The utilization of telehealth services has recently increased in Lebanon during the COVID-19 pandemic. The use of telehealth in Lebanon was limited before 2020, however, the COVID-19 pandemic and its confinement measures have forced physicians and patients to adopt telehealth services using online tools. The utilization of telehealth services in Lebanon is hindered by several challenges including political instability, lack of access to technology, poor internet connectivity, limited infrastructure and resources, the absence of a comprehensive framework to govern telehealth services. Currently, there are several platforms for telehealth services in Lebanon. However, most of these platforms allow patient to have consultations with physicians and medical professional based in Lebanon only. For instance, the American University of Beirut Medical Center (AUBMC) has launched an integrated application that allows a secure connection between patients and healthcare providers at AUBMC. However, this application does not extend to physicians outside the AUBMC. International collaboration is not a new concept between hospitals and healthcare institutions based in Lebanon and the U.S. DRAPP is a Lebanese platform that aims to improve health services through digital and innovative technology, and bridge distance and time between doctors and their patients. The platform mainly allows interaction with Lebanese physicians. It does allow patients in Lebanon to request consultations with medical professionals based in the U.S. HEAL Beirut is a platform that provides free telehealth sessions that connects patients in Lebanon with international healthcare providers. The platform is established by healthcare professionals based in the U.S., many of whom with strong connections to Lebanon. Telehealth services should be categorized by specialty (such as cardiovascular, oncology, orthopedics. This is important as different specialties may have different requirements and regulations to govern its services. From the regulatory perspective, the Lebanese Ministry of Public Health (MoPH) and the Lebanese Medical Associations should establish comprehensive medicolegal frameworks to govern transnational telehealth activities with U.S. based medical professionals. The framework should include specific laws or regulations regarding integrated medical services at the national and healthcare institution level between the two countries, clinical guidelines for transnational telehealth services, regulations for real-time video visits with patient and remote second opinions, remote patient-monitoring algorithms, secure transfer of patient data, research on foreseen issues arising from these services. In addition, for effective implementation, these efforts should be conducted in coordination with the MoPH who has plans to expand telehealth services in the country. This framework can be utilized as a mean of Decentralized Clinical Trial tool to capture, promote, advocate and expand the inclusion of eligible patients in clinical trials in the U.S., Middle East and North Africa (MENA) region. The inclusion of Arabs in clinical trials as a separate marginalized group and in subgroup analyses of clinical trial study findings will assist in generalizability purposes of findings and enhance external validity. Arabs possess different drug metabolizing genes like the Cytochrome enzymes and have different cultures and heath behaviors would place them at a unique place to be included and analyzed separately for the betterment of global health and strategic planning. Currently, Arabs in the U.S. are categorized as “Whites” according to the U.S. census. An effort is being proposed to the U.S. federal register to remove people from the MENA region from the “White” category and placed on their own. This will only enhance specificity of clinical trials of investigational drugs and representation of marginalized populations for better health for all.
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