the medical worker, i.e., his or her direct violation of the requirements of the relevant regulations governing the provision of medical care.
They are very detailed and would take a long time to read.
Dexis Partners is preparing one.
Not so long as the final decisions are in the hands of the doctor in Ukraine. Responsibility for the quality of care will be borne directly by the Attending physician of the pertinent medical institution. Consultations are of an advisory nature, and the methods of treatment of the patient depend on the attending physician. That is, the role of a consultant is ancillary, subordinated to the priority of the attending physician.
Yes. The necessary condition for a doctor to be held liable for his professional activity is a direct connection between the doctor’s acts and harmful effects of such acts on the patient’s health and life. Under Ukrainian law, it is difficult to prove that there is a causal link between the actions of the person sued and the damage caused, because the human body’s response to medical intervention is not always unambiguous.
A forensic medical examination establishes or refutes the existence of such a connection. If the damage is attributable to individual characteristics of the patient’s body or was caused by the patient’s actions (non-compliance with the doctor’s recommendations, e.g.), the doctor’s liability is excluded. It is possible to recover funds for damages only if the negligence of the medical worker is proved. The mere fact of a patient’s health deterioration (or even death) during treatment is not grounds for imposing civil liability on a medical institution in Ukraine.
The amount of compensation in each case is set by the court. To calculate the amount of material costs, the patient must submit to the court the relevant documents (e.g., pharmacy checks).
The law does not provide for an upper or lower limit on the amount of non-pecuniary damage. Usually the court takes into account: the amount of monetary damages; the severity of physical and moral suffering; the nature of the reduction of abilities or deprivation of the opportunity to function; the culpability of the person who caused moral damage; and other circumstances that had a significant impact on the situation. The requirements of expediency and fairness are also taken into account.
The amount of compensation differs significantly from the practice of American courts. The predominant amount of compensation is 10-20 thousand hryvnias (about $329.82 to $659.73) in case of damage to health and up to 100 thousand hryvnias (approx. $3,385.54) if the doctor’s actions led to the patient’s death.
Provide explanations and give recommendations, but do not make a diagnosis and do not prescribe treatment. This way the US provider will not bear responsibility as an Attending physician does.
If you communicate with Ukrainian providers independent of the coalition, and in doing so you use a website, post a limitation of liability clause (known as disclaimer) on the website and/or in the application forms. A patient should be acquainted with the mentioned disclaimer before the consultation begins.
No. The disclaimer referred to here is for use only by a US provider who elects to offer services to Ukrainians independent of the coalition.
Yes, as long as it accurately reflects the relationship between the two parties.
Our website contains general medical information. Any information we provide cannot be considered as advice you should follow. The medical information on our website is provided without any guarantee of recovery. You should not rely on the information on our website as an alternative to medical advice from your attending physician. If you think you may be suffering from any medical condition, you should consult with your attending physician and visit him without delay. You should never delay visiting a doctor, ignoring medical advice, or stopping medical treatment because of the information on our website.
You understand that, owing to the limited nature of communicating with the interactive features of our website, any assistance you may receive through such features may be incomplete or may be misleading. Any assistance you may receive in connection with any other active features of our website is not specific advice and should not be relied upon without further independent confirmation and precise investigation by the attending physician. Nothing in this disclaimer will
• limit or exclude any liability for death or personal injury caused by negligence;
• limit or exclude any liability for fraud or fraudulent misrepresentation;
• limit any obligations in any way not permitted by applicable law; or • exclude any obligations that cannot be excluded in accordance with applicable Ukrainian law.
The patient needs to review the website and project type. Understanding and agreement can be documented with a check-box or pop-up to receive confirmation. Because it relates to healthcare, a check-box would be the better solution.
VSee purchased insurance ($1M/3M) for This American Doc from The Doctors’ Insurance Agency against tort liability for HCPs providing care abroad through Aimee. A volunteer who registers at ThisAmericanDoc will get coverage. Note: a doctor need not register individually; VSee can do bulk registrations. As with the waivers, however, at this writing this coverage does not extend beyond Aimee-affiliated professionals. The Doctor’s Insurance Agency certificate of coverage covers only “This American Doc, Inc.,” and not individual physicians.
Neither CTeL nor Telehealth4ukraine provides insurance of any kind.
If a Ukrainian patient sued a foreign doctor, litigation would be very difficult, as it would be necessary to send summonses abroad and get confirmation of receipt. Online litigation in Ukraine is not yet operational. All documents should be legalized in the defendant’s country. That is, such a lawsuit would be extremely time- and money consuming, with but a low chance of winning.
It is extremely unlikely that a foreign doctor will be sued. In fact, this is possible only in case of gross disregard for professional standards, a clear violation of medical protocols and the patient’s willingness to incur high costs of litigation.
In the case of pure consulting without making a diagnosis and prescribing treatment, such a risk is absent.
Yes. A healthcare professional may be held criminally liable for failing to perform or improperly performing his or her professional duties as a result of negligent or dishonest treatment, if this has resulted in serious consequences for the patient. A difficulty the prosecutor faces in all criminal cases against doctors is the impact of a significant number of evaluative concepts (in particular, the inability to unambiguously determine whether a doctor’s actions were appropriate or inappropriate, whether in full or superficially performed by a health worker, etc.).
To convict, the prosecutor must show that the defendant could at least either foresee the possibility of socially dangerous consequences of his own actions or should have foreseen them.
Criminal liability of a doctor in Ukraine is limited to cases of obvious neglect of professional duties – usually in the form of a direct violation of medical protocols, which the doctor has been acquainted with on receipt. In other cases, the corpus delicti (concrete evidence of a crime, such as a corpse) is absent. Therefore, cases of bringing doctors to criminal responsibility in Ukraine are very rare.
Clinician to clinician.
In Ukraine, such service may be provided only by doctors who have a Ukrainian medical education or legalized foreign diplomas. Therefore, there are three ways to provide care to Ukrainian patients directly:
1. Engage doctors with diplomas acknowledged in Ukraine, or
2. Cooperate with a Ukrainian medical institution and provide consultations on behalf of it, or
3. Provide online consultations.
Yes, but the process is very difficult and time-consuming.
Yes, clearly with respect to in-person care by a foreign provider. According to the Order of the Ministry of Health, “On the involvement of foreign medical workers in the provision of services to victims of martial law” from 2/26/2022 No. 383, foreign doctors may be involved in medical assistance in Ukraine. Until the state of war in Ukraine is at an end, there are no restrictions.
In pertinent part, the Order says:
Order of the Ministry of Health of Ukraine dated 26.02.2022 № 383: “On the involvement of foreign medical workers in providing assistance to victims of war under the applicability of martial law”
… in connection with the imposition of martial law in Ukraine in accordance with the Decree of the President of Ukraine of February 24, 2022 № 64/2022 “On the imposition of martial law in Ukraine,” in order to ensure timely, continuous assistance to victims, the minister of health of Ukraine ORDERS:
1) Heads of health care institutions during martial law:
4. if there is a necessity, to ensure the provision of medical care with the use of telemedicine with the involvement of foreign medical professionals who meet the requirements for professional education and qualifications of the country where the relevant medical worker works, in compliance with personal data protection legislation.
Order 383 remains in effect.
Statutes are higher authorities, with higher power, than MOH orders. The order remains binding, however, until a statute says otherwise.
Yes. This order protects both Ukrainian healthcare institutions and foreign consultants.
Yes. “Medical assistance” can be construed broadly.
Yes. Counsel at Dexis Partners have concluded that the same principle applies to medical services provided on a remote basis. Moreover, the representative of the Ministry of Health of Ukraine, Sergiy Ubogov, Director General of the Directorate of Medical Personnel, Education and Science of the Ministry of Health of Ukraine, also confirmed this conclusion over the phone. As of 13 May 2022, written confirmation pending.
The Director General reports directly to the Minister of Health.
Yes. This is possible, but unlikely.
Yes. We can interpret “victims of martial law” as meaning “Persons who became victims because of the war.” Dexis Partners believes “victims” of war can be interpreted broadly.
Foreign medical workers can be interpreted broadly to include broad range of specialists and licensee groups.
Data Protection regulations in Ukraine are just on their way to development, which is why there is no precisely elaborated accountability mechanism for data protection violations.
Ukraine’s existing legislation on personal data protection is neither strict nor detailed. There is no special legislation on the processing of personal health information (PHI) in the field of online medical consultation (telemedicine). The Order of the Ministry of Health “On the organization of medical care with the use of telemedicine” provides no special requirements for the processing of personal data, referring only to the need to comply with the requirements of Art. 7 (6) of the Law on Personal Data Protection, which identifies cases in which health data cannot be processed. It means, as you provide health care services you are empowered to process health care data, which is considered as sensitive kind of data.
Under Ukrainian law, PHI is a category to which “special requirements” apply. Ukrainian law stipulates that uses and disclosures of PHI is allowed if it is necessary for health care purposes, however, in particular for: “establishing a medical diagnosis, providing care or treatment or providing medical services, operation of an electronic health care system provided that that such data are processed by a medical worker, rehabilitation specialist or other person of a health care institution, rehabilitation institution or a natural person – entrepreneur who has received a license to conduct business in medical practice, and its employees covered by the legislation on medical secrecy, employees of the central executive body implementing the state policy in the field of state financial guarantees of medical care, employees of the institution carrying out state sanitary and epidemiological supervision and activities in the field of public health, which received a license to conduct business in medical practice “.
This means restrictions on sharing private health information without patient consent. These laws are rarely enforced, however, and there are no significant penalties for violations.
There are exceptions for emergency services. The declaration of “martial law” would be considered an emergency.
No. The attending physician will already have obtained such a consent from the patient and is empowered to share patient’s information with other medical staff to the extent necessary for a patient’s relief.
Under Ukrainian legislation, every person should sign a specific declaration (a kind of agreement) with her family doctor, in which the person’s consent to data collection and sharing is also given. This family doctor fills out a particular form with a person’s information on the governmental platform e-health (https://ehealth.gov.ua/). That is why, as soon as the family doctor permits, the patient’s information may become available for all the doctors across the country. If a patient needs help, but a family doctor is not entitled to provide it owing to the lack of specific qualifications in the required field, a family doctor may send or make available the patient’s information to the specialist in charge (otolaryngologist, e.g.). That is why there is no necessity to receive a separate consent to data collection.
No. Ukraine is outside the EU and so the GDPR does not directly apply to it. The coalition is planning to bring services to Ukrainian refugees in neighboring countries, however, such as Poland and Romania, which are EU member states to which GDPR pertains.
Ukrainian regulations is less strict than the EU’s GDPR. Health institutions are asked not to share private health care information. Health institutions can share de-identified health care information. Before a Ukrainian court would consider health privacy suits, there must be significant damage to the patient.
Ukraine allows unconditional processing of PHI in the case of emergency medical care, when it is impossible to obtain the patient’s prior consent. In other cases when there is no emergency, it is recommended that the doctor obtain a separate written consent of individuals on the processing of personal data in the process of telemedicine.
There are two main mechanisms. Standard Contractual Clauses (“SCCs”) are pre-defined contractual clauses that can be included in agreements and bind both the sending and receiving entities to data protection principles consistent with those of the GDPR.
Binding Corporate Rules (“BCRs”) are intended for inter-entity data transfers. BCRs also require the parties to adhere to rules intended to protect the personal data that the process in GDPR-compliant fashion..
Physicians for Human Rights developed an app called medicapt that clinicians could use to document injuries from SGBV for legal purposes.
Another tool: the Istanbul Protocol, the protocol for documenting torture
The most needed type of service is trauma surgery consultations in real time. Second: behavioral/mental health.
Roman Shurduk (Member of the Board at Ukrainian Coalition for Legal Aid) : +380672365546 WatsApp.
Project Aimee, https://seeaimee.vsee.me, a VSee project. Aimee is a telemedicine platform with a 17-year history of providing no-cost humanitarian health care services in refugee and war-torn areas. Project Aimee offers a “24×7 Ukrainian/English dispatch service to collect medical requests and match them with the appropriate physician.” Aimee is collaborating with American Duty, run by James Oleen, former US Army Public Affairs Officer. The Coalition will help VSee Aimee staff its platform with clinicians with diverse medical specialties and licenses.
If and when other platforms become available, however, the coalition would be happy to use them.
Doctor Online is a telemedicine company currently being utilized in Ukraine that has requested the Coalition’s database of clinicians. The platform was Ukrainian-based and recently purchased by a US based company. The platform is an asynchronous messaging app, with translation services built in. A U.S. clinician can interface with the app in English while the Ukrainian patient interfaces in Ukrainian or Russian. Doctor Online has not received a formal waiver to allow U.S.-based clinicians to utilize the application; however, the Ministry of Digital Transformation recently recommended this platform in a press release.
Doctor Online – Health Assistant – here the patient can consult a family doctor or a specialist, order medication or decipher the results of laboratory tests online on the portal.
Helsi Medical Service – here the patient can make an appointment with doctors of all specialties. The qualifications of all doctors are confirmed by the Ministry of Health. The patient does not need to have a declaration and a referral from a family doctor to register for a consultation; it is enough to choose the right specialist and the time of the consultation.
Likar.support is an online service where volunteer doctors will provide emergency medical care online.
Northwell Center for Global Health, https://mhealthintelligence.com/news/northwellhealth-provides-telehealth-services-assistance-toukraine?eid=CXTEL000000246916&elqCampaignId=25327&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=36fa35a9448b4b538a9d84d5b530ea73&elq=8dccfc502c3c43eaa0fb49fd115295f6&elqaid=26144&elqat=1&elqCampaignId=25327
As Ukrinform reported, the mobile application TacticMedAid, which teaches first aid, has become available to Android users. TacticMedAid is also available to iOS users. The application provides two areas of instruction: for the military and for the civilian population. The block for servicemen contains algorithms of actions in case of various common types of injuries and wounds in combat, in the block for civilians – detailed information about stopping the bleeding.
teplo.app is an application that will help the patient get a free consultation with a psychologist if the patient’s request is related to war.
Viveo Cares Foundation is an application where doctors provide advice 24/7 to Ukrainians who have health problems and live in the country’s combat zone.
UC Davis Jana
The Ukrainian Student Association at Stanford: teleHELP
Language Line -the medical translation app is called Jeenie.
UMANA can provide contacts for translators. Logistical challenges with translation are ultimately what led UMANA to focus more on direct-to-patient telehealth, as it may be difficult to coordinate 3 different schedules. There are, however, both operational (e.g. regular shifts for translators) and software solutions (e.g. translation technology), that could help mitigate this. The technology to facilitate this isn’t yet built, however
UVa, UC Davis, UCLA
Ukraine is 7h ahead.