Regulating telemedicine and personalising healthcare: an overview of the latest revision to the Bulgarian Public Health Act

1. Prioritisation of Electronic Health Records (EHR)

The revised PHA emphasises the importance of EHRs over traditional paper-based records. This shift aims to reduce the administrative burden on healthcare providers, improve data quality, and ensure comprehensive health information management. Key points include:

• Mandatory EHR for all medical activities: All medical activities, regardless of how they are financed, must be recorded in the electronic health record of each Bulgarian citizen. This ensures that all health-related information is centralised and easily accessible for the healthcare providers.
• Evaluation of medical software: Medical software will now be evaluated for ease of use and proper integration with EHR systems. The evaluation aims to ensure that the software is user-friendly for the medical professionals and that the data submitted through these systems are accurate, but also adequately protected.
• Verification of data entry: The National Health Information System will have the capability to verify the data entry, helping to reduce errors in the recording of medical activities. This feature is expected to enhance the reliability of the recorded health data.

2. Comprehensive digital health management

The amendments introduce several measures to streamline digital health management, such as:

• Regulation of telemedicine: The PHA now formally regulates telemedicine, allowing for diagnostic and other medical activities to be conducted remotely using information technologies. This regulation aims to expand access to healthcare services, especially in remote areas experiencing a shortage of healthcare providers.
• Preliminary data checks: All health-related data will be checked before being entered into the health insurance system. This measure aims to reduce the risk of penalties and arbitrary actions during subsequent audits.
• Online appointment booking: The PHA introduces a digital scheduling system for medical appointments in public hospitals, aiming to integrate the intrahospital doctors' schedules and thus simplify appointment booking. Patients will be able to book appointments in public healthcare facilities online. Currently, this is an option for private hospitals and practices only. Now a similar system (as a common platform) will be available for doctors working in state or municipal hospitals and polyclinics, reducing the need for patients to wait without knowing when they will be seen.

3. Improving patient care

How the revision of the PHA will improve patient care:

• Ease for parents and patients: The telemedicine and the digital scheduling system will benefit patients with special needs or in remote areas who need to see specific medical specialists. It will also improve patients' access to healthcare. Currently, many patients are referred to private practices, which can be financially burdensome. The new system will make it easier for them to secure appointments with medical specialists in public healthcare facilities where the services are covered by public funds.
• Regulation of private practice during working hours: The amendments also clarify that while all doctors in Bulgaria have the right to practice in private clinics, this should not occur during their working hours if they are employed in state or municipal hospitals. This regulation aims to ensure that public healthcare resources are used efficiently and that patients will receive timely care.